In cases presenting diagnostic or therapeutic challenges, you may arrange most consultations with specialists without prior authorization.
- Attending providers should notify the claim manager of a referral for any second opinion consultation. Timing can be an issue if a claim manager is already scheduling an Independent Medical Examination (IME), the claim has been closed, or if a claim re-opening is pending.
Exceptions to this are Independent Medical Exams and Mental Health consultations.
- Independent Medical Exams (IME) can only be arranged by the insurer. An IME is a response to a request or an issue raised by the attending doctor or by the employer (who was the worker’s employer at the time of injury).
- Mental health consultations require prior authorization. If you have recently referred a worker for a mental health consultation and you learn that the claim manager is arranging an IME, you should immediately advise the claim manager of the mental health consultation.
Need help finding a doctor near you? Use our Find A Doctor tool.
Second Opinion or Independent Medical Examination?
Consultants
Find an L&I-approved Chiropractic Consultant who has 2+ years of experience treating workers and is educated on documentation requirements and occupational health best practices.
To find a chiropractic consultant:
- Use L&I’s Find a Doctor site.
- Check "All Providers" and search for your city.
- On the results page, under the left menu “Provider Specialties”, click “Specialists.”
- When the filter window comes up, check the box by “Chiropractor/Consultant” and click “Apply.”
Referral for consultation or second opinion
Referral for any second opinion examination, including to Chiropractic Consultants or medical providers in the community, does not require prior authorization. However, attending providers should notify the claim manager of a referral for any second opinion consultation. Timing can be an issue if a claim manager is already scheduling an Independent Medical Examination (IME), the claim has been closed, or if a claim re-opening is pending.
Any attending provider can request a second opinion about diagnosis or treatment from approved Chiropractic Consultants located throughout Washington State. Consultants are a trained resource for clinical guidance regarding:
- Active Rehabilitation for Work-related Low Back Conditions.
- Additional insight for conservative care, return to work, and/or injury rehabilitation options.
- Advice for deciding on a specialist referral or advanced diagnostics (including imaging).
- Assistance with stalled progress.
- Issues leading to complications or disputes in a claim, or
- Guidance for a non-emergency diagnostic or therapeutic conundrum.
Independent Medical Exam (IME)
If you see a need for an IME on a claim, include this information in chart notes or contact the claim manager.
Claim managers create a request for an independent medical examination (IME) through the online scheduling system. This letter contains instructions about the location for the examination and the specialty of the examiner(s) requested.
Use this online list to search for an approved medical examiner.
For more information:
Mental Health
The claim manager may request that your worker obtain a mental health consultation. If you see a need for an evaluation in your worker, be sure to discuss with the claim manager for authorization.
For more information:
See Mental Health