News

QUALIFIED MEDICAL EVALUATOR REGULATIONS - By Debra Tobias

2023-02-08

On 2/2/2023, the Office of Administrative Law approved the DWC’s regulations affecting Medical-Legal Evaluations which include the permanent adoption of emergency regulations (Title 8 CCR Section 31.3, 31.5, 34, 46.3) allowing telehealth evaluations by QMEs as well the rules regarding scheduling of QME appointments. The adoptive changes include the following:

 

•  EXTENDED TIME FRAME FROM 30-60 DAYS FOR INITIAL EXAMS.   The time frame to schedule an initial and subsequent medical-legal evaluation by an additional 30 days and clarifies that the time frame for scheduling an evaluation is for both initial and subsequent evaluations:  § 31.3 (e) extends the timeframe for scheduling a QME  appointment from 60 days to 90 days of the date of the appointment request and the parties may waive the right to a replacement in order to accept an appointment no more than 120 days after the date of the party’s initial request for an appointment. When the selected QME is unable to schedule the evaluation within 120 days of the date of that party’s initial request for an appointment request, either party may report the unavailability of the QME and the Medical Director shall issue a replacement pursuant to section 31.5 of Title 8 of the California Code of Regulations upon request, unless both parties agree in writing to waive the 120 day time limit for scheduling the initial or any subsequent evaluation.    

•  LOCATION FLEXABILITY.  If the parties agree now an initial evaluation can occur at any office listed with the DWC Medical Director. § 34 (b) provides the parties may enter into a written agreement to use a different office listed with the Medical Director for the medical-legal evaluation and not just the one on the panel selection.

•  RESCHEDULING FLEXABILITY. A QME or Agreed Medical Evaluator (AME) can reschedule an evaluation within 60 days of the date of the cancellation unless the parties agree beyond the 60 days. § 34 (e) now states if a QME or AME cancels a scheduled appointment, the QME or AME shall reschedule the appointment within 60 calendar days of the date of the cancellation, unless the parties agree in writing to accept an appointment beyond the 60 day limit.

•   REMOTE EVALUATIONS.  A permanent mechanism for remote health Medical-Legal evaluations is in place if specific criteria are met. § 46.3 (a) now provides a remote health evaluation by a QME, AME, or other medical-legal evaluation may be performed through the use of electronic means of creating a virtual meeting between the physician and the injured worker where both parties can visually see and hear each other and may not be in the same physical space or site. § 46.3 (a) (2)(A) – (D) provides when the QME or AME may complete a medical-legal evaluation through remote health when a hands on physical examination is not necessary and all of the stated conditions are met. § 46.3(b) provides identification of office location when a remote health evaluation is conducted.

 

 

https://www.dir.ca.gov/dwc/DWCPropRegs/2021/QME-Regulations/Index.htm

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