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296-23-372  <<  296-23-377 >>   296-23-381

If an independent medical examination (IME) provider is asked to do an impairment rating examination only, what information must be included in the report?

When doing an impairment rating examination, the IME provider must first review the determination by the attending doctor that the worker has reached maximum medical improvement (MMI).
(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 296-23-382.)
[Statutory Authority: RCW 51.32.055, 51.32.112, 51.32.114, 51.36.060, and 51.36.070. WSR 04-04-029, § 296-23-377, filed 1/27/04, effective 3/1/04.]