Category: Medical Providers (Page 13 of 18)

L&I Claims and the Bias in Independent Medical Exam (IME) Reports

Independent Medical Examinations (IME) are part of every L&I claim and workers’ compensation claim in Washington State. Doctors that perform IME exams must have a certification from the Department of Labor and Industries (L&I). In turn, they provide L&I with an IME report. When performing IME tests, doctors have to abide by certain rules and regulations. These rules are available in L&I’s Medical Examiner Handbook. However, if that’s the case, then why is there bias in almost every IME report?

Bias in workers’ compensation IME exam and report

As a workers’ compensation attorney, in my experience, IME doctors often demonstrate clear bias. In many cases, they ignore relevant sections of the law and ignore accepted conditions under the claim. Furthermore, it’s common to see internally inconsistent exam notes and reports. Interestingly, L&I still accepts the results of bad IME tests. Even though they are undoubtedly contrary to the law and to the facts of cases and claims. Personally, I’m fed up with this trend, which neither helps L&I nor work injury claimants.

The reality of IME exams in L&I claims

Here are some examples of issues from actual cases.

Clearly biased

I recently cross-examined an IME provider who opined that the work injury claimant did not want to return to work. An opinion like that is nothing but biased, especially when it comes to the facts of the case. Looking at the facts, my client has been working and maintaining a job since the time of the examination.

Ignoring the law

In another workers’ compensation claim, the IME doctor states that the injured worker doesn’t need additional treatment. Furthermore, the doctor said that if the claimant needs a new MRI, then the MRI is not a treatment rather it’s diagnostic. The doctor’s response made my blood boil. In Washington State, people that suffer a work injury are eligible to receive necessary and proper health care services.

Ignoring accepted conditions

I recently received and reviewed an IME report. I was shocked when I saw the IME provider arguing that the complex medical condition does not exist. All while the work injury claimant is receiving ongoing treatment for the condition on a monthly basis. On top, L&I accepted the condition as final and binding years ago. At this point in the L&I claim, it’s very possible that L&I will accept the IME’s opinion. I won’t be surprised if L&I uses the wrongful report to make adverse determinations in this workers’ compensation claim.

IME report can be internally inconsistent

I came across yet another IME report the other day. Here, L&I asked the IME examiner to consider 3 possible jobs for my client following the work injury. All three jobs require prolonged standing on feet, which the work injury claimant can’t tolerate because of their industrial injury. In the report, the IME examiner disapproved 2 of the jobs. However, for reasons unclear to me, the IME doctor approved the 3rd job. Even though it also requires prolonged standing. L&I terminated time-loss compensation benefits and closed the workers’ compensation claim.

Some personal notes and conclusions about IME report quality

IME exams are now big business in Washington State. Unfair and biased exams don’t help L&I because as an L&I attorney, I’m ready for a legal fight. The fight is very costly to L&I. These IME reports also don’t help people that had a work injury. It stalls their L&I claims and their ability to return to work.

I believe that L&I needs to revisit the misuse of IME exams. They need to employ corrective measures. That means obtaining unbiased and consistent opinions. IME tests must rely on the facts and the reality of cases and claims. They must also comply with workers’ compensation law in Washington State.

L&I Claim Travel Reimbursement

/ L&I attorney / 0 Comments

If you have a work injury claim, such as a workers’ compensation claim or L&I claim, then you can see any medical provider you choose. The only requirement is that the medical provider must be a member of the Medical Provider Network or MPN. For work injury claimants living in rural places or remote areas, finding a provider in the MPN can mean extensive travel. The good news is that L&I provides travel reimbursement in some cases.

How to get travel reimbursement for my workers’ compensation claim?

Under certain circumstances, the Department of Labor and Industries (L&I) will reimburse injured workers for travel to medical appointments. However, you must meet three criteria in order to get reimbursement for your travels. If you think that you meet all the requirements, then you should fill a travel reimbursement form. Once you complete the form, be sure to submit it to your claim manager.

First, the medical provider must be more than 15 miles away from the residence of the work injury claimant. Second, there can’t be any other available providers that have closer offices. Third, you must get pre-authorization for the reimbursement from your L&I claim manager. Furthermore, it is important to note that you can get reimbursements for mileage, toll road payments, and parking fees in excess of $10.

What do I need to do to get travel reimbursement from L&I?

On its face, travel reimbursement seems like a relatively simple and a valuable benefit for people with L&I claim. Clearly, it’s an excellent benefit for people with a work injury that incur extraordinary travel expenses for treatment. However, practically speaking, it is rather challenging to successfully receive travel reimbursement.

One of the most frustrating problems is when a workers’ compensation claim manager questions the need for travel. In my experience, this happens all the time when work injury claimants need to change their medical provider in the middle of an L&I claim. Nearly all medical providers are reluctant to become the attending physician for an older L&I claim. Therefore, people with existing claims often need to travel afar to find a doctor that is willing to see them.

L&I claim travel reimbursement form and pre-authorization

In many cases, before authorizing travel reimbursement, some L&I claim managers require us to produce a journal showing that we tried to find a provider within 15 miles of the worker’s residence. Despite the frustration, once we submit the journal to the claim manager, the claim manager usually authorizes the reimbursement.

Another common frustration I encounter all the time is when work injury claimants are unaware of the travel reimbursement requirements. It’s common for me to speak with people with a workers’ compensation claim who completely gave up on the reimbursement process. Usually, they give up because they either don’t understand or don’t seem to meet the requirements. The most frequent mistake I see is failing to get pre-authorization. Interestingly, in most cases it’s because they do not fill out the travel reimbursement form correctly. However, having done this so many times, it is fairly easy to correct these errors.

Takeaways and final notes

In summary, if you got hurt at work and you have a workers’ compensation claim or L&I claim, if you travel to medical appointments, then you can (and should) get travel reimbursement. Remember, to get travel reimbursement and eliminate unnecessary frustration, make sure you know the requirements, fill the form above, and ask for pre-authorization from your claim manager.

IME Exam in L&I Claims in Washington State

/ L&I attorney / 2 Comments

The Department of Labor and Industries (L&I) sometimes requires injured workers to attend Independent Medical Examinations or IME. In many cases, L&I asks work injury claimants to attend an L&I IME exam to help L&I make claim-related decisions. From L&I’s perspective, an IME provides objective medical-legal examination for the purpose of establishing medical findings, opinions and conclusions about an injured worker’s physical condition.

IME tests in L&I claim appeals

It’s important to note that IME exams can only be performed medical examiners that are pre-approved by L&I. Fundamentally, I don’t share L&I’s perspective on IME examinations. When I represent work injury plaintiffs in appeals before the Board of Industrial Insurance Appeals (BIIA), often L&I medical arguments rely on IME opinion. In fact, it is very common for me to cross examine the same seven or eight IME doctors repeatedly.

IME panels in Washington State

There are several panel corporations that provide IME services to L&I. These include Sunrise Medical, Objective Medical Assessments Corporation (OMAC), Central Seattle Panel of Consultants, Medical Consultants Network (MCN), and others. Interestingly, most of the examiners who perform IME tests are contracted with more than one of these panels. In other words, having a variety of panels offering IME tests does not result in a greater variety of examiners.

IME exams are inherently biased and unfair

On occasion I’m surprised by the outcome of an IME. However, more often I predict the outcome before the examination even occurs. There are several reasons for this. L&I argues that IME tests are an objective process. I’ve had IME doctors testify that they are in the best position to provide opinions to L&I because they have no stake in the outcome. Whether these providers want to admit it or not, they have a bias in favor of L&I.

The Department of Labor and Industries controls the process and procedure of every IME from start to finish. For one, L&I sets the ground rules for these examinations. Moreover, as mentioned earlier, the examiners must be approved by L&I. In addition, examiners are mandated to follow the Medical Examiner’s Handbook written by L&I.

IME examiners are asked to answer specific questions given to them by the claim manager. Typically, along with the questions presented to IME doctors, the claim manager usually provides claim related information. This information can include the status of the claim, the L&I claim accepted conditions and the contested conditions. The IME examiner reviews the medical records provided by L&I and is paid according to fee schedules dictated by L&I. Finally, the examiner must produce a report in accordance with L&I timelines.

IME exams from the viewpoint of injured workers

In my experience, injured workers who are required to attend an IME rarely feel that the process is unbiased and objective. For example, a work injury claimant has no choice when it comes to the IME doctor. In addition, the date and time of the IME exam is set by L&I. Then, if there are any scheduling conflicts for the injured worker, he or she must ask for permission from the claim manger to reschedule.

Frequently, injured workers feel attacked and judged by the IME examiners. It’s very common for work injury plaintiffs to report that the examiners seem to ignore what they are saying. Consequently, the IME process leaves work injury claimants feeling frustrated, insecure, and unheard. People that suffer a work injury contact me all the time to inquire about representation. Many times, they call me because they have been scheduled for an IME, or recently attended an IME. As a result, they are concerned about the future of their claim.

IME notes from an L&I attorney

In my opinion, there are many legitimate reasons for which L&I needs outside, impartial medical opinions to help resolve L&I claim issues. However, I don’t believe that the current IME process is fair. I also don’t feel that the current format of IME examinations accomplishes the goals of the Industrial Insurance Act.