The Division of Workers’ Compensation (DWC) was called out recently by a California State Auditor for failing to provide the proper guidance and support for Qualified Medical Evaluators (QMEs). As per the auditor’s report, the DWC has been unable to make it attractive for doctors to come out and become QMEs – leading to major problems in the state’s Workers’ Compensation System. Following are the three main causes cited by the report as reasons behind the struggle to provide working Californians with their right to workplace injury and/or sickness benefits.

  • Unfair Regulatory Process – The DWC is being blamed for regulating QMEs unfairly, choosing to ban doctors from being reappointed as QMEs instead of following through with due process. There also are allegations that the DWC intentionally delays (and in some cases, ignores) appeals from targeted QMEs requesting for reinstatement hearings – effectively, hampering a physician’s source of income until they have no recourse but to pay damages to insurers just so they can continue their service.
  • Inconsistent Reportorial Standards – Another issue is the DWC’s inability to uphold reportorial standards for QMEs. Reports submitted are erratic and oftentimes unsatisfactory in expressing the necessary medical information. The inconsistencies hamper the DWC’s ability to spot fundamental problems with reporting, causing delays in the evaluation and/or treatment of patients. Furthermore, QMEs that have had five reports rejected by judges in the DWC are not allowed to file for reappointment, forcing employers to spend even more time and money searching for other QMEs to fill any void left by a rejected QME.
  • Lack Of Active QMEs – Finally, the DWC has neglected to update, revise, or change the Medical-Legal Fee Schedule for QMEs since 2007. Because of this, the number of doctors willing to provide QME services are dwindling while the demand for them continues increasing by the day. The result is that there are too many cases circulating without available physicians to provide evaluation, causing even more delays in extending workers their right to Workers’ Compensation.

The good news is that change is on the horizon as California seeks answers to Workers’ Comp issues during the Covid-19 pandemic. Will the upcoming adjustments help or hinder QMEs all over the Golden State? Only time will tell. If these allegations are true, then the DWC must somehow get their act together – not just for the industry, but for every single working citizen of California.

Meanwhile, if you are looking for the best QME solutions, you’ve come to the right place. Contact TukkoMed today and find out how we can take the pain away from your process so you can live happy and free.

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