The California Division of Workers’ Compensation on Thursday proposed amendments to its qualified medical evaluator regulations that would increase the length of the mandatory disability evaluation report-writing course by four hours to facilitate sessions on anti-bias training and case law review.

Other changes in proposed rules the division posted to its online forum would require part of the QME training to be conducted in person and require evaluators to declare under penalty of perjury that they didn’t discriminate against any parties.

The division is also proposing to review the rules governing the process of appointing and reappointing QMEs.

Under the proposal, providers would need to complete a 16-hour course in disability evaluation report writing prior to being appointed as a QME. Proposed rules would also require QMEs to complete 16 hours of continuing education every 24 months. Current regulations require providers to complete a 12-hour course before being appointed and to earn 12 hours of continuing education credits every two years.

The extra four hours would include a two-hour session on reviewing workers compensation case law and a two-hour session on anti-bias training that meets qualifications set out in the proposed rules.

The rules require that the anti-bias training course provide “instruction designed to increase awareness and understanding of differences in human experience,” as well as implicit bias, stereotyping and discrimination. This section would explore the ways that unconscious bias can impact decision-making and lead to disparities in health care strategies. Its intent is to help reduce implicit bias in medical evaluations and reporting.

The anti-bias training would require at least one example of potential gender bias in a fictitious QME evaluation in which the apportionment rating is made based on an assumption about a risk factor related solely to the injured worker’s gender.

The course would need at least one example of an evaluation and rating of permanent disability resulting from industrial breast cancer, taking into account the ways that gender bias can impact an assessment.

Providers would be required to pass a post-course examination to receive credit for this part of the training. The rules would also allow the administrative director to audit the providers’ exams and their scores.

The division is also proposing to mandate that at least six hours of QME training consist of in-person lecture, eliminating the option under the current rules to provide all training by distance learning.

Another provision would require that each QME include in medical-legal reports a declaration under penalty of perjury stating that the evaluator “did not discriminate in any way against the parties to the action or the injured worker in the evaluation process or in the content of the report.”

The DWC is also proposing to identify some grounds for denying reappointment of a QME as part of the new regulatory package, including:

• Failure to comply with evaluation time frames on at least three occasions during a calendar year.
• Filing notification of unavailability for more than 90 calendar days in a year.
• Refusing to perform an evaluation without good cause on any single occasion.
• Having more than five evaluations rejected by the Workers’ Compensation Appeals Board.
• Three or more instances of billing evaluations, reports or testimony in violation of the fee schedule.
• A finding that a QME violated an order or ruling of a WCAB judge.
• Performing an evaluation without certification.
• Providing false information when applying for appointment or reappointment.
• Failing to render expert opinions or conclusions without regard to an injured worker’s race, sex, national origin, religion or sexual preference.
• Three or more instances of failing to communicate with the injured worker in a respectful, courteous and professional manner.
• Failure to notify the division within 90 days that the provider’s license was encumbered.

Providers who are denied reappointment as a QME would have a right to a hearing if they file a timely appeal of the division’s notice. The rules would declare that providers who have not paid the QME appointment fee, whose license has been suspended, revoked or terminated, or who was kicked out of the workers compensation system following a fraud conviction would be ineligible for appointment automatically and have no right to notice or appeal, under the proposed rules.

The DWC is accepting comments on the proposal through May 14.

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