Section 92-01-02-41 - Independent medical examinations - Definitions1. The organization may request an independent medical examination or independent medical review pursuant to North Dakota Century Code section 65-05-28: a. To establish a diagnosis or to clarify a prior diagnosis that may be controversial or ill-defined.b. To outline a program of rational treatment, if treatment or progress is controversial.c. To establish medical data from which it may be determined whether the medical condition is related, or not related, to the injury.d. To determine whether and to what extent a preexisting medical condition is aggravated by an occupational injury.e. To establish when the injured employee has reached maximum medical improvement or medically stationary status.f. To establish a percentage of rating for permanent impairment.g. To determine whether a claim should be reopened for further treatment on the basis of aggravation of a compensable injury or significant change in a medical condition.h. To determine whether over utilization by a medical service provider has occurred.i. To determine whether a change in medical service provider is indicated.j. To determine whether treatment is necessary if the injured employee appears to be making no progress in recuperation.k. When the medical service provider has not provided current medical reports.2. It is the organization's intention to obtain objective examinations to ensure that correct determinations are made of all benefits to which the injured employee might be entitled.3. Examiners must be willing to testify or be deposed on behalf of the injured employee, employer, or the organization.4. The organization must provide at least fourteen days' notice to the injured employee of an independent medical examination. The organization must reimburse the claimant's expenses for attending the independent medical examination pursuant to North Dakota Century Code section 65-05-28.5. As used in subsection 3 of North Dakota Century Code section 65-05-28 regarding allied health care professionals designated or approved by the organization, "duly qualified allied health care professional" means a person chosen by the organization who is an allied health care professional who has the specialization necessary to perform an independent medical examination or an independent medical review. The organization's determination of whether an individual it has chosen is a duly qualified allied health care professional and the organization's choice of the duly qualified allied health care professional who will perform an independent medical examination or an independent medical review are not appealable decisions and these decisions may not be considered when determining whether a claimant has failed to submit to, or in any way intentionally obstructed, or refused to reasonably participate in an independent medical examination.6. As used in subsection 3 of North Dakota Century Code section 65-05-28, "reasonable effort" means an attempt by the organization to locate and consider individuals as possible duly qualified allied health care professionals for independent medical examinations using criteria established by the organization. These attempts need not be exhaustive and need not be on a specific case-by-case basis. An attempt may consist of a review performed by the organization from time to time of individuals in North Dakota or other states in order to form an informal group from which the organization may select an examiner. Whether the organization has undertaken reasonable effort may not be considered when determining whether an injured employee has failed to submit to, or in any way intentionally obstructed, or refused to reasonably participate in an independent medical examination. Whether the organization has undertaken reasonable effort may not be considered when weighing the opinion of the examiner who performed the independent medical examination.N.D. Admin Code 92-01-02-41
Effective January 1, 1994; amended effective October 1, 1998; July 1, 2010.Amended by Administrative Rules Supplement 376, April 2020, effective 4/1/2020.General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07