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Calif. proposes extending time for medical evaluations in comp


The California Division of Workers’ Compensation on Friday proposed changes to its qualified medical evaluator rules that would allow an extra 30 days to schedule appointments.

Instead of requiring a qualified medical evaluator to evaluate an injured worker within 60 days of being selected from a panel, the proposed rule would require that the exam be held within 90 days. The longer time frame will apply to requests for a comprehensive medical-legal evaluation and to requests for a follow-up evaluation.

The DWC said in an initial statement of reasons that it is proposing the change to increase the availability of physicians and reduce the number of replacement QME panels it has to issue.

“In 2021, when this regulation was in place we saw a decrease in replacement panel requests ostensibly because physicians had available appointments within these time frames,” the DWC said. “In 2019, the DWC replaced 24,995 panel codes because a physician was not available in 60 days, while in 2021, when the time for scheduling was 90 days, the DWC replaced only 10,267 panel codes for this reason.”

The proposed rules would also define remote health evaluations and outline criteria for when med-legal evaluations can be done using video conferencing or similar technology. The rules would allow remote exams when there’s a disputed medical issue involving causation, termination or indemnity benefits or work restrictions and the parties agree to the evaluation.

Remote exams must be consistent with the fifth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and the physician must attest that there is no need for a physical exam.

The division said the rules will also allow for electronic service of documents.

The DWC is holding a public hearing on the proposed rules on Nov. 15.

WorkCompCentral is a sister publication of Business Insurance. More stories here.