In the event of complication, controversy, or dispute over the treatment aspects of any claim, the department or self-insurer will not authorize treatment until the attending doctor has arranged a consultation with a qualified doctor with experience and expertise on the subject, and the department or self-insurer has received notification of the findings and recommendations of the consultant.
This consultation must be arranged in accordance with WAC 296-20-051
Consultations are also required in the following situations:
(1) All nonemergent major surgery on a patient with serious medical, emotional or social problems which are likely to complicate recovery.
(2) All procedures of a controversial nature or type not in common use for the specific condition.
(3) Surgical cases where there are complications or unfavorable circumstances such as age, preexisting conditions or interference with occupational requirements, etc.
(4) If the attending doctor, the department, self-insurer, or authorized department representative requests a consultation.
(5) Conservative care, (e.g., nonsurgical cases) extending past one hundred twenty days following initial visit. Such consultation may be with a chiropractic or a medical or osteopathic consultant.
[Statutory Authority: RCW 51.04.020(4) and 51.04.030. 90-04-057, § 296-20-045, filed 2/2/90, effective 3/5/90. Statutory Authority: RCW 51.04.020(4), 51.04.030, and 51.16.120(3). 81-01-100 (Order 80-29), § 296-20-045, filed 12/23/80, effective 3/1/81. Statutory Authority: RCW 51.04.030 and 51.16.035. 79-12-086 (Order 79-18), § 296-20-045, filed 11/30/79, effective 1/1/80; Order 71-6, § 296-20-045, filed 6/1/71; Order 70-12, § 296-20-045, filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-045, filed 11/27/68, effective 1/1/69.]