Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 10 - MEDICAL SERVICES › Section 436-010-0265 - Independent Medical Exams (IMEs) and Worker Requested Medical Exams (WRMEs)

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
(a) An independent
			 medical exam (IME) means any medical exam (including a physical capacity or
			 work capacity evaluation or consultation that includes an exam) that is
			 requested by the insurer under ORS
			 656.325, except as provided in
			 section (13) of this rule. A worker requested medical exam (WRME) is an exam
			 available to a worker under ORS
			 656.325. An IME or WRME is
			 completed by a medical service provider other than the worker's attending
			 physician or authorized nurse practitioner.
(b) The insurer may obtain three IMEs for
			 each opening of the claim without authorization by the director. These IMEs may
			 be obtained before or after claim closure. For the purpose of determining the
			 number of IMEs, any IME scheduled but not completed does not count as one of
			 the three IMEs. A claim for aggravation, Board's Own Motion, or reopening of a
			 claim when the worker becomes enrolled or actively engaged in training under
			 OAR 436-120 (Vocational Assistance to Injured Workers) allows a new series of
			 three IMEs. Refer to section (12) of this rule to request additional
			 IMEs.
(c) The IME may be conducted
			 by one or more providers of different specialties, generally performed at one
			 location. If the providers are not at one location, the IME must be at
			 locations reasonably convenient to the worker. IMEs completed within a 72-hour
			 period count as one IME.
(d) The
			 insurer must choose the medical service provider from the director's list of
			 authorized IME providers online at
www.oregonwcdoc.info
. If a provider is not
			 on the director's list of authorized IME providers at the time of the IME, the
			 insurer may not use the IME report and the report may not be used in any
			 subsequent proceedings.
(e) The
			 provider will determine the conditions under which the IME will be conducted.
			 The IME should be performed in a professional setting that is primarily used
			 for conducting exams. If an IME is not performed in a professional setting that
			 is primarily used for conducting exams, the IME location should be a safe and
			 secure environment, including a place for the worker to disrobe in private, and
			 allow for confidentiality.
(f) IMEs
			 must be scheduled at times and intervals reasonably convenient to the worker
			 and must not delay or interrupt medical treatment that the worker has
			 scheduled.
(g) The insurer must
			 comply with the notification and reimbursement requirements under OAR
			 436-009-0025 and
			 436-060-0095.
(h) A medical service provider must not
			 unreasonably interfere with the right of the insurer to obtain an IME by a
			 medical service provider of the insurer's choice.
(i) A medical provider who unreasonably fails
			 to provide diagnostic records for an IME under OAR
			 436-010-0240 may be assessed a
			 penalty under ORS 656.325.
(j) The worker may complete an online survey
			 at
www.wcdimesurvey.info
or make a
			 complaint about the IME on the division's website. If the worker does not have
			 access to the Internet, the worker may call the division at
			 800-452-0288.