DWC modifies QME regulations

By CMTA Staff

Capitol Update, Oct. 16, 2008 Share this on FacebookTweet thisEmail this to a friend

The Division of Workers' Compensation (DWC) first introduced qualified medical evaluator (QME) regulations in January of 2008.  This week DWC proposed modifications. Comments will be accepted until 5 p.m. on Oct. 30.

The amended regulations prohibit QMEs from canceling appointments less than six days in advance without good cause and provide procedures for rescheduling. Under the proposed changes, QMEs must reschedule within 30 days and agreed medical evaluators (AMEs) must reschedule within 60 days.

Another proposed change modifies information sheets to address the California Supreme Court's decision in the Sandhagen case.  The court ruled that employers are required to use utilization review, not the QME process, to resolve medical disputes.

Revisions also include:

    •    Section 1(d), the definition of "agreed panel QME" entitles them to be paid the same as regular AMEs for reports and testimony;

    •    Section 34(d), regarding appointment cancellations, provides that all evaluators (AMEs and QMEs) shall not cancel a scheduled appointment less than six business days prior to the appointment, except for good cause. When a QME cancels, he must notify the parties in writing of the reason and reschedule to a date within 30 calendar days of the date of cancellation. An AME must reschedule within 60 calendar days of the date of the cancellation;

    •    Section 34(e)  will apply the same six-business day cancellation rule to parties; require the reason for cancellation in writing; adds that the injured worker shall not be liable for any missed appointment fee whenever an appointment is canceled for good cause; and the appeals board retains jurisdiction to resolve disputes over good cause;

    •    Section 35.5, regarding compliance with the administrative director’s evaluation and reporting guidelines, adds language that previously was in subdivision 35(l) about notifying the parties at the earliest opportunity of disputed issues outside the scope of the evaluator’s scope of practice and clinical competence;

    •    Section 36, regarding service of medical/legal reports, is re-worded to clarify what forms the evaluator must use to show the proof of service and the forms a panel QME in an unrepresented case must serve with the report when it is sent to Disability Evaluation Unit ;

    •    Section 36.5, regarding service of the medical/legal reports in psyche cases, is clarified to explain when to use the form to make Health & Safety Code section 123115(b) findings and how to serve the report; and

    •    Section 105 (QME panel request unrepresented case) and section 106 (represented QME panel)modifies forms and information sheets to be attached to address the Sandhagen decision that disallows defendants from using panel process to dispute the nature and extent of medical treatment under Labor Code section 4062.

For more information go to www.dir.ca.gov/dwc/DWCPropRegs/qme_regulations/qme_regulations.htm
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