California 2023 Employment Law Updates: Key Changes to Medical-Legal Evaluations

The Division of Workers’ Compensation (DWC) introduced important updates to medical-legal evaluation regulations, effective February 2, 2023. These updates, detailed in the DWC’s official announcement, aim to improve scheduling processes and accessibility.

Key Changes to Medical-Legal Evaluation Regulations

Extended Time Limits for QME Appointments

• Initial QME Appointments: Now must be scheduled within 90 days of a request. However, scheduling parties can accept an appointment up to 120 days after the initial request.
• Follow-Up Evaluations: The same time limits apply to follow-up evaluations as for the initial comprehensive medical-legal evaluations.

Flexibility in Examination Location

The first QME examination must still occur at the office selected on the panel form. However, by written agreement, parties can allow the evaluation to occur at any office listed with the medical director.

Rescheduling Canceled Appointments

A QME or AME who cancels a scheduled appointment must now reschedule it within 60 calendar days, instead of the previous 30-day requirement. Parties may agree in writing to accept later rescheduling if necessary.

Permanent Adoption of Remote Medical-Legal Evaluations

The emergency regulations allowing remote medical-legal evaluations have been made permanent. Evaluations can now be conducted remotely if specific conditions are met.

Why These Changes Matter

The DWC’s updates aim to address ongoing challenges in scheduling QME appointments, including:

• Reducing Delays: In 2019, the DWC replaced 24,995 panels due to unavailable physicians. By 2021, after extending scheduling limits to 90 days, panel replacements dropped to 10,267.
• Increasing Flexibility: Allowing evaluations at alternate locations and extending rescheduling timelines helps maximize appointment availability.
• Enhancing Remote Options: Permanent remote evaluation regulations provide more accessible solutions when hands-on physical examinations aren’t required.

Remote Medical-Legal Evaluations: Conditions for Eligibility

Under California Code of Regulations (CCR) 46.3, remote evaluations are permissible when:

• A dispute involves:
  • Determining whether an injury is AOE/COE.
  • Termination of an injured worker’s indemnity benefits.
  • Disagreements over work restrictions.
• All parties (injured worker, employer/carrier, and evaluator) agree in writing.
• The evaluation adheres to ethical medical practices, the AMA Guides (5th Edition), and licensing board standards.
• The evaluator confirms in writing that a physical examination is unnecessary.

Additional Notes on Remote Evaluations

The updated regulations remove the previous requirement that agreements to remote evaluations could not be “unreasonably denied.” The Workers’ Compensation Appeals Board retains jurisdiction to address disputes related to the QME process.

Conclusion

These updates represent significant steps toward improving the efficiency of the California workers’ compensation system. By extending timelines and embracing remote options, the DWC aims to reduce scheduling delays and enhance accessibility for injured workers and medical professionals alike.

For more information about the regulatory updates, you can read the DWC’s official news release here.