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CA: DWC Posts Revised Draft QME Regulations For Comment

Oakland, CA (CompNewsNetwork) - The Division of Workers' Compensation (DWC) has revised selected qualified medical evaluator (QME) regulations and posted them to the online forum where members of the public may review and comment on the proposal. The proposed changes would limit a physician...

CA: DWC Is Accepting Applications For QME

Oakland, CA (CompNewsNetwork) - The Division of Workers' Compensation (DWC) is now accepting applications for the Qualified Medical Evaluator (QME) examination. The deadline for filing applications is Thursday, March 17, 2011. The examination will be held Saturday, April 30, 2011 … read more

California: W.C.A.B. Provides Guidance on AME/QME Request Process Timing Issues

If there was ever a question the medical legal process in workers’ compensation has become concerned with tactical minutia rather than dealing with substantive issues in the day to day comp practice, the W.C.A.B.’s en banc opinion in Tsegay Messele v. Pitco Foods, Inc.; California Insurance...

California: W.C.A.B. Provides Guidance on AME/QME Request Process Timing Issues

If there was ever a question the medical legal process in workers’ compensation has become concerned with tactical minutia rather than dealing with substantive issues in the day to day comp practice, the W.C.A.B.’s en banc opinion in Tsegay Messele v. Pitco Foods, Inc.; California Insurance...

California: What Constitutes an Ex-Parte Communication Post-Alvarez?

There have been a number of cases decided by the Workers’ Compensation Appeals Board (WCAB) dealing with Labor Code Section 4062.3 and what constitutes a prohibited ex parte communication with a Panel Qualified Medical Evaluator (PQME). Though many thought the Court of Appeal’s decision in...

California: W.C.A.B. Limits Application of Messele Decision

After seeking input on its Notice of Intent to limit application of the Messele decision prospectively, and getting none, the W.C.A.B. has confirmed its decision to limit the application of its holding. The W.C.A.B. has, in a decision which issued yesterday as follows: To cases where a QME panel...

Does an Employee Have to Obtain a Comprehensive Medical-Legal Evaluation Prior to Disputing a Utilization Review Determination?

In State Compensation Insurance Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981] (Sandhagen), the California Supreme Court clarified that an employer did not have the option of going through either UR or the QME process in addressing a treatment request...

Lien Claimant’s PQME Reports Admitted Into Evidence: Cal. Comp. Cases February Advanced Postings (2/10/2012)

Here’s the second batch of advanced postings for the February 2012 issue of Cal. Comp. Cases. Lexis.com subscribers can link to the case to read the complete headnotes and summaries. County of Mendocino, PSI, Petitioner v. Workers' Compensation Appeals Board, City of Willits, PSI, Aaron...

California Panel QME Process: Is It Time to Admit We Are Dealing With a Monster?

A serious question needs to be asked about whether requiring the use of one Qualified Medical Evaluator (QME) in a workers’ compensation case, as opposed to the use of “battling QME’s”, has reduced litigation or has actually served to increase litigation. No question, at least...

California: W.C.A.B. Affirms Prior En Banc Decision Re: ADR 35.5(e) as Invalid

The W.C.A.B. has issued its follow-up decision in the previously issued en banc decision in Navarro v. City of Montebello . In its original decision the W.C.A.B. had issued a notice of intent to rule that Administrative Directive Rule 35.5(e) is an invalid interpretation of the provisions of Labor Code...

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?

With respect to the increasing litigation over the UR process, is Dubon really the issue in many of these UR disputes? Utilization Review (UR) has been around for more than ten years now. UR first came into play in 2003 when Governor Gray Davis passed Senate Bill 228 . The following year, on April...

California: Quirky Regs and Rules Related to the Medical Legal Evaluation Process

Trial calendars have been inundated lately with expedited hearings dealing with Qualified Medical Evaluator (QME) and Agreed Medical Evaluator (AME) issues. As a result of the Post-SB 863 onslaught of new regs, rules and procedures, the legal community is having a difficult time keeping up with many...

California: Requirements for Requesting Additional QME Panels

In Martinez v. Santa Clarita Community College District , 2015 Cal. Wrk. Comp. P.D. LEXIS 2 (lexis.com), 2015 Cal. Wrk. Comp. P.D. LEXIS 2 (Lexis Advance), the WCAB denied the applicant’s petition for removal and affirmed the WCJ’s finding that the applicant, who worked as a custodian and...

California: Streamlining the QME Process for Represented Employees

In Bahena v. Charles Virzi Construction , 2014 Cal. Wrk. Comp. P.D. LEXIS 638 (lexis.com), 2014 Cal. Wrk. Comp. P.D. LEXIS 638 (Lexis Advance), the WCAB affirmed the WCJ’s finding that a request by a legally represented applicant for a QME panel in the chiropractic specialty that was made more...

California: The Muddied Waters of the QME Panel Strike Process Post-SB 863

When is a strike of a QME timely post-SB 863? Until further clarification is provided, parties should proceed conservatively and strike a QME within the 10-day time period. Selection of Qualified Medical Evaluator Panels has been a frequent topic at many recent expedited hearings. One of those hearings...

California: Diagnostic Testing: Medical Treatment or Medical-Legal Expense? (Part 2)

In the May 4, 2015 issue of the LexisNexis Workers’ Compensation eNewsletter California Edition we reported the noteworthy panel decision of Hubbard v. United Parcel Service , 2015 Cal. Wrk. Comp. P.D. LEXIS 223 (April 21, 2015). On July 3, 2015, the WCAB panel rescinded its prior decision in which...

California QME Selection Process: Timing and Documentation Requirements

The WCAB has recently issued two noteworthy panel decisions on the QME selection process. In Murray v. County of Monterey , 2015 Cal. Wrk. Comp. P.D. LEXIS 304 (lexis.com), 2015 Cal. Wrk. Comp. P.D. LEXIS 304 (Lexis Advance), the WCAB provided guidance on the contentious QME selection process by interpreting...

California Workers’ Compensation: 2015 Year in Review

By Julius Young, Esq., Richard M. Jacobsmeyer, Esq., Barry D. Bloom, Co-Editors-in-Chief, Herlick, California Workers' Compensation Handbook This 2016 edition is the 35th edition of Herlick, California Workers’ Comp Handbook (hereinafter “Herlick”). The latest Herlick Handbook...

Does Violation of the QME Regulations Make a Report Inadmissible?

When policy, practice, and punishment collide and the art of discretion By Brad Wixen, Esq. In the case of Chaides v. The Kroger Company , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the Panel Qualified Medical Evaluator (QME) on the case evaluated the applicant several times and issued many supplemental...