Kamin: What to Do When Your QME Moves

Tuesday, May 21, 2024 | 0

One factor that can delay a workers’ compensation claim is when a qualified medical evaluator moves offices or changes med-legal services and doesn’t tell the parties. This can and has added months to claims.

John P. Kamin

If one practices workers’ compensation law on either side of the aisle long enough, this is bound to happen to you. This article will help provide some tips and strategies to help move your claim forward when your QME has decided to throw you a change-up.

Know this link

The DWC Medical Unit’s QME database lists all the addresses available for each QME, along with a phone number.

It is a helpful link to know, as it can tell you where the QMEs perform evaluations and even which ones practice in specific ZIP codes or geographic areas.

When the QME moves

The threshold question that will dictate your remedies is, “When did the QME move?”

It’s important to know whether the QME moved to a new address before the original evaluation or after the initial evaluation.

If QME moves after panel issues but before the initial evaluation

In this scenario, the parties have usually issued their strikes and one doctor remains on the QME panel. However, when they call to book the evaluation appointment, they find out the QME has moved to a new address.

If the QME moved to a new address that is different than the one on the DWC Medical Unit’s panel, the parties must get a replacement panel unless there is a written agreement between the parties to use another QME address listed with the DWC Medical Unit. Then, they may choose to have the evaluation performed at a different address, according to CCR 34(b).

The problem is that when a QME changes med-legal service providers (the scheduling company that also organizes their records), often all of the addresses change. Still, all of the addresses should be listed with the DWC Medical Unit.

If the QME moves after the initial evaluation

What happens if your QME moves offices after the initial evaluation? Well, CCR 34(b) says you can do a reevaluation at a new address, as long as it’s located “within a reasonable geographic distance from the injured worker’s residence.”

In other words, you can schedule a reevaluation address as long as it’s not too far away from the applicant.

Other problems

One thing that is more annoying than the most annoying sound in the world (thanks, Jim Carrey) is when your QME changes med-legal companies and/or moves but doesn’t tell any of the parties. This often leads to a situation where the parties have requested a supplemental report from the QME, only to get no response. After 60 days pass, usually someone will object to the report as untimely and call the QME’s phone number listed on the reports or QME panel only to have the receptionist say, “Sorry, that doctor has moved on and we have no idea where they moved to. I cannot provide you with any more information than that.”

Questions about what happened to your supplemental report are given similar answers. In other words, they probably know where the QME moved to, but instead, they pretend that they have no idea what is going on.

Do not fear! Just fire up your trusty computer and go back to that handy link we told you about.

If your QME is still practicing, the new addresses and phone numbers will be listed on that link. Call the new phone numbers listed on the QME database, ask if he or she ever got your supplemental (they usually will say they didn’t), and then ask where it should be sent.

That should get you your supplemental report.

One other noteworthy problem that occurs when QMEs switch med-legal companies is that they trash all of the records that the doctor previously reviewed earlier in the case. So if you intend to ask the QME a question about a record reviewed before the change in med-legal companies, you might have to resend it. Sometimes you resend things to the new address, and the QME’s office feigns never receiving them. When that happens, you must simply resend and follow up with the office manager.

Remember to comply with LC 4062.3(e)

While doing all of this fun QME stuff, please remember to comply with LC 4062.3(e) and avoid any ex-parte communication with the QME. This important statute says all communications with a medical evaluator before a medical evaluation shall be in writing and shall be served on the opposing party 20 days in advance of the evaluation. Any subsequent communication with the medical evaluator shall be in writing and shall be served on the opposing party when sent to the medical evaluator.

If you’ve already abided by this statute and the other party didn’t object, simply resending your correspondence to the QME’s new address shouldn’t be a problem. Just make sure you haven’t made any notable changes to your letter.

Conclusion

When your QME moves or changes scheduling companies, it’s not the end of the world as long as you know about CCR 34(b) and the DWC’s QME database. So keep these handy tools in mind, and you should be able to proceed with discovery as you originally intended.

John P. Kamin is a workers’ compensation defense attorney and equity partner at Bradford & Barthel’s Woodland Hills location. He is WorkCompCentral's former legal editor. This entry from Bradford & Barthel's blog appears with permission.