Chapter

CHAPTER 18

EXAMINATIONS BY IMPARTIAL PHYSICIAN(S) PURSUANT TO 39-A M.R.S.A. Section 611

1. Administration The Workers' Compensation Board delegates authority for administration of 39 A M.R.S.A. Section 611 to the Deputy Director of Medical/Rehabilitation Services.

2. Date of Injury This Chapter is promulgated pursuant to 39-A M.R.S.A. Section 611. It shall apply to all requests for appointment of an impartial physician under Section 611 on or after the effective date of this Chapter, regardless of the employee's date of injury.

3. Assignment of Impartial Physician

1. Any party, including Hearing Officers, may request an examination by an impartial physician in a case involving occupational disease.

2. The request shall be submitted to the Deputy Director of Medical/Rehabilitation Services.

3. The Deputy Director of Medical/Rehabilitation Services shall verify that the claim involves occupational disease as defined by 39-A M.R.S.A. Section 603 and determine the applicability under 39-A M.R.S.A. Section 611.

4. If the Deputy Director of Medical/Rehabilitation Services determines that the claim does not conform to the definition of occupational disease according to 39-A M.R.S.A. Section 603, the request shall be denied and the parties notified.

5. If the disease is deemed to conform to the definition in Section 603, the Deputy Director of Medical/Rehabilitation Services may consult with an expert in occupational diseases to determine an appropriate physician or physicians with the expertise to perform the examination depending on the particular occupational disease involved in the request.

6. The Deputy Director of Medical/Rehabilitation Services shall have the authority to schedule the appointment with an out of state physician whenever appropriate.

7. The parties shall submit any medical records or other pertinent information to the examiner a minimum of seven (7) days prior to a scheduled examination. The medical records shall be in chronological order or chronologically by provider and accompanied by an index.

8. The appointed physician shall examine the employee, inspect the industrial conditions under which the employee has worked and review submitted medical records to properly determine the nature, extent and probable duration of the occupational disease. In the medical findings, the physician shall include the likelihood of the origin of the disease in the employee's work place and the date of incapacity.

9. Upon completion of the final examination, the examiner shall submit a written report to the employee, employer and the Office of Medical/Rehabilitation Services no later than fourteen (14) days after completion of the examination.

10. The fee for the examination shall be submitted to the Deputy Director Office of Medical/Rehabilitation Services for review and determination of reasonableness. After review, the bill shall be forwarded to the employer and payment shall be made within thirty (30) days of receipt.

11. The Deputy Director of Medical/Rehabilitation Services may order an autopsy be performed when a claim is made for death due to occupational disease taking into consideration the sensitivities of the family, religious attitudes, and normal human feeling against exhumation of remains when making the decision.

4. Expenses and Fees for Employees Attending a Board Appointed Examination

1. Expenses incurred by the employee attending a Board appointed examination pursuant to Section 611 are to be paid for by the employer. The following rates of reimbursement shall apply for travel:

A. $.22 per mile for mileage reimbursements.

B. $45.00 per evening for overnight lodging. Reimbursement for overnight lodging shall be allowed only when the employee has traveled 150 miles or more, one way, from the employee's place of residence.

C. $4.00 for breakfast, $5.00 for lunch, and $8.00 for dinner. Reimbursement for meals shall be allowed only when the employee has traveled 80 miles or more, one way, from the employee's place of residence.

D. Actual charges for tolls, accompanied by a receipt.

E. Employees may be advanced funds to cover the expenses of travel by making a request to the employer. The employer shall make every effort to honor such requests in a timely manner.

STATUTORY AUTHORITY: 39-A M.R.S.A. Sections152(2) and 611 CHAPTER 18 EFFECTIVE DATE: July 14, 1996

CHAP18.WPD Updated: 08/27/1997

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