WAC 296-23-317
What qualifications must a provider meet
to become an approved independent medical examination (IME)
provider and be assigned an IME provider number? To ensure
that independent medical examinations are of the highest
quality and propriety, examiners and firms (partnerships,
corporations, or other legal entities) that derive income from
independent medical exams must apply and meet the following
requirements for department approval:
(1) Examiners must:
(a) Have a current, unrestricted, and active professional
license to practice in this state or in any other jurisdiction
where the applicant would conduct an examination.
(i) Unrestricted is defined as not currently having a
temporary or permanent probation, suspension, revocation or
any other limitation of any kind placed on a professional
license or privilege to practice by any court, board, or
administrative agency in any jurisdiction.
(ii) If any restriction once existed against the
applicant's license, the department must automatically deny
the application if the applicant's record has not been clear
for at least five years. If after five years the record has
been cleared, then the department exclusively reserves the
right to grant or deny the application based on the nature of
the prior restriction.
(iii) Exception to the five-year limit may be granted for
any restriction or offense deemed by the department to be of a
minor or clerical nature.
(iv) If an applicant has any pending action on their
privilege to practice by any court, board, or administrative
agency, or by any health care institution such as a hospital
in any jurisdiction, the department exclusively reserves the
right to grant or deny the application based upon the nature
of the action.
(b) Have no final action by the department to suspend or
revoke a previously assigned provider number as a treating
provider or independent medical examiner.
(i) If the applicant has any criminal history, history of
a violation of statutes or rules by any administrative agency,
court or board in any jurisdiction, the department must
automatically deny the application if such history exists
within five years of the application. If such history exists
but is older than five years, then the department exclusively
reserves the right to grant or deny the application based upon
the nature of the history.
(ii) Exception to the five-year limit may be granted for
any restriction or offense deemed by the department to be of a
minor or clerical nature.
(c) Have no pending action in any jurisdiction. The
department will not process the application until the matter
has been resolved.
(d) Attest that all information submitted on the
application is true and accurate and must sign under penalty
of perjury.
(e) Comply with all federal, state, and local laws,
regulations, and other requirements with regard to business
operations, including specific requirements for the provision
of medical services.
(f) Adhere to the independent medical examination
standards of conduct, and all other laws, rules, and policies.
These include but are not limited to the following:
• Provider application agreement;
• Medical Aid Rules and Fee Schedules (MARFS);
• Payment policies;
• Medical Examiners' Handbook.
(g) Review and sign the IME report and attest to its
accuracy.
(h) Conduct examinations in a facility designed as a
professional office suitable for medical, dental, podiatric,
chiropractic or psychiatric examinations where the primary use
of the site is for medical services. The site must not be
residential, commercial, educational or retail in nature. The
site must be clean, sanitary and provide adequate access,
climate control, light, space, and equipment. The site must
provide for the comfort and safety of the worker and for the
privacy necessary to conduct examinations and discuss medical
issues. Providers must have a private disrobing area and
adequate provision of examination gowns.
(i) Have telephone answering capability during regular
business hours, Monday through Friday, in order to facilitate
scheduling of independent 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.
(j) Agree that either they or the department may
inactivate their IME provider number or numbers. If an IME
provider number has been inactivated and the examiner wishes
to resume performing IMEs, they must reapply and meet current
requirements.
(k) Agree to keep the department informed and updated
with any new information regarding changes or actions that may
affect their status as an IME examiner.
(l) Reapply every three years in order to maintain an
active IME provider number.
(i) In the first year of the new rule, effective March 1,
2010, all examiners must reapply.
(ii) Examiners will be notified by mail sixty days prior
to their renewal application due date.
(m) Achieve a passing score on the Medical Examiners'
Handbook test prior to initial application and every three
years thereafter.
(2) Requirements for specific examiner specialties:
(a) Medical physician and surgeon (MD) or osteopathic
physician and surgeon (DO) applicants must: Hold a current
board certification in their specialty; or have completed a
residency and become board certified within five years of
completing the residency.
(i) Residency must be in a program approved by the
American College of Graduate Medical Education (ACGME) or the
American Osteopathic Association (AOA) or equivalent approving
body.
(ii) Fellowships will not be accepted in lieu of
accredited residency training though they may be used to
determine examination specialty qualifications.
(b) Podiatric physician (DPM) applicants must: Have a
current board certification in their specialty or have
completed a residency and become board certified within five
years of completing the residency.
(i) Complete a residency program approved by the American
Podiatric Medical Association (APMA).
(ii) Fellowships will not be accepted in lieu of
accredited residency training though they may be used to
determine examination specialty qualifications.
(c) Chiropractic physician (DC) applicants must be a
chiropractic consultant for the department for at least two
years and attend the department's chiropractic IME seminar in
the twenty-four months before initial application.
(d) Dentist (doctor of dental science/doctor of dental
medicine) (DDS/DMD) applicants must have at least two years of
clinical experience after licensure, and:
(i) Hold current certification in their specialty; or
(ii) Have one year of postdoctoral training in a program
approved by the American Dental Association Commission on
Dental Accreditation (CODA); or
(iii) Be a general dentist.
(3) All examiners must meet one of the following two
criteria:
(a) Document a minimum of three hundred eighty-four hours
of patient related services (excluding independent medical
examinations) per calendar year; or
(b) Complete a minimum of twelve continuing medical
education (CME) units of department-approved education and
training per year or a total of thirty-six CMEs in three
years. This training would focus on improving the provider's
skills in completing IMEs or staying current in the provider's
specialty. Topics include, but are not limited to:
• Report writing;
• Providing testimony;
• Standards of practice;
• Medical ethics;
• Patient care;
• Impairment rating.
Only examiners 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
Outside
Washington
Yes
Yes
Yes
No
Yes
(4) IME firms (partnerships, corporations or other legal
entities) that derive income from independent medical
examinations must:
(a) Have a medical director. The medical director must
be a licensed medical physician and surgeon (MD) or an
osteopathic physician and surgeon (DO), be responsible to
provide oversight on the quality of independent medical
examinations, impairment ratings and reports, and be available
to resolve any issue that department staff may bring to the
medical director's attention.
(b) Have no previous business or audit action by the
department to suspend or revoke an assigned provider number.
(c) Have no previous action taken by any federal or state
agency for any business previously owned or operated.
(d) Facilitate scheduling of providers both for the
examination and for any required follow up, including
amendments to the report, subsequent reports, or for any
testimony required. If the provider fails to participate in
scheduling or otherwise causes an undue expense to the
department, whether intentionally or not, the department may
fine the provider up to five hundred dollars per violation.
(e) Attest that all information submitted on the
application is true and accurate and must sign under penalty
of perjury.
(f) Comply with all federal, state, and local laws,
regulations, and other requirements with regard to business
operations including specific requirements for any business
operations for the provision of medical services.
(g) Adhere to the independent medical examination
standards of conduct, and all other laws, rules, and policies.
These include, but are not limited to, the following:
• Provider application agreement;
• Medical Aid Rules and Fee Schedules (MARFS);
• Payment policies;
• Medical Examiners' Handbook.
(h) Ensure that examinations are conducted in a facility
designed as a professional office suitable for medical,
dental, podiatric, chiropractic or psychiatric examinations
where the primary use of the site is for medical services. The site must not be residential, commercial, educational or
retail in nature. The site must be clean, sanitary and
provide adequate access, climate control, light, space, and
equipment. The site must provide for the comfort and safety
of the worker and for the privacy necessary to conduct
examinations and discuss medical issues. Providers must have
a private disrobing area and adequate provision of examination
gowns.
(i) Have telephone answering capability during regular
business hours, Monday through Friday, in order to schedule
independent medical examinations and communicate with workers
about scheduled examinations. If an exam site is open on
Saturday, telephone access must be available.
(j) Agree that either the firm or the department may
inactivate their IME provider number or numbers. If an IME
provider number has been inactivated and the firm wishes to
resume related services, they must reapply and meet current
requirements.
(k) Agree to keep the department informed and updated
with any new information such as exam site or administrative
office locations, phone numbers or contact information.
(l) Reapply every three years in order to maintain an
active IME provider number.
(i) In the first year of the new rule, effective March 1,
2010, all IME firms must reapply.
(ii) Firms will be notified by mail sixty days prior to
their renewal application due date.
(m) Have a representative from their quality assurance
(QA) staff achieve a passing score on the Medical Examiners'
Handbook test prior to initial application and every three
years thereafter.