by Sure Log
Once a qualified medical evaluator (QME) has been selected in a represented case, California Code of Regulation (CCR) 34(b) explains that any subsequent evaluation may be performed at a different medical office of the selected QME if that office is listed with the medical director and is “within a reasonable geographic distance from the injured worker’s residence.” Labor Code § 4062.3(k) further directs that, after a medical evaluation is prepared, the parties “shall utilize the same medical evaluator who prepared the previous evaluation to resolve the medical dispute” to the extent possible. Together, those provisions reflect a strong preference for continuity of the medical-legal evaluator, and they set the framework for disputes that arise when a QME relocates his or her practice.
The question of what constitutes a “reasonable geographic distance” under CCR 34(b) does not lend itself to a bright-line rule. A recent WCAB panel decision, Garcia v. J M Eagle, 2026 Cal. Wrk. Comp. P.D. LEXIS 55, applies a multifactorial framework to a QME relocation dispute and clarifies that geographic distance alone is not sufficient to justify replacement of a QME when the evidentiary record does not include medical evidence contraindicating the applicant’s travel to the new location.
FACTS OF THE CASE
In Garcia, the parties previously had obtained a QME in neurology whose offices were located in the greater Sacramento region near the applicant’s residence in French Camp, Calif. The QME subsequently relocated his practice and would perform evaluations only in Indio, Calif., more than 450 miles away from the applicant’s residence.
The parties proceeded to trial on whether the applicant was entitled to a replacement QME if the defendant agreed to provide appropriate transportation, including air travel. The workers’ compensation judge (WCJ) issued a findings of fact and order determining that the applicant was entitled to a replacement QME in neurology regardless of the defendant’s offer to provide transportation.
The WCJ reasoned that although an evaluation at the QME’s former Sacramento-area offices would have required a single full day, the trip to Indio probably would require a day of travel in each direction in addition to the evaluation day itself — a potential three-day exercise — given the applicant’s credible testimony that he required breaks from extended sitting and standing, could drive only for one hour at a time and could walk no more than approximately 200 yards.
The defendant filed a petition for removal, contending that the WCJ had treated geographic distance as the sole determinative factor without conducting the required multifactorial analysis, and that the mandate to use the same QME to the extent possible had not been given adequate weight.
WCAB’S DECISION
The WCAB granted the defendant’s petition because the evidentiary record did not warrant replacement of the QME. The WCAB began its analysis by emphasizing the statutory mandate of LC 4062.3(k), which requires the parties to continue using the same medical evaluator for subsequent evaluations “to the extent possible.” It then applied the multifactorial framework established in prior cases.
Although the WCAB agreed that the applicant’s physical tolerances for extended travel were a relevant consideration under CCR 34(b), it concluded that the WCJ had given undue weight to the geographic change without adequately accounting for the absence of any medical evidence contraindicating the applicant’s travel to Indio. The WCAB observed that although the applicant’s credible testimony established a need for periodic breaks from sitting and standing, his testimony also indicated that he was capable, “depending on how far he has to go,” of engaging in air travel and navigating airport security. Because the evidentiary record contained no medical advice precluding the travel, the WCAB concluded that the current record did not justify replacing the QME, and granted the defendant’s petition accordingly.
The WCAB explicitly noted that its decision was based on the record as it currently stood, and that the parties remained free to revisit the replacement issue before the WCJ if new facts or circumstances warranted reconsideration.
ANALYSIS OF THE DECISION
The Garcia decision provides important guidance on the standard that governs QME replacement disputes arising from a physician’s geographic relocation, and it delivers a clear message: Geographic inconvenience, standing alone, is an insufficient basis to replace a QME. The dispositive question under CCR 34(b) and LC 4062.3(k) is whether the evidentiary record, including medical evidence specifically addressing the applicant’s ability to travel, supports a finding that re-evaluation with the original QME is no longer reasonably possible.
The WCAB’s emphasis on the absence of medical evidence contraindicating travel is the central practical lesson of Garcia. The WCJ’s analysis relied on the applicant’s lay testimony about his functional limitations to conclude that a three-day travel process was unreasonable. The WCAB did not reject that testimony as not credible. Rather, it found that the applicant’s lay testimony, standing alone, fell short of establishing that travel was medically contraindicated. Practitioners defending against a replacement request, therefore, should focus discovery on whether any treating or evaluating physician has actually recommended travel restrictions, and highlight the absence of such a recommendation if none exists.
The decision also reinforces that the statutory preference for continuity of the evaluator under LC 4062.3(k) is a substantive factor that must be weighed in the multifactorial analysis. The burden falls on the party seeking replacement to demonstrate, through medical or other competent evidence, that re-evaluation with the original QME is not reasonably possible. A showing that travel has become more burdensome than it once was does not meet that burden without corroborating medical evidence.
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Sure S. Log is a seasoned specialist in workers’ compensation defense and related labor law, providing expert analysis on litigation and settlement strategies. His expertise includes conducting thorough legal research, reviewing case records to streamline discovery, and drafting comprehensive trial and appellate briefs.
A thought leader in the field, Mr. Log regularly develops seminar materials and co-authors influential white papers on critical workers’ compensation topics. His publications include “An Analysis of the New Regulations Regarding Disputes Over Medical-Legal Expense and Medical Treatment,” “Special Report: A First Look at SB 863” detailing the 2012 reforms to California’s workers’ compensation system, and “SB 863: Five Years Later.”
Mr. Log is also the co-author of Sullivan on Comp, a 16-chapter definitive analysis of California workers’ compensation law, which is updated monthly to ensure ongoing relevance and accuracy for industry professionals.
