The Office of Administrative Law (OAL) has approved California’s Division of Workers’ Compensation medical-legal evaluation regulations, including the permanent adoption of emergency regulations allowing remote health evaluations by Qualified Medical Evaluators (QMEs). Keep reading to learn more.
OAL Approves DWC’s Medical-Legal Evaluation Regulations
California’s Division of Workers’ Compensation announced that the Office of Administrative Law has approved a set of medical-legal evaluation regulations that include the permanent adoption of emergency regulations allowing telehealth evaluation by QMEs.
The emergency regulations were adopted to help workers and QMEs deal with the challenges of the COVID pandemic.
Telehealth emergency regulations were first adopted at the beginning of 2022 and extended twice, but from the outset, the DWC announced its intention to make the measures permanent.
The regulations approved by OAL include the following changes, among others:
- Extends the time frame to schedule a medical-legal evaluation by an additional 30 days
- Clarifies that the time frame for scheduling an evaluation is for both initial and subsequent evaluations
- Provides flexibility if the parties agree so that an initial evaluation can occur at any office listed with the DWC Medical Director
- Provides for a QME or Agreed Medical Evaluator (AME) to reschedule an evaluation within 60 days of the date of the cancellation unless the parties agree beyond the 60 days
- Provides a mechanism for remote health Medical-Legal evaluations if specific criteria are met
- Provides a definition of remote health evaluations and identification of office location when a remote health evaluation is conducted.
About Remote Health Medical-legal Evaluations
The final text of regulations (available here), defines “remote health medical-legal evaluation”as a remote health evaluation by a QME, AME, or other medical-legal evaluation [that] may be performed through the use of electronic means of creating a virtual meeting between the physician and the injured worker where both parties can visually see and hear each other and may not be in the same physical space or site.
A QME or AME may complete a medical-legal evaluation through remote health when a hands on physical examination is not necessary and all of the following conditions are met:
- There is a medical issue in dispute which involves whether or not the injury is AOE/COE (Arising Out of Employment / Course of Employment), or the physician is asked to address the termination of an injured worker’s indemnity benefit payments or address a dispute regarding work restrictions.
- There is agreement in writing to the remote health evaluation by the injured worker, the carrier or employer, and the QME.
- The remote health evaluation conducted by means of a virtual meeting is consistent with appropriate and ethical medical practices and the AMA Guides 5th edition, as determined by the QME and the relevant medical licensing board.
- The QME attests in writing that the evaluation does not require an in person physical exam.
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