Workers’ comp QME system creates lengthy delays for Californians injured on the job
Injured workers in California cities like Fontana, Rancho Cucamonga and Ontario often wait months or even years to receive the medical evaluations required to get needed treatment, and in some cases to determine how disabled they are as a result of the injury. The reason? The state lacks enough physicians signed up with the state’s program to serve as experts.
That’s among the findings of a first-ever state audit of California’s Division of Workers’ Compensation, which noted that the state has not increased the pay schedule for expert doctors, known as Qualified Medical Evaluators, in 13 years.
The State Auditor found that the Division of Workers’ Compensation:
- “Failed” to address the shortage of medical experts — there were 2,800 medical evaluators in 2017-2018 and 100,000 new requests for evaluations that same year.
- “Inappropriately” disciplined doctors for alleged overbilling issues by not reappointing them, raising “due process concerns.”
- Has not ensured that the evaluators’ reports meet quality standards as accurate and complete, and has not tracked how often judges reject those reports as a result.
When injured workers endure lengthy waits, their health may suffer, their condition could worsen, they may lose their financial footing, and some have even lost their homes, according to lawyers representing injured workers. Typically workers require an evaluation when an employer disputes whether an injury is actually work-related, or the worker feels they need more treatment or wants a second opinion regarding temporary or permanent disability. When a worker, or the worker’s attorney, asks for a medical review, the state provides a list of three experts to choose from, but also requires that the appointment takes place within 60 days. If a doctor can’t do it in that timeframe, the worker will be given a fresh list and the process begins all over again.
If you need assistance in the processing of the qualified medical evaluator QME request, would like free advice on what to do with your QME qualified medical evaluator list of Fontana, Ontario, Rancho Cucamonga areas, or generally have any questions about the process, contact us immediately as there are several very important time limits with regards to qualified medical evaluations. There are numerous qualified medical evaluators with offices in Fontana, Rancho Cucamonga and Ontario. Our consultation and advice is free, know your rights and benefits as well as your time limitations in the QME medical evaluator system.