In the complex world of workers’ compensation, one of the critical elements that can significantly impact the outcome of a case is the selection of a Qualified Medical Evaluation (QME) panel. These panels play a pivotal role in determining the extent of an injured worker’s injuries, which in turn can affect the compensation they receive. In this article, I will delve into the importance of selecting an
appropriate QME panel and the nuances of ensuring proper service of the panel upon all parties involved in a workers’ compensation case.
The Significance of a Qualified Medical Evaluation Panel
A Qualified Medical Evaluator (QME) panel is a group of medical professionals certified by the California Division of Workers’ Compensation to assess the medical condition of an injured worker. These evaluations are critical as they help determine the worker’s eligibility for benefits and the extent of their disability. The QME’s findings can profoundly impact the compensation awarded to the injured employee. Choosing the right QME panel is a crucial decision. An appropriately qualified panel can ensure a fair and accurate evaluation, whereas an inadequately chosen panel can lead to biased or inaccurate assessments. What key factors should you consider when deciding what or who is the best QME for you?
Specialization: Look for a QME panel that specializes in the type of injury or medical condition the worker is facing. A specialist’s expertise can provide a more accurate evaluation. Too often we find ourselves arguing over the appropriateness of the specialty. The applicant’s side seems to always want chiropractors or pain management as opposed to orthopedics. Why? They tend to be more liberal and tend to recommend a greater amount of treatment before P&S status.
Impartiality: It’s essential to choose a QME panel known for its impartiality. The panel members should not have any affiliations or biases that could influence their assessment. Your defense attorney can help you determine which particular doctor’s on a panel may have bias towards the defendant.
Experience: Consider the experience of the QME panel. Seasoned professionals often provide more comprehensive and accurate evaluations. As a general rule of thumb, physicians who have been in practice for a longer period of time provide a more comprehensive and balanced assessment of the applicant.
Reputation: Research the reputation of the QME panel in the workers’ compensation community. A panel with a solid track record is more likely to provide reliable assessments. We often find QME’s who are struck almost every time by the applicant side and the defense side. They have a poor reputation in the community as being biased for one side or the other.
Note a common theme in looking at all of these factors. Your Defense attorney can be your best asset in obtaining a favorable panel, or minimizing the negative impact of an unfavorable one.
Complying with the Regulations to ensure proper service
The Labor Code establishes specific timelines that must be followed when requesting a panel of QME’s. Generally, a party must wait at least 10 days after mailing a request for a medical evaluation (plus 5 per the mailbox rule), pursuant to Labor Code §4060 through §4062. Because of the specific timeline, parties will often race to be first to obtain a panel in a specialty they believe will be most favorable to
them.
As of October 1, 2015, pursuant to CCR §30(b)(1)(c), all requests for initial panels must be submitted online. Once obtained, this section also requires a requesting party to do three things after obtaining a panel online: (1) serve the panel list, with a copy of any supporting documentation on the opposing party; (2) include a proof of service; and (3) serve within one working day after generating the QME list.
Recently, in Lopez v. Rockstar Staffing, Inc., 2023 Cal. Wrk. Comp. P.D. LEXIS 199, the Workers’ Compensation Appeals Board held that a panel was invalid because it did not comply with CCR §30(b)(1)(C). In Lopez, the defendant had requested a panel on January 9, 2023, but failed to serve the panel until January 13, 2023, and also did not serve any of the supporting documentation. The Lopez case is a change in the Board’s prior stance to not invalidate panels in cases where defendants are not prejudiced by an applicant’s failure to strictly comply with 8 CCR §30(b). As such, parties should now cite Lopez when challenging the validity of panels when there’s a failure to comply with the rules.
Conclusion
Selecting a Qualified Medical Evaluation (QME) panel is a decision that should not be taken lightly. The right panel can ensure a fair and accurate assessment of an injured worker’s condition, while the wrong one may lead to a biased or inaccurate evaluation. Furthermore, ensuring proper service of the QME panel’s report is crucial for the timely resolution of workers’ compensation cases.
At Siegel, Moreno & Stettler APC, we understand the complexities of the workers’ compensation system, and we guide our clients through the entire process, from selecting the right QME panel to ensuring proper service of their reports. Reach out to us with any questions you may have so we can get you the best panel possible.
