H‑0060.3   _____________________________________________

HOUSE BILL 1457

           _____________________________________________

State of Washington      57th Legislature     2001 Regular Session

By Representatives Conway, Campbell, Kenney, Barlean, Hunt, Wood, Keiser, Hurst and Santos

Read first time 01/26/2001.  Referred to Committee on Commerce & Labor.

_1      AN ACT Relating to medical examinations under the industrial

_2  insurance system; amending RCW 51.32.110, 51.36.070, and

_3  51.32.112; adding a new section to chapter 51.36 RCW; creating a

_4  new section; recodifying RCW 51.32.112; and repealing RCW

_5  51.32.114.

_6  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

_7      Sec. 1.  RCW 51.32.110 and 1997 c 325 s 3 are each amended to read

_8  as follows:

_9      (1) Any worker entitled to receive any benefits or claiming

10  such under this title shall, if requested by the department or

11  self-insurer, submit himself or herself for medical examination((,

12  at a time and from time to time, at a place reasonably convenient

13  for the worker and as may be provided by the rules of the

14  department.  An injured worker, whether an alien or other injured

15  worker, who is not residing in the United States at the time that

16  a medical examination is requested may be required to submit to an

17  examination at any location in the United States determined by the

18  department or self-insurer)) as authorized in RCW 51.36.070.

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_1      (2) If the worker refuses to submit to medical examination, or

_2  obstructs the same, or, if any injured worker shall persist in

_3  unsanitary or injurious practices which tend to imperil or retard

_4  his or her recovery, or shall refuse to submit to such medical or

_5  surgical treatment as is reasonably essential to his or her

_6  recovery or refuse or obstruct evaluation or examination for the

_7  purpose of vocational rehabilitation or does not cooperate in

_8  reasonable efforts at such rehabilitation, the department or the

_9  self-insurer upon approval by the department, with notice to the

10  worker may suspend any further action on any claim of such worker

11  so long as such refusal, obstruction, noncooperation, or practice

12  continues and reduce, suspend, or deny any compensation for such

13  period:  PROVIDED, That the department or the self-insurer shall not

14  suspend any further action on any claim of a worker or reduce,

15  suspend, or deny any compensation if a worker has good cause for

16  refusing to submit to or to obstruct any examination, evaluation,

17  treatment or practice requested by the department or required

18  under this section.

19      (3) If the worker necessarily incurs traveling expenses in

20  attending the examination pursuant to the request of the

21  department, such traveling expenses shall be repaid to him or her

22  out of the accident fund upon proper voucher and audit or shall be

23  repaid by the self-insurer, as the case may be.

24      (4)(a) If the medical examination required by this section

25  causes the worker to be absent from his or her work without pay:

26      (i) In the case of a worker insured by the department, the

27  worker shall be paid compensation out of the accident fund in an

28  amount equal to his or her usual wages for the time lost from work

29  while attending the medical examination; or

30      (ii) In the case of a worker of a self-insurer, the self-

31  insurer shall pay the worker an amount equal to his or her usual

32  wages for the time lost from work while attending the medical

33  examination.

34      (b) This subsection (4) shall apply prospectively to all claims

35  regardless of the date of injury.

36      Sec. 2.  RCW 51.36.070 and 1977 ex.s. c 350 s 60 are each amended

37  to read as follows:

HB 1457                        p. 2

_1      (1) When a medical examination is conducted under this title:

_2      (a) The examination must be conducted at a medical facility

_3  suitable for the examination and reasonably convenient for the

_4  worker;

_5      (b) The examination must be conducted with due regard and

_6  respect for the privacy and dignity of the injured worker and for

_7  the safety and convenient access of the worker; and

_8      (c) The worker may be accompanied by an uncompensated person

_9  who may observe the examination but not interfere with or obstruct

10  the examination.  The worker or person accompanying the worker may,

11  at the worker's expense, make an audio or video recording of the

12  examination, if the recording is made in an unobtrusive

13  manner.  This section does not limit the department or self-

14  insurer's obligation to provide necessary interpreter services.

15      (2) Subject to subsection (3) of this section, whenever the

16  director or the self-insurer deems it necessary in order to

17  resolve any medical issue, the department or self-insurer may, at

18  a time and from time to time and as may be provided by department

19  rules, order a worker ((shall)) to submit to examination by ((a

20  physician or physicians selected)) a provider or providers

21  approved by the director((, with the rendition of a report to the

22  person ordering the examination)) and competent to examine the

23  worker and evaluate the injury or disease from which the worker

24  suffers.  An injured worker who is not residing in the United States

25  at the time that a medical examination is ordered may be required

26  to submit to an examination at any suitable medical facility in

27  the United States as determined by the department or self-insurer.

28      (3)(a) When ordering a medical examination, the department or

29  self-insurer must first request in writing, with a copy of the

30  request submitted to the worker and the worker's representative,

31  if any, that the worker's attending physician or other treating

32  provider conduct an examination and make a report on the medical

33  issue in question.  The attending physician or treating provider

34  may, without prior authorization from the department or self-

35  insurer, make a consultation referral to a provider approved by

36  the director and licensed to practice in the same field or

37  specialty as the attending physician or treating provider, as

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_1  relevant.  The consultant shall conduct the examination and make a

_2  report to the provider requesting the examination.

_3      (b) If the medical issue is not resolved by the requested

_4  examination and report, the department or self-insurer may request

_5  the attending physician or treating provider to make a

_6  consultation referral to a provider approved by the director and

_7  licensed to practice in the same field or specialty as the

_8  worker's attending physician or treating provider, as relevant.

_9      (c) If the worker's attending physician or treating provider is

10  unwilling or unable to conduct the examination or make a

11  consultation referral, as requested by the department or self-

12  insurer, the department or self-insurer may order a medical

13  examination by a provider or providers agreed upon by the worker

14  and the department or self-insurer.

15      (d) To resolve a material dispute regarding treatment or

16  diagnosis between the attending physician or treating provider and

17  a consulting provider, the department or self-insurer may order a

18  medical examination to be conducted by a provider that the injured

19  worker chooses from a list of at least five providers submitted by

20  the department or self-insurer to the worker.

21      (4)(a) A provider conducting a medical examination ordered

22  under this section must submit a report to the department or self-

23  insurer as the case may be and, on the same day that the report is

24  submitted, submit a copy of the report to the worker, the worker's

25  representative, if any, the worker's attending physician, and the

26  worker's employer.

27      (b) If the department or self-insurer relies on the examination

28  report to deny, limit, or terminate benefits to a worker, the

29  department or self-insurer must give the worker's attending

30  physician no less than thirty days from the physician's receipt of

31  the report to provide a written response to the report.

32      (5) In resolving a medical issue under this title, the

33  department or self-insurer must:

34      (a) Base the decision only on medical opinion that is founded

35  on factual data supported by the evidence; and

36      (b) Give more weight to the medical opinion of the worker's

37  attending physician or treating provider than to the opinion of a

38  provider who has examined, but not treated, the worker.

HB 1457                        p. 4

_1      (6) The director, in his or her discretion, may charge the cost

_2  of ((such)) a medical examination or examinations ordered under

_3  this title to the self-insurer or to the medical aid fund as the

_4  case may be.  The cost of ((said)) the examination shall include

_5  payment to the worker of reasonable expenses connected

_6  ((therewith)) with the examination as provided in RCW 51.32.110.

_7      (7) For the purposes of this section, "medical issue" includes

_8  all questions within the expertise of the provider, including but

_9  not limited to, cause of the injury or disease, establishment of

10  diagnoses, the course of or need for treatment, the condition of

11  the worker and whether the condition is fixed and stable,

12  limitations on return-to-work activities, review of job analyses,

13  and assessment of permanent disability.

14      Sec. 3.  RCW 51.32.112 and 1993 c 515 s 4 are each amended to read

15  as follows:

16      (1) The department shall ((develop standards for)) adopt rules

17  governing the conduct of ((special)) medical examinations ((to

18  determine permanent disabilities)) ordered under this title,

19  including, but not limited to:

20      (a) The qualifications of persons conducting the examinations.

21  To conduct an examination, a provider must, at a minimum, be

22  licensed to practice at the time of the examination:

23      (i) In the same field or specialty as the worker's attending

24  physician or treating provider, as relevant, with an active

25  practice involving direct patient care at least weekly in that

26  field or specialty.  This requirement may be waived by mutual

27  agreement between the worker and the department or self-insurer;

28  and

29      (ii) Medicine or surgery under chapter 18.71 RCW, osteopathic

30  medicine and surgery under chapter 18.57 RCW, podiatric medicine

31  and surgery under chapter 18.22 RCW, dentistry under chapter 18.30

32  RCW, chiropractic under chapter 18.25 RCW, or psychology under

33  chapter 18.83 RCW;

34      (b) The criteria for removing examiners from the list of

35  approved examiners, including but not limited to the department

36  determining after reasonable investigation that the provider:

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_1      (i) Committed professional or other misconduct, including a

_2  violation of RCW 51.48.280, or demonstrated incompetency in

_3  connection with providing medical examinations under this title;

_4      (ii) Exceeded the limits of his or her professional competence

_5  in conducting medical examinations or made materially false

_6  statements regarding his or her qualifications in his or her

_7  application as an examiner;

_8      (iii) Failed to transmit copies of medical reports, or failed

_9  to submit full and truthful medical reports of his or her

10  findings, as required by this title;

11      (iv) Knowingly made a false statement or representation as to a

12  material fact in any medical report made under this title or in

13  testifying or otherwise providing information for the purposes of

14  this title; or

15      (v) Refused to appear before, testify, submit to deposition, or

16  answer a material question of the department, or board of

17  industrial insurance appeals, or produce a material document

18  concerning his or her provision of services under this title;

19      (((b))) (c) The criteria for conducting the examinations,

20  including guidelines for the appropriate treatment of injured

21  workers during the examination; and

22      (((c))) (d) The content of examination reports, including a

23  requirement that examination reports contain a signed statement

24  certifying that the report is a full and truthful representation

25  of the examiner's professional opinion with respect to the injured

26  worker's condition.

27      (2) Within the appropriate scope of practice, chiropractors

28  licensed under chapter 18.25 RCW may conduct special medical

29  examinations to determine permanent disabilities under RCW

30  51.32.055 in consultation with physicians licensed under chapter

31  18.57 or 18.71 RCW.  The department, in its discretion, may request

32  that a special medical examination be conducted by a single

33  chiropractor if the department determines that the sole issues

34  involved in the examination are within the scope of practice under

35  chapter 18.25 RCW.  However, nothing in this section authorizes the

36  use as evidence before the board of a chiropractor's determination

37  of the extent of a worker's permanent disability if the

38  determination is not requested by the department.

HB 1457                        p. 6

_1      (3) The department must examine the credentials of providers

_2  conducting medical examinations ordered under this title and must

_3  monitor the quality and objectivity of the examinations and

_4  examination reports obtained by the department and self-insured

_5  employers.  The department's rules must ensure that examinations

_6  ordered under this title are performed only by qualified providers

_7  meeting department standards.

_8      (4) The department shall investigate the amount of examination

_9  fees received by persons conducting ((special)) medical

10  examinations ((to determine permanent disabilities)) ordered under

11  this title, including total compensation received for examinations

12  of department and self-insured claimants, and establish

13  compensation guidelines and compensation reporting criteria.

14      (((4))) (5) The department shall investigate the level of

15  compliance of self-insurers with the requirement of full reporting

16  of claims information to the department, particularly with respect

17  to medical examinations, and develop effective enforcement

18  procedures or recommendations for legislation if needed.

19      NEW SECTION. Sec. 4.  RCW 51.32.112 is recodified as a new

20  section in chapter 51.36 RCW.

21     NEW SECTION. Sec. 5.  RCW 51.32.114 (Medical examination‑-

22  Department to monitor quality and objectivity) and 1988 c 114 s 3

23  are each repealed.

24      NEW SECTION. Sec. 6.  This act applies to all medical

25  examinations ordered under Title 51 RCW on or after the effective

26  date of this act.

‑‑‑ END ‑‑‑

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