Referrals to Specialists

In cases presenting diagnostic or therapeutic challenges, you may arrange most consultations with specialists without prior authorization.

Exceptions:

• 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.
  • The claim manager may request that you obtain a mental health consultation.
• Independent medical exams can only be arranged by the insurer.
  • The insurer may arrange for an IME in 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).
  • If you see a need for an IME on a claim, include this information in chart notes or contact the claim manager.

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