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California: An Alternative to the PQME Process Madness

September 17, 2019 (2 min read)

There are undeniably many cases where the Panel Qualified Medical Evaluation (PQME) process simply does not work. No question, at least conceptually, the idea of having one doctor evaluate an injured worker instead of two doctors with diametrically opposed opinions seemed like a good idea. However, time and again, cases are proceeding through the worker’ compensation system where there are either extensive delays caused by the PQME process or where the parties are simply not able to obtain a valid PQME so as to have the injured worker’s entitlement to benefits evaluated.

In the recent case of Campbell v. City of Red Bluff Fire Department, 2019 Cal. Wrk. Comp. P.D. LEXIS --, the first QME panel was defective because the last physician standing could not schedule an evaluation within 60 days. A second panel was issued, and again, the last physician standing could not schedule an evaluation within 60 days. Two additional panels of doctors were then issued. The validity of those two panels proceeded to trial with the Workers’ Compensation Administrative Law Judge (WCJ) invalidating one and ordering the parties to proceed with the fourth panel.

The Workers’ Compensation Appeals Board (WCAB) panel of commissioners reviewed the WCJ’s decision, and after reviewing applicable PQME rules, found that the fourth panel was also invalid. Accordingly, after four attempts, the parties continued to be left without a PQME to evaluate the case!

Instead of sending the parties back through the PQME process for a fifth time, the WCAB gave the parties 10 days to agree on an AME or the WCJ would be allowed to appoint a “regular physician” under Labor Code Section 5701. Interestingly, the commissioners cited to the California Constitution’s mandate to “accomplish substantial justice in all cases expeditiously, inexpensively and without incumbrance of any character” as a justification for its order.

In other words, the panel of commissioners in Campbell ordered the parties, and if not the parties, the WCJ, to take matters into their own hands in order to obtain a medical-legal evaluation though the workers’ compensation process.

In conclusion, Campbell provides both practitioners as well the WCJ with an important alternative to the often dysfunctional PQME process. Indeed, in those cases where the PQME process is causing delays or is failing to produce a valid panel of evaluating doctors, the parties would be well advised to make greater efforts to utilize Agreed Medical Evaluators (AME’s) and WCJ’s should be ready to utilize their powers under Labor Code Section 5701 so as to appoint an evaluating physician.

Practitioners should check the subsequent history of any cases before citing to them.

Any information or opinions contained in this commentary are not necessarily endorsed by LexisNexis® or its affiliates.

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