PROPOSED RULES
LABOR AND INDUSTRIES
Original Notice.
Preproposal statement of inquiry was filed as WSR 03-15-113.
Title of Rule: Impairment rating examinations by attending doctors and consultants and independent medical examinations: WAC 296-20-200 General information (impairment ratings), 296-20-210 General rules (impairment ratings) and 296-23-255 through 296-23-270, Independent medical examinations.
Purpose: The department is implementing a number of changes to improve the quality and timeliness of independent medical examinations. The purpose of the proposed rules is to ensure providers know the department's requirements to be an independent medical examiner, the expectations of providers in the treatment of injured workers during an examination and other standards providers are expected to meet as approved examiners. In addition, the rules clarify requirements of attending physicians or consultants when doing impairment rating examinations.
Statutory Authority for Adoption: RCW 51.32.055, 51.32.112, 51.32.114, 51.36.060, and 51.36.070.
Statute Being Implemented: Chapters 51.32 and 51.36 RCW.
Summary: AMENDATORY SECTION: WAC 296-20-200 General information for impairment rating examinations by attending doctors, consultants or independent medical examination (IME) providers, this section was changed to accurately reflect the title of the subject addressed in this WAC, and to change some of the terminology to reflect current language used.
NEW SECTIONS: WAC 296-20-2010 General rules for impairment rating examinations by attending doctors and consultants, 296-20-2015 What rating systems are used for determining an impairment rating conducted by the attending doctor or a consultant?, 296-20-2020 When may attending doctors perform impairment rating examinations or refer to a consultant?, 296-20-2025 May a worker bring someone with them to an impairment rating examination conducted by the attending doctor or a consultant?, 296-20-2030 May the worker video or audio tape the impairment rating examination conducted by the attending doctor or a consultant?, 296-23-302 Definitions, 296-23-307 Why are independent medical examinations requested?, 296-23-312 Can a provider conduct independent medical examinations (IME) for the department or self-insurer without an active IME provider number from the department?, 296-23-317 What qualifications must a provider meet to receive an independent medical examination (IME) provider number?, 296-23-322 What boards are recognized by the department for independent medical examiner (IME) provider approval?, 296-23-327 What other factors may the department's medical director consider in approving or disapproving an application for an independent medical examiner (IME) provider number?, 296-23-332 What are the requirements for notifying the department if an independent medical examination (IME) provider has a change in status?, 296-23-337 What factors does the department consider in suspending or terminating an independent medical examiner (IME) provider number?, 296-23-342 Are providers entitled to referrals from the department?, 296-23-347 What are the independent medical examiner (IME) provider's responsibilities in an examination?, 296-23-352 Must the independent medical examination (IME) provider address job analyses (JAs) at the request of the department or self-insurer?, 296-23-357 May an independent medical examiner (IME) provider offer to provide ongoing treatment to the worker?, 296-23-362 May a worker bring someone with them to an independent medical examination (IME)?, 296-23-367 May the worker video or audio tape the independent medical examination?, 296-23-372 Can a worker file a complaint about a provider's conduct during an independent medical examination?, 296-23-377 If an independent medical examiner (IME) provider is asked to do an impairment rating examination only, what information must be included in the report?, 296-23-382 What information must be included in an independent medical examination (IME) report?, 296-23-387 What are the responsibilities of an independent medical examiner (IME) provider regarding testimony?, and 296-23-392 Is there a fee schedule for independent medical examinations?
REPEALED SECTIONS: WAC 296-20-210 General rules, moved requirements from this section to WAC 296-20-2010; WAC 296-23-255 Independent medical examinations, moved requirements from this section to WAC 296-23-307; WAC 296-23-260 Examination reports, moved requirements from this section to WAC 296-23-387; WAC 296-23-265 Who may perform independent medical examinations?, moved requirements from this section to WAC 296-23-317; WAC 296-23-26501 How do doctors become approved examiners?, moved requirements from this section to WAC 296-23-312, 296-23-317, 296-23-322, 296-23-327, 296-23-332; WAC 296-23-26502 Where can doctors get an application to become an approved examiner and other information about independent medical examinations?, moved requirements from this section to WAC 296-23-312, 296-23-317, 296-23-322; WAC 296-23-26503 What factors does the medical director consider in approving, suspending or removing doctors from the approved examiners list?, moved requirements from this section to WAC 296-23-337; WAC 296-23-26504 What happens if an examiner is suspended or removed from the approved examiner list by the medical director?, moved requirements from this section to WAC 296-23-327; WAC 296-23-26505 Is there a fee schedule for independent medical examinations?, moved requirements from this section to WAC 296-23-392; WAC 296-23-26506 Can a worker file a complaint about an independent medical examiner's conduct?, moved requirements from this section to WAC 296-23-372; WAC 296-23-267 When may attending doctors perform impairment rating examinations?, moved requirements from this section to WAC 296-20-2020; and WAC 296-23-270 Independent medical examinations two or more examiners, this section is no longer applicable because each individual provider will be receiving a provider number.
Name of Agency Personnel Responsible for Drafting: Paulette Golden, Tumwater, (360) 902-6299; Implementation and Enforcement: Nancy Peterson, Tumwater, (360) 902-6823.
Name of Proponent: Department of Labor and Industries, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The proposed rules contain the department's requirements for providers wishing to perform independent medical examinations for injured workers, the expectations of providers in the treatment of injured workers during an examination and other standards providers are expected to meet as approved examiners. In addition, the rules clarify requirements of attending physicians or consultants when doing impairment rating examinations. The anticipated effect is improved quality and timeliness of independent medical examinations.
Proposal Changes the Following Existing Rules: WAC 296-20-200 was changed to clarify the general information applies to attending doctors, consultants or IME providers conducting impairment rating examinations.
WAC 296-20-210 repealed and moved to new section that clarifies this rule applies to attending physicians and consultants conducting impairment rating examinations. The remainder of the changes in chapter 296-20 WAC bring current department policy into rule.
Repeated current rules regarding independent medical examinations and replaced with a new section. The new rules add definitions of terms, bring current department policy into rule and add new requirements:
| • | Require a provider number for anyone conducting IMEs; |
| • | Establish business requirements for anyone conducting IMEs; |
| • | Notification of the department of a provider's change in status; |
| • | Define IME provider responsibilities in conducting an examination; |
| • | Establish conditions regarding who may attend an IME with a worker; |
| • | Set requirements for IME providers completing job analysis; and |
| • | Establish reporting requirements including 14 days to submit IME report. |
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has considered whether these proposed rules are subject to the Regulatory Fairness Act and has determined that they do not require a small business economic impact statement because the costs associated with the proposed rules will not place a more than minor impact on any business or contractor and/or they are exempted by law (see RCW 19.85.025 referencing RCW 34.05.310 (4)) from the small business economic impact requirements.
RCW 34.05.328 applies to this rule adoption. Significant rule-making criteria does not apply to these rule changes because the exempt criteria outlined in RCW 34.05.028(5) [34.05.328(5)] was not met.
Hearing Location: Red Lion Hotel Seattle Airport, Seattle Room, 18220 International Boulevard, Seattle, WA 98188, on December 2, 2003, at 1:00 p.m.; and at the Hampton Inn, Sunset C Room, 2010 South Assembly Road, Spokane, WA 99224, on December 3, 2003, at 9:00 a.m.
Assistance for Persons with Disabilities: Contact Paulette Golden by November 15, 2003, at (360) 902-6299.
Submit Written Comments to: Paulette Golden, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, fax (360) 902-4249, by December 10, 2003.
Date of Intended Adoption: January 13, 2004.
October 14, 2003
Paul Trause
Director
OTS-6667.2
AMENDATORY SECTION(Amending WSR 97-09-036, filed 4/14/97,
effective 5/15/97)
WAC 296-20-200
General information for impairment rating
examinations by attending doctors, consultants or independent
medical examination (IME) providers.
(1) The department of
labor and industries has promulgated the following rules and
categories to provide a comprehensive system of classifying
unspecified permanent partial disabilities in the proportion
they reasonably bear to total bodily impairment. The
department's objectives are to reduce litigation and establish
more certainty and uniformity in the rating of unspecified
permanent partial disabilities pursuant to RCW 51.32.080(2).
(2) The following system of rules and categories directs
the ((examiner's)) provider's attention to the actual
conditions found and establishes a uniform system for
conducting rating examinations and reporting findings and
conclusions in accord with broadly accepted medical
principles.
The evaluation of bodily impairment must be made by
experts authorized to perform rating examinations. ((This
system recognizes and provides for this.)) After conducting
the examination, the ((examiner)) provider will choose the
appropriate category for each bodily area or system involved
in the particular claim and include this information in the
report. The ((examiner)) provider will, therefore, in
addition to describing the worker's condition in the report,
submit the conclusions as to the relative severity of the
impairment by giving it in terms of a defined condition rather
than a personal opinion as to a percentage figure. In the
final section of this system of categories and rules are some
rules for determining disabilities and the classification of
disabilities in bodily impairment is listed for each category.
These last provisions are for the department's administrative
use in acting upon the expert opinions which have been
submitted to it.
(3) In preparing this system, the department has complied with its duty to enact rules classifying unspecified disabilities in light of statutory references to nationally recognized standards or guides for determining various bodily impairments. Accordingly, the department has obtained and acted upon sound established medical opinion in thus classifying unspecified disabilities in the reasonable proportion they bear to total bodily impairment. In framing descriptive language of the categories and in assigning a percentage of disability, careful consideration has been given to nationally recognized medical standards and guides. Both are matters calling for the use of expert medical knowledge. For this reason, the meaning given the words used in this set of categories and accompanying rules, unless the text or context clearly indicates the contrary, is the meaning attached to the words in normal medical usage.
(4) The categories describe levels of physical and mental
impairment. Impairment is anatomic or functional abnormality
or loss of function after maximum medical ((rehabilitation))
improvement has been achieved. This is the meaning of
"impairment" as the word is used in the guides mentioned
above. This standard applies to all persons equally,
regardless of factors other than loss of physical or mental
function. Impairment is evaluated without reference to the
nature of injury or the treatment therefore, but is based on
the functional loss due to the injury or occupational disease.
The categories have been framed to include conditions in
other bodily areas which derive from the primary impairment. The categories also include the presence of pain, tenderness
and other complaints. Workers with comparable loss of
function thus receive comparable awards.
(5) These rules and categories (WAC 296-20-200 through 296-20-690) shall only be applicable to compensable injuries occurring on or after the effective date of these rules and categories.
(6) These rules and categories (WAC 296-20-200 through 296-20-690) shall be applicable only to cases of permanent partial disability. They have no applicability to determinations of permanent total disability.
[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.112, 51.32.114 and 51.36.015. 97-09-036, § 296-20-200, filed 4/14/97 effective 5/15/97. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 91-07-008, § 296-20-200, filed 3/8/91, effective 5/1/91; Order 74-32, § 296-20-200, filed 6/21/74, effective 10/1/74.]
(1) Impairment rating examinations shall be performed only by doctors currently licensed in medicine and surgery (including osteopathic and podiatric) or dentistry, and department-approved chiropractors subject to RCW 51.32.112. The department or self-insurer generally prefers the impairment rating examination be conducted by the worker's attending doctor. If the attending doctor is unable or unwilling to perform the impairment rating examination, a consultant, at the attending doctor's request, may conduct a consultation examination and provide an impairment rating based on the findings. The department or self-insurer can also request an impairment rating examination from an independent medical examination (IME) provider. A chiropractic impairment rating examination may be performed only where the worker has been clinically managed by a chiropractor.
(2) Whenever an impairment rating examination is made, the attending doctor or consultant must complete a rating report that includes, at a minimum, the following:
(a) Statement that the patient has reached maximum medical improvement (MMI) and that no further curative treatment is recommended;
(b) Pertinent details of the physical examination performed (both positive and negative findings);
(c) Results of any pertinent diagnostic tests performed (both positive and negative findings). Include copies of any pertinent tests or studies ordered as part of the exam;
(d) An impairment rating consistent with the findings and a statement of the system on which the rating was based (for example, the AMA Guides to the Evaluation of Permanent Impairment and edition used, or the Washington state category rating system - refer to WAC 296-20-19000 through 296-20-19030 and WAC 296-20-200 through 296-20-690); and
(e) The rationale for the rating, supported by specific references to the clinical findings, especially objective findings and supporting documentation including the specific rating system, tables, figures and page numbers on which the rating was based.
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| Rating System | Used for These Conditions | Form of the Rating |
| RCW 51.32.080 | Specified disabilities: Loss by amputation, total loss of vision or hearing | Supply the level of amputation |
| AMA Guides to the Evaluation of Permanent Impairment | Loss of function of extremities, partial loss of vision or hearing | Determine the percentage of loss of function, as compared to amputation value listed in RCW 51.32.080 |
| Category Rating System | Spine, neurologic system, mental health, respiratory, taste and smell, speech, skin, or disorders affecting other internal organs | Select the category that most accurately indicates overall impairment |
| Total Bodily Impairment (TBI) | Impairments not addressed by any of the rating systems above, and claims prior to 1971 | Supply the percentage of TBI |
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If the attending doctor is unable or unwilling to perform the impairment rating examination, a consultant, at the attending doctor's request, may conduct a consultation examination and provide an impairment rating based on the findings. The department or self-insured employer can also request an impairment rating examination from an independent medical examination (IME) provider.
Attending doctors and consultants performing impairment rating examinations must be available and willing to testify on behalf of the department or self-insurer, worker, or employer and accept the department fee schedule rate for testimony.
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(2) The accompanying person cannot be compensated for attending the examination by anyone in any manner.
(3) The worker may not bring an interpreter to the examination. If interpretive services are needed, the department or self-insurer will provide an interpreter.
(4) The purpose of the impairment rating examination is to provide information to assist in the determination of the level of any permanent impairment, not to conduct an adversarial procedure. Therefore, the accompanying person cannot be:
(a) The worker's attorney, paralegal, any other legal representative, or any other personnel employed by the worker's attorney or legal representative; or
(b) The worker's attending doctor, any other provider involved in the worker's care, or any other personnel employed by the attending doctor or other provider involved in the worker's care.
The department may designate other conditions under which the accompanying person is allowed to be present during the impairment rating examination.
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The following section of the Washington Administrative Code is repealed:
| WAC 296-20-210 | General rules. |
OTS-6668.2
NEW SECTION
WAC 296-23-302
Definitions.
Direct patient care. For
the purpose of meeting the qualifications of an independent
medical examination (IME) provider, direct patient care means
face-to-face contact with the patient for the purpose of
evaluation and management of care that includes, but is not
limited to:
• History taking and review of systems;
• Physical examination;
• Medical decision making;
• Coordination of care with other providers and agencies. This does not include time spent in consultation or independent medical examinations.
Impairment rating examination. An examination to determine whether or not the injured/ill worker has any permanent impairment(s) as a result of the industrial injury or illness after the worker has reached maximum medical improvement. An impairment rating may be a component of an IME.
Independent medical examination (IME). An objective medical examination requested by the department or self-insurer to establish medical facts about a worker's physical condition.
Independent medical examination (IME) provider. A firm, partnership, corporation, or individual doctor who has been approved and given an independent medical examination (IME) provider number by the department to perform IMEs.
Medical director. A licensed doctor in the firm, partnership, corporation or other legal entity responsible to provide oversight on quality of independent medical examinations, impairment ratings and reports.
Medical examiners' handbook. A handbook distributed by the department containing department policy and information to assist doctors who perform independent medical examinations and impairment rating examinations.
Provider number. A unique number(s) assigned to a provider by the department of labor and industries. The number identifies the provider and is linked to a payer tax identification number that has been designated by the provider for payment purposes. A provider may have more than one provider number assigned by the department.
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(1) Establish a diagnosis;
(2) Outline a program of treatment;
(3) Evaluate what, if any, conditions are related to the claimed industrial injury or occupational disease/illness;
(4) Determine whether an industrial injury or occupational disease/illness has aggravated a preexisting condition and the extent or duration of that aggravation;
(5) Establish when the accepted industrial injury or occupational disease/illness has reached maximum medical improvement;
(6) Establish an impairment rating;
(7) Evaluate whether the industrial injury or occupational disease/illness has worsened; or
(8) Evaluate the worker's mental and/or physical restrictions as well as the worker's ability to work.
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(1) Providers who wish to bill or get paid for independent medical examinations or related services must apply for and receive an IME provider number. Issuance of an IME provider number does not guarantee IME referrals.
(2) Providers must have and maintain a current license to practice in the state in which they conduct IMEs and meet at least one of the two following requirements:
(a) Board certification in their medical specialty; or
(b) A minimum of an average of eight hours per week over the past two years of direct patient care in their medical specialty (excluding IMEs).
(3) Only providers in the following practice specialties who meet all other requirements may perform IMEs;
| Doctors licensed to practice: | |||||
| Examiner is: | Medicine & surgery | Osteopathic medicine & surgery | Podiatric medicine & surgery | Chiropractic | Dentistry |
| In Washington | Yes | Yes | Yes | Yes | Yes |
| Not in Washington | Yes | Yes | Yes | No | Yes |
(a) Be a chiropractic consultant for the department for at least two years;
(b) Take an impairment rating course approved by the department; and
(c) Attend the department's chiropractic consultant and examiners' seminar during the twenty-four months prior to application.
(5) Business requirements:
(a) Providers must conduct independent medical examinations only in a professional office suitable for medical, podiatric, chiropractic or psychiatric examinations where the primary use of the examination site is for medical services; not residential, commercial, educational or retail in nature. The site must have, at a minimum, adequate access, climate control, light, space and equipment to provide for the comfort and safety of the injured/ill worker and provide the privacy necessary for workers to discuss their medical issues.
(b) Providers must comply with all federal and state laws, regulations and other requirements with regard to business operations, including specific requirements for business operations for the provision of medical services.
(c) Providers must have a private disrobing area and adequate provision of examination gowns.
(d) Providers must have telephone answering capability during regular business hours, Monday through Friday, in order to facilitate scheduling of independent medical examinations and means for workers to contact the provider regarding their scheduled examination. If the office is open on Saturday, telephone access must be available.
(e) In order to be assigned an IME provider number, an IME firm, partnership, corporation or other legal entity must have a medical director. The medical director must be a licensed provider and be responsible to provide oversight on the quality of independent medical examinations, impairment ratings and reports.
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(1) American Board of Medical Specialties;
(2) American Osteopathic Association (AOA) Bureau of Osteopathic Specialties;
(3) American Podiatric Medical Association;
(4) American Dental Association.
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(1) Complaints about the provider;
(2) Quality of reports;
(3) Timeliness of reports;
(4) Charges regarding any crime, gross misdemeanor, felony or violation of statutes or rules by any administrative agency, court or board;
(5) Convictions of any crime, gross misdemeanor, felony or violation of statutes or rules by any administrative agency, court or board.
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(1) Changes in time spent in direct patient care;
(2) Loss or restriction of hospital admitting or practice privileges;
(3) Changes affecting business requirements (WAC 296-23-317);
(4) Loss of board certification;
(5) Charges regarding any crime, gross misdemeanor, felony or violation of statutes or rules by any administrative agency, court or board;
(6) Convictions of any crime, gross misdemeanor, felony or violation of statutes or rules by any administrative agency, court or board;
(7) Temporary or permanent probation, suspension, revocation, or limitation placed on their license to practice by any court, board, or administrative agency in any state or foreign jurisdiction.
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(1) Complaints about the provider (see, e.g., WAC 296-23-377);
(2) Disciplinary proceedings or actions;
(3) Proceedings in any court dealing with the provider's professional conduct, quality of care and criminal actions;
(4) Ability to effectively convey and substantiate medical opinions and conclusions concerning workers;
(5) Untimely reports;
(6) Substandard quality of reports or failure to comply with current department policy on report contents;
(7) Unavailability or lack of willingness to responsibly communicate with the department or self-insurer;
(8) Unavailability or lack of willingness to testify on behalf of the department or self-insurer, worker, or employer;
(9) Failure to stay current in the area of specialty and in the areas of impairment rating, performance of IMEs, industrial injury and occupational disease/illness, industrial insurance statutes, regulations and policies;
(10) Failure to continue to maintain the criteria to be an IME provider;
(11) Misrepresentation of information provided to the department;
(12) Failure to inform the department of changes affecting the provider's status as an IME provider;
(13) Failure to comply with the department's orders, statutes, rules, or policies; and
(14) Failure to accept the department fee schedule rate for testimony or independent medical examinations.
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(a) Be familiar with the contents of the medical examiner's handbook;
(b) Review all claim documents provided by the department or self-insured employer;
(c) Contact the worker prior to the examination to confirm the appointment date, time and location; and
(d) Review the purpose of the examination and the questions to be answered in the examination report.
(2) The IME provider's responsibilities during the examination are to:
(a) Introduce himself or herself to the worker;
(b) Verify the identity of the worker;
(c) Let the worker know that the claim documents from the department have been reviewed;
(d) Explain the examination process and answer the worker's questions about the examination process;
(e) Advise the worker that he/she should not perform any activities beyond their physical capabilities;
(f) Allow the worker to remain fully dressed while taking the history;
(g) Ensure adequate draping and privacy if the worker needs to remove clothing for the examination;
(h) Refrain from expressing personal opinions about the worker, the employer, the attending doctor, or the care the worker has received;
(i) Conduct an examination that is unbiased, sound and sufficient to achieve the purpose and reason the examination was requested;
(j) Conduct the examination with dignity and respect for the worker;
(k) Ask if there is any further information the worker would like to provide; and
(l) Close the examination by telling the worker that the examination is over.
(3) The IME provider's responsibilities following the examination are to:
(a) Send a complete IME report to the department or self-insurer within fourteen calendar days of the examination date, or within fourteen calendar days of receipt of the results of any special tests or studies requested as a part of the examination. Reports received after fourteen calendar days may be paid at a lower rate per the fee schedule. The report must meet the requirements of WAC 296-23-387; and
(b) Maintain the claim file information received from the department or self-insurer for ninety calendar days following submission of the examination report. After ninety calendar days information should be disposed of in a manner used for similar health records containing private information.
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(2) The accompanying person cannot be compensated for attending the examination by anyone in any manner.
(3) The worker may not bring an interpreter to the examination. If interpretive services are needed, the department or self-insurer will provide an interpreter.
(4) The purpose of the IME is to provide information to assist in the determination of the level of any permanent impairment not to conduct an adversarial procedure. Therefore, the accompanying person cannot be:
(a) The worker's attorney, paralegal, any other legal representative, or any other personnel employed by the worker's attorney or legal representative; or
(b) The worker's attending doctor, any other provider involved in the worker's care, or any other personnel employed by the attending doctor or other provider involved in the worker's care.
The department may designate other conditions under which the accompanying person is allowed to be present during the IME.
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(1) If, after reviewing the records, taking a history from the worker and performing the examination, the IME provider concurs with the attending doctor's determination of MMI, the impairment rating report must, at a minimum, contain the following:
(a) A statement of concurrence with the attending doctor's determination of MMI;
(b) Pertinent details of the physical or psychiatric examination performed (both positive and negative findings);
(c) Results of any pertinent diagnostic tests performed (both positive and negative findings). Include copies of pertinent tests with the report;
(d) An impairment rating consistent with the findings and a statement of the system on which the rating was based (for example, the AMA Guides to the Evaluation of Permanent Impairment and edition used, or the Washington state category rating system - refer to WAC 296-20-19000 through 296-20-19030 and WAC 296-20-200 through 296-20-690); and
(e) The rationale for the rating, supported by specific references to the clinical findings, especially objective findings and supporting documentation including the specific rating system, tables, figures and page numbers on which the rating was based.
(2) If, after review of the records, a history from the worker and the examination, the IME provider does not concur with the attending doctor's determination of MMI, an IME report must be completed. (See WAC 296-23-387.)
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(a) Contain objective, sound and sufficient medical information;
(b) Document the review of the claim documents provided by the department or self-insurer;
(c) Document the worker's history and the clinical findings;
(d) Answer all the written questions posed by the department or self-insurer or include a description of what would be needed to address the questions;
(e) Include objective conclusions and recommendations supported by underlying rationale that links the medical history and clinical findings;
(f) Be in compliance with current department reporting policies; and
(g) Be signed by the IME provider performing the examination.
(2) An impairment rating report may be requested as a component of an IME. Impairment rating reports are to be done as specified in WAC 296-20-200 and 296-20-2010 (2)(a) through (e).
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The following sections of the Washington Administrative Code are repealed:
| WAC 296-23-255 | Independent medical examinations. |
| WAC 296-23-260 | Examination reports. |
| WAC 296-23-265 | Who may perform independent medical examinations? |
| WAC 296-23-26501 | How do doctors become approved examiners? |
| WAC 296-23-26502 | Where can doctors get an application to become an approved examiner and other information about independent medical examinations? |
| WAC 296-23-26503 | What factors does the medical director consider in approving, suspending or removing doctors from the approved examiners list? |
| WAC 296-23-26504 | What happens if an examiner is suspended or removed from the approved examiner list by the medical director? |
| WAC 296-23-26505 | Is there a fee schedule for independent medical examinations? |
| WAC 296-23-26506 | Can a worker file a complaint about an independent medical examiner's conduct? |
| WAC 296-23-267 | When may attending doctors perform impairment rating examinations? |
| WAC 296-23-270 | Independent medical examinations two or more examiners. |