Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Occupational Health Best Practices and L&I header

Structured intensive multidisciplinary programs (SIMPs) or Interdisciplinary Pain Rehab (IPR) are outpatient programs that deliver regularly scheduled, daily, interdisciplinary care for the treatment of chronic pain. The programs consist of six- to eight-hour days, 5 days per week for two to four weeks duration. The medical services provided in a SIMP are coordinated, goal-directed, and team-based. SIMPs are an integrated and coordinated medical rehabilitation program for chronic pain providing individualized, comprehensive treatment for chronic pain. The medical services provided in a SIMP are coordinated, goal-directed, team-based, and given at a centralized location.

SIMP has three phases:

  • Evaluation Phase - this phase includes a history, physical exam, and review of medical records. It is a comprehensive medical evaluation to assess candidacy for treatment and develop an individualized treatment plan and report.
  • Treatment Phase - this phase provides coordinated, comprehensive individualized treatment including PT/OT, patient education, medical management, cognitive behavioral therapy, medication weaning, mental health treatment and vocational rehabilitation.
  • Follow-up Phase - this phase includes transitioning the worker back to the community, coordinating with attending provider and maintaining functional improvements.

Conditions of Coverage

SIMP services require referral from the AP and prior authorization from the claim manager. A SIMP evaluation may be authorized if the worker:

  • Has had unresolved chronic pain (i.e. pain lasting more than 3 months) despite conservative care, and
  • Has one or more of the following conditions:
    • Is unable to return to work due to the chronic pain, or
    • Has returned to work but needs help with chronic pain management, or
    • Has significant pain medication dependence, tolerance, abuse, or addiction

For additional requirements and current SIMP policy, see MARFS Chapter 27: Rehabilitation Facilities and Programs.

SIMP providers and locations as of May 2026

Washington

Convivio Health (NWRTW)
16201 25th Ave W
Lynnwood, Washington 98087
425-774-9564 | Email: info@cvvoh.com
Website: Comprehensive Injury Rehabilitation | Lynnwood WA | Convivio Health

Convivio Health (NWRTW)
600 SW 39th Street, Suite 100C
Renton, Washington 98507
425-251-3275 | Email: info@cvvoh.com 
Website: Comprehensive Injury Rehabilitation | Lynwood WA | Convivio Health

Rehabilitation Institute of WA
415 1ST AVE N, STE 200
Seattle, WA 98109-4744
206-859-5030

Texas

Chronic Pain Recovery Center
25134 Oakhurst Drive
Spring, TX 77386
936-271-0221

North Texas Rehabilitation Center – Fort Worth Clinic
1001 12th AVE SW, Suite 146
Fort Worth, TX 76104-3926
817-377-4011

Functional Restoration Institute U.S. (PRIDE)
7929 Brookriver Drive, Suite 400
Dallas, Texas 75247
214-351-6600