Long-awaited, the Division of Workers' Compensation has finally published proposed changes to the qualified medical evaluator regulations.
The changes would make up the first 159 sections of the CCR, Title 8, governing the examination, appointment,
reappointment, evaluation report procedures and disciplinary procedures for physicians who are
QME's.
One big change is the death of the Industrial Medical Council. Other substantive changes include:
Psyche cases: Proposed section 36(c) and the related QME form proposed in section 120
provide that an employer may incur the cost of an office visit with a physician,
designated by an unrepresented injured employee, for the purpose of reviewing a
comprehensive medical-legal report with the employee that was written by a QME, in a
case involving a disputed injury to the psyche.
Disclosure of financial conflicts of interest: The administrative director is required by
Labor Code section 139.2(o) to develop regulations to prevent AME's and QME's from requesting or accepting any compensation or other thing of
value that does or could create a conflict with the physician's duties as an evaluator.
Proposed regulation 41.5 will require AMEs and QMEs who know of a disqualifying
conflict of interest, as defined in section 41.5(d), with any of the persons or entities listed
in section 41.5(c), to send a written notification to the injured employee and the employer
or insurer, or their respective attorneys if any, within five business days of the evaluator
becoming aware of the conflict. However, if a conflict does arise, if either party objects to
the evaluator on that ground, the parties are entitled to select a new evaluator.
Prevention of QME's on same panel with shared business interest: The proposed
regulations require QME's to report the existence of specified financial interests, only if
the QME is a limited or full partner, or holds a 5 percent or greater interest in, or is
entitled to receive 5 percent or more of the profits from, a medical practice, medical
group, or other business entity engaged in medical treatment or medical evaluations in the
workers' compensation system. In such cases, the QME must report the business name of
the entity, business address and list other physicians with the same or greater interests.
The information will be used by the administrative director to avoid assigning QME's
with shared financial interest to the same QME panel.
QME specialty list: The regulation proposes a change in the list of physician specialties
including merging some specialties to reduce travel by injured workers.
Primary practice location: A new definition for "primary practice location" is added.
Proposed regulations 17(c) and 30(f) state that a QME may designate up to four primary
office locations and that the administrative director in compiling QME panels will weight
primary office locations at 1.5 when compiling the list of QMEs for a given panel.
Reporting requirements: Subdivision 35.5(d) requires an AME or QME, when
providing an opinion on a disputed medical treatment issue, to apply and be consistent
with the standards of evidence-based medicine set out in the medical treatment utilization
schedule.
Two hearings have been set for next month on the proposals:
January 14th at the Ronald Reagan State Office Building Auditorium,
300 South Spring Street, Los Angeles, CA 90013 and January 17th at the Elihu Harris State Office Building Auditorium, 1515 Clay Street, Oakland, CA 94612.
To read all the proposed regulations,
PLEASE CLICK HERE.
- Help for the Injured Worker
