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Calif. proposes to extend the time for medical evaluations in comp



The California Division of Workers’ Compensation on Friday proposed changes to its rules for qualified medical evaluators that would allow an additional 30 days to schedule appointments.

Instead of requiring a qualified medical evaluator to evaluate an injured worker within 60 days of being selected from a panel, the proposed rule would require the exam to be held within 90 days. The longer time frame will apply to requests for a comprehensive medico-legal evaluation and to requests for a follow-up evaluation.

The DWC said in an initial statement that it is proposing the change to increase accessibility for doctors and reduce the number of replacement QME panels it must issue.

“In 2021

, when this regulation was in place, we saw a decrease in reimbursement panel requests, ostensibly because physicians had available appointments in those time frames,” the DWC said. “In 2019, DWC replaced 24,995 panel codes because a physician was not available for 60 days, while in 2021, when the scheduling time was 90 days, DWC replaced only 10,267 panel codes for this reason.”

The proposed rules would also define remote health evaluations and set criteria for when medical evaluations can be conducted using video conferencing or similar technology. The rules would allow remote examinations when there is a disputed medical issue involving causation, termination or compensation benefits or work restrictions and the parties consent to the evaluation.

Remote examinations must conform to the fifth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and the physician must certify that there is no need for a physical examination.

The department said the rules will also allow for electronic service of documents.

The DWC is holding a public hearing on the proposed rules on November 15.

WorkCompCentral is a sister magazine to Business Insurance. More stories here.


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