Initially scheduled to speak on the topic of utilization of AME & QMEs, they quickly adapted the presentation to the impact of Senate Bill 863.
Mr. Fisher began by noting that while many things have changed with the enactment of SB 863, many of the fundamental dynamics in the workers’ compensation system remain the same. He specifically observed that the system has always been configured to “start and stop” with the opinions of the treating physician. Mr. Fisher explained that the first issue in any medical treatment case is: What did the treating physician conclude? Once the parties know the treating physician’s conclusions, each side can assess whether or not they agree or disagree with the treating physician’s findings. If there is no disagreement, then the case will be concluded based on the treating physician’s reporting. However, if one party disputes the treating physician’s findings, then the medical-legal process could be initiated. Mr. Fisher pointed out that the use of the treating physician’s conclusions have been the underpinnings of the protocol envisioned under California Code of Regulations, Title 8, Section 9785, which has existed in its current form since 2005.
Both panelists emphasized that it is best if the parties can attempt to specifically identify the nature and type of dispute that may exist. They explained that identification of the type of medical dispute would help the parties identify which medical-legal process was best for any individual case. By example, it was noted that because of the genetic advances in identifying the source of spores responsible for Valley Fever, an Agreed Medical Examiner (“AME”) may be best, as the genetic analysis utilized to identify the pathogen may not be commonly found in offices of a Qualified Medical Examiners (“QME”). Alternatively, dispute in cases involving relatively common occupational injuries may be better suited for QMEs who routinely evaluate similar case presentations. One way or the other, both panelists concluded that a medical dispute based upon the treating physician’s report “must exist” before the medical legal process can be initiated.
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