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Friday, January 10, 2020

DWC Director Says Auditor's Recommendations Aren't Guaranteed to Fix QME Process

  • By Tonika Reed
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  3 shares
Division of Workers’ Compensation Administrative Director George Parisotto told California law…

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Danny Thorn Jan 10, 2020 a 4:01 pm PST

The system is broken! Throwing more money at it will not fix it! That includes paying more for the exam. We all know that both sides, defense and applicant, have preferred doctors. What needs to happen is a reform of the exam. Outlining the medical facts, confirming etiology without bias, in either direction. in other words 'a realistic and fair evaluation designed to help the worker get back to work and past the injury.

The system is designed to "disable' the injured worker not help them get back on their feet again.

Gary Nelson Jan 10, 2020 a 5:01 pm PST

When the "stakeholder" insurance companies rewrote the law in 2004 and required the State to insert itself into the QME process, the destruction of efficient discovery had commenced. The process became a complete mess and it has been improved over the years but it is still a disaster. QME's get out of the system because of the ridiculous nature of the process. When each side was able to conduct its own discovery, the process worked quite well. Now we have a system held hostage by the QMEs who require numerous exams and write awful reports in some instances. The reward for writing an incomprehensible report is a deposition fee. Has this reduced litigation? I would say it has increased it by 10 times. Go back to the old system and make it better, then more competent doctors will come back.

Scott Rubel Jan 11, 2020 a 3:01 pm PST

I completely agree with Mr. Nelson. Under the old system each party chose their own QME. The reports would then be submitted to a judge who would decide which was the more well reasoned opinion. This encouraged the participants to select more credible doctors who would conduct AME quality evaluations. If you wanted, you could select a "favored" (read: biased) doctor. But then the other party would prevail having selected a more independent evaluator. This also encouraged parties to utilize AMEs. Parties represented by attorneys should be able to make their own decisions about how to develop the evidence in their case.

Lina Yeung Jan 10, 2020 a 5:01 pm PST

One of the problems is that both sides have certain specialties that they always request--there are probably many QMEs that never end up on a panel because nobody is selecting occupational medicine or general preventive medicine. Every AA wants pain medicine whether it's appropriate or not. Another problem is that both sides are using the PQME process and time limits to doctor shop, causing way more delays than if they just waited 90 or 120 days for a QME on the first panel received. I've been a defense attorney for 20 years and I would not mind if the medical director selected the specialty based on the injury and then just assigned somebody because I'm wasting a lot of time litigating panel issues. The 5-QME panel would also be an improvement, or just go back to applicant and defense QMEs.

Lina Yeung Jan 10, 2020 a 5:01 pm PST

By the way, this is not Lina Yeung--we all use her account!

Victor Bressler Jan 10, 2020 a 11:01 pm PST

HOW TO FIX IT? GO BACK TO THE AME/QME PROCESS IN OPERATION BEFORE 2005.

Ron Perelman Jan 12, 2020 a 12:01 am PST

I am someone who practices in this arena, so I should comment, for what it is worth. About to years ago we escaped persecution, by an overzealous DIR/DWC. The outcome showed that we need a simplified system, with an eval and report simplified charge. There needs to be a record review charge, that anyone can understand. The complexity factors led us to the above situation. We brought this up at the COA meeting almost two years ago. There had been no fee schedule raise, since 2006. But here we are and nothing has been done, and now this article suggests all is fine. We are paid enough, it believes and the complexity factors still exist. But here is the thing. Very few doctors want to be QMEs. It is so nonmedical! Most doctors want to be doctors, not disability evaluators. But payment for treating injured workers is less than desirable, so some physicians chose to be QMEs. Buit guess what? Most of the evaluators are aging. That is a known fact. Just go to the yearly COA meeting and see who shows up. The number of QME test takers is decreasing and the ones who pass, may or may not ever do evals. Yet the DWC thinks all is fine. I think after 14 years, a raise is not too much to ask for. And it shouldn't take 2 years. Suzanne Honor has a reasonable starting proposal, and I think Mr Pasisotto should take it seriously. It is also needed to entice some young doctors to do this kind of work. Otherwise, in a few years, the problem will be bigger. Be smart! Fix it now, no more stalling. Expand to 5 names on the panel, when there is a shortage of doctors? Who comes up with this stuff? Also, get us medical records 2 weeks early, so we can do a good job. If not, let us reschedule the exam..I suggest, the DWC involve QME doctors in formulating all this. I am not sure about these auditor's level of knowledge. However, if the DWC likes, send one to my office to see what it takes to do an eval, review records and prepare a report the parties can use to resolve the case. Enough nonsense!

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