Significant changes to workers’ compensation administrative rules regarding independent medical exams (IMEs)—Effective July 1, 2006

1.                  OAR 436-010-0265(11)(b)

When scheduling an IME, the insurer must ensure that the medical provider has a “Worker IME Survey—Form 440-0858” and the insurer has instructed the provider to give the form to the worker at the time of the IME

*Note:  A copy of the form can be accessed by clicking this link—Worker IME Survey Form 440-0858

2.                  OAR 436-010-0265(13)

Requires medical service providers (physicians, occupational therapists, and physical therapists) performing Independent Medical Examinations (IMEs) & Worker Requested Medical Exams (WRMEs), including Physical Capacity Examinations (PCEs) and Work Capacity Examinations (WCEs) to be on the Worker’s Compensation Division’s (WCD) “approved list” of certified providers.  In order to be placed on the “approved list” providers must:

a.                   Hold a current license and be in good standing with the professional regulatory board that issued their license

b.                  Complete a director-approved three hour IME course (IMEA is and was the first approved training provider in Oregon)

c.                   Submit the “Application for Independent Medical Exam Service Provider Authorization—Form 440-3930”

*Note:  A copy of the form can be accessed by clicking this link—Application for Independent Medical Exam Service Provider Authorization—Form 440-3930

Allows individuals to request the WCD Director to place a provider on the “approved list” with less than three hours of training when:

a.                   Extraordinary circumstances exist.  The following factors may be considered:  medical specialty needed; number of IMEs the provider has performed in a calendar year; where the worker lives; and factors that would make three hour training unreasonable.  *Note:  This list is an “including to, but not limited” list.

OR

b.                  If the worker and insurer agree that a certain provider may perform the examination

*Note:  Providers placed on this list are limited to being on the “approved list” only for the time required for the examination at issue.

Allows WCD to sanction or exclude a provider from the “approved list” if the Director finds the provider has:

a.                   Violated the American Board of Independent Medical Examiners (ABIME) Code of Conduct (see Application for Independent Medical Exam Service Provider Authorization—Form 440-3930 for complete copy of the code)

b.                  Failed to comply with requirements of OAR 436-010-0265 (see OAR 436-010-0265 for a complete copy of the administrative rule)

c.                   Has a current restriction on their license or is under a current disciplinary action from their professional regulatory board

d.                  Has entered into a voluntary agreement with their respective professional regulatory board which the Director determines is detrimental to performing IMEs

e.                   Violated workers’ compensation laws or rules

f.                   Failed to attend training required by the Director

*Note:  Providers have 60 days to appeal the Director’s decision to exclude a provider from the “approved list.”

3.                  OAR 436-010-0265(15)

Prohibits insurers from using an IME report (includes subsequent proceedings) if the Director, Administrative Law Judge (ALJ), Workers’ Compensation Board (WCB) or court finds that the IME was performed by a provider who was not on the “approved list” at the time of the examination

4.                  OAR 436-010-0265(16)

Prohibits observers in psychological examinations unless the provider approves

Requires workers to sign the observer form located in the “Important Information About Independent Medical Exams For Injured Workers—Form 440-3923A” if the worker wants an observer present during the exam.  A provider may exclude an observer if the worker does not sign the form

*Note:  A copy of the form can be accessed by clicking this link—Important Information About Independent Medical Exams For Injured Workers—Form 440-3923A

5.                  OAR 436-010-0265(17)

Requires medical providers to give the “Worker IME Survey—Form 440-0858” to the worker after the exam.

*Note:  A copy of the form can be accessed by clicking this link—Worker IME Survey Form 440-0858

Requires medical service providers to send the insurer a copy of the IME report, and if applicable, the “Worker IME Survey—Form 440-0858” or the “Invasive Procedure—Form 440-3227”

*Note:  A copy of the forms can be accessed by clicking this link—Worker IME Survey Form 440-0858 or Invasive Procedure—Form 440-3227

Eliminates the previous rule that required IME providers to send the exam report to insurers within seven days

6.                  OAR 436-055-0265(3)

Clarifies that, for director approval, the claims examiner training curriculum (for renewal of claims examiner certification) does not need to cover all of the components listed in OAR 436-055-0085(2) and OAR 436-055-0070(6)(b)—the 3 hour training may be completed in increments.

7.                  OAR 436-060-0265(6)

Requires that the insurer send the “Worker IME Survey—Form 440-0858” to the worker with the appointment notice

*Note:  A copy of the form can be accessed by clicking this link—Worker IME Survey Form 440-0858