…..According to the much anticipated report of Auditor Elaine Howle on the Division of Workers’ Compensation’s (DWC) mishandling of the California Workers’ Compensation system, the DWC failed, in several different ways, to entice and maintain a healthy number of qualified medical evaluators (QME’s) needed in order to analyze comp claims – thereby impairing workers’ ability to exercise their right to receive proper evaluations and treatments from workplace injuries. Moreover, Howle indicated that the DWC manipulated the QME reappointment process in order to hit back at medical evaluators that were merely alleged to have violated certain billing policies, instead of relying on due process. The report goes on to state that the DWC also failed to monitor and ensure the quality of QME reports since 2007 – causing difficulties and delays in treatment, dispute resolution, among other things.
…..Howle wrote in a public letter to the Governor & Legislature, “although DWC is responsible for overseeing QME’s and the selection process, it has not adequately ensured that it has enough QME’s to keep up with demand for their services.”
…..She added that “without an adequate number of available QME’s, injured workers can experience delays in receiving evaluations and therefore delays in receiving the benefits they need.”
…..The report mentions that the main goal of the DWC should be to increase the number of QME’s actively participating in medical evaluations, specifically targeting areas with the greatest shortages. Furthermore, they must also make reviewing QME reports a constant activity in order to decrease the likelihood of problems detrimental to the workers’ compensation system. Finally, the Division needs to develop proper procedures and policies that aim to structure QME reappointments and penalties. Howle also recommended that the Legislature have the DWC review and update the Medical-Legal Fee Schedule every other year in order to adjust for inflation – something the Division failed to do which caused doctors to lose interest in providing medical evaluation services.
While the DWC respectfully received the recommendations of Auditor Howle, they also disputed some of her findings – mainly the notion that they have ignored the decreasing numbers of QME’s. They insist that there are enough QME’s to successfully meet the demand for medical-legal services and that increasing payments to QME’s may not help to attract more QME’s, pointing out that an increase of 25% back in 2006 failed to slow the decline of QME’s.
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