Dr. Craig Smith and Kris Tefft: Take care in changing workers’ compensation medical exams
Hippocrates, the ancient Greek whose oath guides physicians’ care for their patients, wrote that a doctor’s first obligation is to “do no harm.”
Lawmakers should remember that concept before disrupting the medical “checks and balances” in Washington’s workers’ compensation system.
Fortunately for both workers and employers, the state Senate heeded this edict in passing Substitute Senate Bill 6440. This amended version should receive similar support in the House and from everyone who wants the system to work better.
SSB 6440 deals with the critical role independent medical examinations (IMEs) play in workers’ compensation. IMEs are performed by board-certified, licensed physicians, usually specialists, at the request of the self-insured employers or the Department of Labor & Industries on behalf of smaller employers in the state workers’ compensation pool.
An IME is an important step in ensuring workers’ injuries are accurately and completely diagnosed. They assess appropriate treatment plans and ensure progress is made relative to those plans. An IME can also benefit an injured worker by determining whether disability or work restrictions are medically sound.
The current IME system isn’t perfect – no system is. There aren’t enough participating doctors, so scheduling exams sometimes takes longer than anyone would like. Some workers become nervous about IMEs because they don’t get enough information regarding the reason for the exam and potential benefits to them. When an injured worker lives in a rural community, travel to see the appropriate specialist may be necessary. Sharing medical records and coordinating services among multiple doctors, the claimant, and those responsible for paying the claim can be cumbersome.
SSB 6440 intends to address these challenges, but the original version of the bill would have eliminated the current balance in the system and created an inefficient and unworkable structure. That bill would have limited the number of independent medical exams used in any given case, creating a risk that complex injuries might not be fully diagnosed or inappropriate treatment plans put in place.
It also would have imposed a variety of new restrictions and obligations on doctors performing IMEs, burdens that could have prompted more than half of the participating doctors to leave the system.
An exodus of IME doctors would be bad for everyone. Fewer doctors means more time away from work for injured workers, more delays in receiving medical treatment, and more time to resolve claims. All of this not only impacts injured workers, but also increases system costs and workers’ compensation premiums for everyone.
Limiting exams or driving out IME doctors would have more human consequences as well. Take the case of a law enforcement professional who was seriously injured in an on-the-job incident. In examining the officer, the IME doctor identified a more appropriate course of care, dramatically improving the officer’s prognosis for recovery. This wouldn’t have happened without that independent examination.
The amended bill moving in Olympia would create a task force of legislators, organized labor, employer groups and other stakeholders to thoroughly review the rules governing IMEs and recommend potential improvements for legislators’ consideration in the 2021 session.
This thoughtful and systematic approach improves on the original bill, which would have imposed potentially damaging new rules and restrictions on IMEs and then, only after making fundamental policy changes, convened a stakeholder group to understand the implications and review the system.
A cost-effective workers’ compensation system with appropriate checks and balances is important to Washington’s economic health. Independent medical exams are an important component of that system. Workers, employers, state regulators and the medical community should work together to determine whether, and how, IMEs could work even better. SSB 6440 gives them that opportunity.
Dr. Craig Smith, MD, is an IME physician and former chair of the board of directors of Bloodworks Northwest. Kris Tefft is executive director and general counsel of the Washington Self-Insurers Association.