|Author||Subject: Re: Number of IMEs' a worker must attend|
|Del|| Posted At 11:01:06 06/08/2000
The following answers apply only to Oregon and may have been changed since their official release. You'll notice in (5) that there are several loopholes accorded carrier's to the 3 IME rule. Also we've been told that Managed Care Organizations (MCO's) can demand as many as they want, they get aound it by "not calling them IME's." I have underlined text below that was discussed above or is of significant importance. It's a very good idea to call the Oregon Ombudsman for Injured Workers at (800) 927-1271 when you have any questions regarding WC. The following is on page 21+ at http://www.cbs.state.or.us/external/wcd/docs/436_010.pdf You must have Acrobat Reader to view these files that I've linked to in this posting except the Oregon Board of Medical Examiners letter discussing ..."allegations of
sexual boundary violations, especially following physical assessment around the breasts and pelvis of female patients."
Insurer Medical Examinations (IME)
OAR 436-010-0265 (1) The insurer may obtain three medical examinations of the worker by physicians of their choice for each opening of the claim. These examinations may be obtained prior to or after claim closure. A claim for aggravation, Board's Own Motion, or reopening of a claim where the worker becomes enrolled or actively engaged in training according to rules adopted pursuant to ORS 656.340 and 656.726 permits a new series of three medical examinations. For purposes of this rule, "insurer medical examination" (IME) means any medical examination including a physical capacity or work capacity evaluation or consultation that includes an examination, except as provided in section (5) of this rule, that is requested by the insurer and completed by any medical service provider, other than the worker's attending physician. Examinations shall not include invasive procedures without the prior consent of the worker in the form and format as the director may prescribe by bulletin. The examination may be conducted by one or more medical providers with different specialty qualifications, generally done at one location and completed within a 72-hour period. If the medical providers are not at one location, the examination is to be completed within a 72-hour period and at locations reasonably convenient to the worker.
(2) When the insurer has obtained the three medical examinations allowed under this rule and wishes to require the worker to attend an additional examination, the insurer shall first notify and request authorization from the director. Insurers that fail to first notify and request authorization from the director, may be assessed a civil penalty. The process for requesting such authorization shall be as follows:
(a) The insurer shall submit a request for such authorization to the director in a form and format as prescribed by the director including, but not limited to, the purpose for the examination, dates, times, places, purposes of previous examinations, and reasons why the additional examination is necessary. A copy of the request shall be provided to the worker and the worker's attorney; and
(b) The director will review the request and determine if additional information is necessary prior to issuing an order approving or disapproving the request. Upon receipt of a written request for
additional information from the director, the parties shall have 14 days to respond. If the parties do not provide the requested information, the director will issue an order approving or disapproving the request based on available information.
(3) In determining whether to approve or deny the request for an additional IME, the director may give consideration, but is not limited, to the following:
(a) Whether an IME involving the same discipline(s) and/or review of the same condition has been completed within the past six months.
(b) Whether there has been a significant change in the worker's condition.
(c) Whether there is a new condition or compensable aspect introduced to the claim.
(d) Whether there is a conflict of medical opinion about a worker's treatment, impairment, stationary status or other issue critical to claim processing/benefits.
(e) Whether the IME is requested to establish a preponderance for medically stationary status.
(f) Whether the IME is medically harmful to the worker.
(g) Whether the IME requested is for a condition for which the worker has sought treatment or the condition has been included in the compensable claim.
(4) Any party aggrieved by the director's order may request a hearing by the Hearings Division of the Workers' Compensation Board pursuant to ORS 656.283 and OAR Chapter 438.
(5) For purposes of determining the number of insurer required examinations, any examinations scheduled but not completed are not counted as a statutory IME. The following examinations shall not be considered IMEs and do not require approval as outlined in section (2) above:
(a) An examination conducted by or at the request or direction of the worker's attending physician;
(b) An examination obtained at the request of the director;
(c) A consultation obtained in accordance with OAR 436-010-0250(3);
(d) An examination of a permanently totally disabled worker required under ORS 656.206(5); and
(e) An examination by a consulting physician that has been arranged by the worker's attending physician in accordance with OAR 436-010-0280.
(6) Examinations shall be at times and intervals reasonably convenient to the worker and shall not delay or interrupt proper treatment of the worker.
(7) When a worker is required to attend an examination by a physician of the insurer's choice, the insurer shall comply with the notification and reimbursement requirements contained in OAR 436-060-0070 and OAR 436-060-0095.
(8) The person conducting the examination shall determine the conditions under which the examination will be conducted. Subject to the physician's approval, the worker may use a video camera or tape recorder to record the examination. Also subject to the physician's approval, the worker may be accompanied by a family member or friend during the examination. If the physician does not approve a worker's request to record an examination or allow the worker to be so accompanied, the physician must document the reasons.
(Caroline, as you know, the above OAR is why that ?doctor? knows he can get away with repeated sexual assaults. The State of Oregon has been covering up these incidents for years. We have, in the FTP File Room, here just one of the letters that prove they know what's been going on.)
(9) Upon completion of the examination, the examining physician shall send a copy of the report to the insurer and attending physician within seven days.
Stat. Auth: ORS 656.726(3)
Stat. Implemented: ORS 656.252, 656.325, 656.245, 656.248, 656.260, 656.264
Hist: Filed 12/16/98 as Admin. Order 98-060, eff 1/1/99
Amended 4/28/99 as Admin. Order 99-055, eff 4/28/99
4/15/99 - Mary C. Neidig, Administrator, Workers' Compensation Division
The purpose of this bulletin is to prescribe a form to be provided to an injured worker whenever a medical provider decides to perform invasive procedures as part of an IME.
During the course of an IME, an injured worker may be asked to undergo an invasive procedure.
OAR 436-010-0265(1) states that "[e]xaminations shall not include invasive procedures without the prior consent of the worker." At the time a worker receives notice of an IME appointment, the worker is advised that their benefits can be suspended if they fail to cooperate. Workers requested to undergo an invasive procedure may believe that failure to consent to the requested invasive procedure will result in the suspension of their benefits. The attached consent Form 440-3227, "Invasive Medical
Procedures Authorization," has been developed to avoid confusion and to ensure that all workers are fully informed of their right to refuse invasive procedures without jeopardizing their benefits.
If a medical service provider intends to perform an invasive procedure as part of an IME, the worker must be given the attached consent form to complete and sign.
Insurers must provide the form to the medical service provider when the examination is scheduled.
Insurers may produce a computer-generated facsimile (same text) of the attached form.
If you have any questions about this bulletin, contact a Benefit Consultant at (503) 947-7585.
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