Judge and Gavel

New independent medical examination rules take effect April 23

New Washington Administrative Code (WAC) rules that set guidelines for independent medical examinations (IME) take effect April 23, 2022.

The rules were created and/or updated to support ESSB 6440, passed during the 2019-2020 legislative session.


ESSB 6440 amended RCW 51.36.070. The new state law sets parameters for when an independent medical examination can be requested, states that examinations must be scheduled in reasonably convenient locations, and establishes telemedicine as an option for IMEs.


The L&I Self-Insurance training unit will be presenting on the new rules at the Washington Self Insurers Association (WSIA) conference, “Meet the Moment 2022,” on May 4, 2022.


The new rules, and their highlights, include:
WAC 296-15-440, “Use of independent medical examinations. What will the department consider when resolving a dispute to a scheduled independent medical exam (IME) in a self-insured claim?”


•    Details what the department needs to receive when an IME is disputed. 


o    A copy of the IME notification/assignment letter sent to the worker no later than 28 calendar days prior to the exam.
o    Self-insured employers must use Form F207-238-000 or a substantially similar document (WAC 296-15-001) when communicating notification of an IME to a worker.
o    The dispute should state the specific reason(s) why the worker or provider feels the IME is not appropriate.


•    Establishes timeframes associated with the resolution of IME disputes. 


o    The department will only consider instructing a self-insurer to postpone an independent medical examination if the dispute is received by the department at least 15 calendar days prior to the scheduled date of the exam.


•    Explains how the department will resolve IME disputes. 


o    The department will consider the facts in the IME notification/assignment letter and the facts the worker and/or provider provide to determine if an IME should be canceled.
o    If a worker attends a disputed IME and, after-the-fact, the department determines the IME was in violation of RCW 51.36.070, the report may not be considered in the administration of the claim.


WAC 296-15-440 is effective April 23, 2022 for IMEs scheduled after that date.


WAC 296-23-302, “Definitions.”


•    Updated to include a definition of case progress examination.

WAC 296-23-308, “Scheduling case progress examinations.”


•    Establishes thresholds that must be met in order for a case progress IME to be appropriate: 


o    Time (120 days from receipt of claim) or last case progress IME.
o    Requirements related to consultations and requests of the attending provider.


WAC 296-23-309, “How many examinations may be requested?”


•    Establishes criteria for the total number of examinations per claim.


WAC 296-23-403, “Independent medical examinations—Department data reporting.”


•    Explains that the department will regularly provide independent medical examination data.


WAC 296-23-401, “Can the department schedule an examination or order a self-insured employer to schedule an examination after receipt of an appeal to the board of industrial insurance appeals (BIIA)?


•    States that the department can reassume following receipt of an appeal and direct a self-insured employer to schedule an IME.
•    Copies of the rules can be found at 2114 Adoption (wa.gov) and 2128 Adoption (wa.gov). 
•    Updates to the Claim Adjudication Guidelines will be available April 22, 2022.

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