Section 351-4-2 - Assignment of Independent Medical Examiners Pursuant to 39-A M.R.S.A. section 3121. If the parties agree to the selection of a particular independent medical examiner, they shall file a form prescribed by the Board with the Office of Medical/Rehabilitation Services, Workers' Compensation Board, 27 State House Station, Augusta, Maine 04333. If the employee is unrepresented by counsel, the independent medical examiner agreed upon must be chosen from the Board's list of independent medical examiners or approved by the Executive Director or the Executive Director's designee.2. If the parties do not agree to the selection of a particular independent medical examiner, the requesting party shall file a Request for Independent Medical Examination (WCB M-2) with the Office of Medical/ Rehabilitation Services, Workers' Compensation Board, 27 State House Station, Augusta, Maine 04333 and follow the procedures contained in section 3 of this rule. The Executive Director or the Executive Director's designee shall assign an examiner from the list of qualified examiners. If the list does not contain a qualified examiner, the Executive Director or the Executive Director's designee may select a qualified medical examiner of his/her choice. An Administrative Law Judge may also request an independent medical examination. The requesting party must: A. Complete Board Form M-2 and file it with the Office of Medical/ Rehabilitation Services, Workers' Compensation Board, 27 State House Station, Augusta, Maine 04333.B. Attach to Board Form M-2 a joint medical stipulation containing all medical records and other pertinent information, including an index of all treating health care providers and examinations performed under 39-A M.R.S.A. §207 since the date of injury.3. Assignment of a Board appointed independent medical examiner in a particular case will be performed by the Executive Director or the Executive Director's designee from the list of Board approved independent medical examiners with possible input from the individual Administrative Law Judge. The assignment will be made from a relevant area of specialty for the medical issues in question. The time it takes to schedule an examination may be a consideration in the selection. If a particular provider on the independent medical examiner list is precluded by rule or statute from acting as an independent medical examiner in the parties' case, the parties should notify the Board prior to the selection process.4. A Board appointed independent medical examination under 39-A M.R.S.A. §312 may be requested only after an unsuccessful mediation or after a request for a provisional order has been acted on and the case must be proceeding to the formal hearing level.5. Parties are limited to one Board appointed independent medical examiner per medical issue unless significant medical change can be shown.6.Disqualification and Disclosure in Individual CasesThe independent medical examiner must disclose potential conflicts of interest that may result from a relationship(s) with industry, insurance companies, and labor groups. A potential conflict of interest exists when the examiner, or someone in their immediate family, receives something of value from one of these groups in the form of an equity position, royalties, consultantship, funding by a research grant, or payment for some other service. If the independent medical examiner performs equivalent examinations as an employee of another organization, potential conflicts of interest may arise from that organization's contracts with industry, insurance companies, and labor groups. The Executive Director or the Executive Director's designee shall determine whether any conflict of interest is sufficiently material as to require disqualification in the event of initial disclosure. In the event an undisclosed conflict of interest is revealed during the hearing process, the Administrative Law Judge may disqualify the independent medical examiner and order a new examiner which shall be assigned in accordance to this rule.
90- 351 C.M.R. ch. 4, § 2