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A case involving two qualified medical evaluators who lost their QME licenses despite never having any billing issues with California officials highlights one of the contributing factors to the state’s QME shortage.
In September, Timothy C. Howard and Benjamin Simon sought a writ of mandate asking the California Department of Industrial Relations, California Division of Workers Compensation to cease and desist from enforcing improperly adopted regulations and to reappoint them as QMEs, according to a case called Dr. Timothy C. Howard, et al. v. California Department of Industrial Relations, et al.
Neither Mr. Howard, an orthopedist who was first appointed a QME in 2005, nor Mr. Simon, a practicing cardiologist appointed as a QME in 2015, had ever received billing complaints from the DWC, according to court documents.
QMEs are appointed for two-year terms in specialties required for the evaluation of medical issues. The DWC is obligated to reappoint QMEs who meet all the educational and other standards set forth by California Labor Code section 139.2 and who have not violated certain regulations after a due process hearing, according to case documents.
But Mr. Simon was denied QME reappointment without a due process hearing, according to a Superior Court of the State of California County of Los Angeles ruling dated Feb. 20.
Meanwhile, Mr. Howard is currently in settlement negotiations with the DWC, according to his attorney Nicholas Roxborough, a Los Angeles-based partner at Roxborough, Pomerance, Nye & Adreani L.L.P. Mr. Roxborough has other writs of mandamus pending on behalf of other QMEs similarly denied reappointment.
A significant drop in the number of qualified medical evaluators in California has experts concerned about the potential effect on injured workers and their employers and urging state regulators to staff up.