Back to Columns | Print Column

State: Calif. Successfully Obtaining A Replacement QME Panel: [2010-07-23]

By Laura Mendivel Grancell, Lebovitz, Stander, Reubens and Thomas The need to replace a physician on a Panel Qualified Medical Evaluator (PQME) list is occurring more and more frequently.  A replacement panel involves the replacement of at least one and possibly three qualified evaluators (as distinguished from a second panel, which involves an entirely new list of qualified evaluators).    Title 8, CCR section 31.5 sets forth the legal criteria for requesting a replacement of one or all of the names on a panel, although this section distinguishes between the represented and unrepresented employee. For unrepresented employees, a replacement QME on a panel is required to be issued if any one of the following conditions exist:  A QME on the panel issued does not practice in the specialty requested by the employee;  A QME on the panel issued cannot schedule an examination of the employee within 60 days of the employee’s request;  The employee has changed his/her residence address in the geographic area in which the panel was requested;  A physician on the QME panel issued is a member of the same group practice (as defined by Labor Code section 139.3) as another QME on the panel; or, The QME is unavailable pursuant to Title 8, CCR section 33. CCR section 31.5(b) et. seq. notes that either party may request a replacement QME if any of the following conditions occur:  The employee’s primary treating physician (as set forth in CCR section 9785) is on the panel;  The claims administrator (or if none, the employer) and the employee agree to the issuance of a new panel in the geographic area of the employee’s workplace;  The Medical Director, upon written request, finds good cause that a replacement QME is appropriate for reasons related to the medical nature of the injury (for purposes of this condition, “good cause” is defined as documented medical or psychological impairment); or,  The Medical Director (again upon written request) determines, after a review of all appropriate medical records, that the specialty chosen by the injured worker is medically or otherwise inappropriate for the injury to be evaluated. Additionally, either party may request a replacement QME for any violation of 8 CCR section 34. Section 34(a) requires that when an unrepresented employee makes the appointment with the QME, the QME shall complete an appointment notification form by submitting the form in section 110. The completed form must be postmarked or faxed to the employee and the claims administrator (or if none, the employer) within five working days from the date the appointment was made. In fact, violation of this section constitutes grounds for denying the particular physician’s reappointment as a PQME!    Section 34(b) requires the PQME to conduct the evaluation only at the medical office listed on the panel selection form.   Section 34(c) requires the PQME to note within the appointment notification whether a Certified Interpreter is required and if so, the PQME must specify the language. Note, however, that this subsection requires that the party who is to pay the costs of the interpreter (i.e., defendant in almost all scenarios) must make the actual arrangements for the interpreter to be present at the evaluation.   Assuming that a replacement PQME is available upon any of the forgoing conditions, the Medical Unit will issue the replacement without the need to request an order form the WCAB. Pursuant to 8 CCR section 31.5(c), any such replacement QME shall be selected at random.  Laura Mendivel is an attorney in the Orange office of Grancell, Lebovitz, Reubens and Thomas. This column was reprinted with permission from the firm's client newsletter.