Friday, February 1, 2008, 12:11 AM - QME processThe Division of Workers' Compensation has now posted transcripts of testimony at recent hearings on QME regs. They make for interesting reading (see links below to download the testimony).
Testifying in Los Angeles on January 14 were:
Linda E. Atcherley (legislative chair of the California Applicant Attys)
Steven Becker (a chiropractor)
Mark Webb (VP for state relations of Employers Direct Insurance Co.)
Robert Zeidner (attorney with the CAAA regulations committee)
Testifying in San Francisco on January 17 were:
Kristine Schultz (California Chiropractic Association)
Ed Troy (a doctor with one of the large "traveling doctor groups")
Susan Borg (president of CAAA)
Carlyle K. Brakensiek (California Society of Industrial Medicine &
Steve Cattolica (speaking for the Calif. Society of Physical Medicine &
Diane M. Przepiorski (California Orthopaedic Association)
Barry Gorelick (a Bay Area applicant attorney)
You can see the Los Angeles comments here:
http://www.dir.ca.gov/dwc/DWCPropRegs/q ... ngeles.pdf
The Oakland hearing comments are here:
http://www.dir.ca.gov/dwc/DWCPropRegs/q ... akland.pdf
Industrial Relations Counsel Suzanne Marria is working on these regs. There will surely be changes in the proposed regs, but here is the current version:
http://www.dir.ca.gov/dwc/DWCPropRegs/q ... ations.pdf
To see my prior post on this "The Tanning Salon Doc", click here:
http://www.workerscompzone.com/index.ph ... 410-212233
(you can see Mr. Young's bio by clicking here:
http://workerscompzone.com/static.php?p ... 6d259248fa
Friday, November 30, 2007, 07:14 PM - QME processThe California Division of Workers' Compensation has finally unveiled proposed new QME regulations.
The regs were posted on the DWC website today. Interested parties have awaited these regs for months.
The regs are in the public comment phase. Public hearings will be held on these in January 2008 in Los Angeles and San Francisco. If past experience is any guide, there will probably be revisions before final regs are adopted.
The proposed regulations are 113 pages, but you can view them or download them by clicking here:
http://www.dir.ca.gov/dwc/DWCPropRegs/q ... ations.pdf
I'll be covering this in more detail in future posts. Stay tuned.
Thursday, August 30, 2007, 07:39 AM - QME processWouldn't touch it with a ten foot pole.
That's what California doctors seem to be saying about becoming QMES (qualified medical examiners). The California DWC (Division of Workers' Comp) revealed this week that the number of QMEs in California has dropped 25% since 2004. There has been an exodus of about 350 QMEs each year. The number of doctors signing up to take the QME exam is significantly less than the number of doctors dropping out.
QMEs decide many critical issues in California workers' comp cases. In addition to determining whether there was a valid work injury in the first place, they often determine what periods of temporary disability are appropriate, what medical treatment is needed, as well as the rating for permanent disability. Without a stable corps of capable and fair QMEs, the California workers' comp system may crumble.
Workcompcentral.com writer Colleen Murray, quoted DWC spokesperson Susan Gard, as saying that the DWC is working on the problem by trying to have new and easier forms to use. Gard also apparently referred to new DWC regulations which would increase physicians' chances of being chosen to serve as a QME in the communities where they live. Perhaps that is a reference to the problem that has developed with the "fly-around" QME doctors who have "offices" in pretty much every town. That's a problem I addressed in an earlier blog post "The Tanning Salon Doc," which you can see by clicking here:
http://www.workerscompzone.com/index.ph ... 4f787d6811
But any DWC revision of the QME regs is under wraps for the moment.
The exodus of QMEs may mirror a general exodus of doctors from the California workers' comp system. Anecdotal evidence has been streaming in about doctors who no longer want to treat comp cases due to the red tape involved with utilization reviews and treatment guidelines. In some smaller communities this has reached crisis proportions as specialty doctors are no longer available to treat workers. You can see my earlier post on this ("Hasta La Vista Chico") by clicking here:
http://www.workerscompzone.com/index.ph ... 670342ae49
Workers and attorneys are often finding that when they are provided lists of doctors on the MPNs (medical provider networks), many of the doctors simply aren't willing to treat workers' comp patients. Not with a ten foot pole.
Thursday, February 15, 2007, 07:50 AM - QME processMost important issues in California workers' comp cases are resolved by the QME process (QME is short for "qualified medical examiner").
This usually occurs when the insurance adjuster sends the worker a letter saying that the worker must request a QME panel from the state. Often, the adjuster says that they are "objecting" to a determination by the treating doctor on issues of medical treatment, temporary disability or permanent disability. The worker is sent a form to request the medical specialty (i.e. kind of doctor) of the QME. If the worker does not pick the specialty, the adjuster can do so. That is important, but the real fun starts when the list of three doctors from the state arrives.
Many workers choose a QME for dumb resaons:
- "the doctor's office was the closest to where I live" (what makes you think that doctor will be the most sympathetic to you?)
- "I picked the doctor who went to the most prestigious medical school" (do you believe that makes that doctor the most likely to be thorough?)
- "I picked the youngest (or the most experienced) doctor" (do you think that is an indicator of who will be most fair?)
- "I didn't know anything about any of the doctors, so I just picked one at random"(did you consider talking to an attorney or to your treating doctor about the pros and cons of the various choices?)
- "the adjuster (or nurse case manager) suggested one of the three names, so I went with that one" (do you really think that employees of the insurer are looking out for your best interests?)
- "I chose a doctor at random because I figure an attorney can send me to another QME if I don't like this one" (true under California law at one time, but not true now)
The bottom line: talk to an attorney BEFORE you pick a QME evaluating doctor from a panel of three. Due to the fast time lines for picking a specialty and picking the doctor once the panel is issued, you should act quickly. Otherwise, the adjuster can pick the specialty AND the particular doctor. That's bad news for you.
Tuesday, February 6, 2007, 10:08 PM - QME processCalifornia workers' comp regulations specify that QME examiners must spend "face time" with the worker being evaluated.
One of the most frequent complaints I hear is from workers who tell me that the QME spent almost no time examining or talking to them. Apparently, many QMEs are in a hurry to rush the injured worker out the door.
How is face time defined? It is defined as the time the injured worker is with the QME. This includes any time the doctor spends "taking a history" or notes on symptoms, as well as the actual physical exam itself. Time you spend taking lab tests or sitting in a waiting room filling out a questionnaire would not be included.
What are the MINIMUM face time requirements?
-for a musculoskeletal evaluation: 20 minutes
-for a cardiovascular evaluation: 30 minutes
-for a lung evaluation: 30 minutes
-for a psychiatric evaluation: 1 hour
-for other types of disorders: 30 minutes
Note: these are the specified minimums for uncomplicated cases. If it is a complicated case, the required time may in fact be longer.
If you are a worker going to a QME doctor, keep these minimums in mind. You do not have to put up with shoddy treatment by a QME. You can print out this blog page and take it with you to the exam. To print out the regulations (part of Title 8, California Code of Regulations Sections 49 through 49.9), click here: