On January 18, 2022, the California Division of Workers’ Compensation (DWC) announced that updated COVID-19 related emergency regulations for Qualified Medical Evaluations (QMEs) are taking effect. The latest round of emergency regulations are set to last until July 19, 2022—with two separate 90-day extensions possible if deemed necessary. In this article, our Fresno workers’ compensation defense lawyers provide an overview of the latest emergency regulations promulgated by the California DWC.

California Put Temporary QME Regulations in Place for the COVID-19 Pandemic

Injured workers are entitled to benefits through a workers’ compensation claim. In some cases, there are disputes regarding the extent and severity of an individual’s injury. The California Qualified Medical Evaluation (QME) process allows an independent doctor to conduct an assessment.

Given the public health threat posed by COVID-19, California regulators put temporary rules in place that dramatically expanded the use of telemedicine (telehealth) for QMEs. While in-person exams are still happening in California—and are required for certain types of injuries and illnesses—many examinations are being conducted largely through telemedicine.

DWC Extends QME Regulations for Another Six Months (With a Few Changes)

The QME telehealth regulations have always been designed to be a temporary provision. However, the COVID-19 virus has remained a persistent public health threat. As a result, the temporary emergency regulations have been extended several times. That being said, the latest extension (starting January 18, 2022) is a little bit different. The California DWC includes a few relatively modest changes. Currently, a virtual QME is appropriate if the following conditions are met:

  • Dispute: QMEs are used to resolve underlying medical disputes that are relevant to a workers’ compensation claim. A QME is appropriate if there is some form of issue that needs to be resolved by a neutral third party.
  • Agreement: Both parties—the injured worker and the employer, administrator, or insurer—must agree that a telehealth QME is appropriate. If either party refuses to consent to a telehealth QME, that is considered grounds for proceeding with the case. 
  • Doctor Certification: Finally, the doctor in question (the QME) must certify that a telemedicine evaluation is medically appropriate given the nature and scope of the injury or illness. Not all medical issues can be evaluated through a virtual appointment.  

As currently drafted by the California DWC, the emergency telehealth QME regulations will last for six months, until July 19, 2022. Under the current authority, the DWC can issue two additional 90-day extensions of the current rule if emergency circumstances persist. The DWC could also promulgate separate emergency regulations if the public health needs change.

Call Our Fresno, CA Workers’ Compensation Defense Attorneys for Legal Help

At Yrulegui & Roberts, our California workers’ compensation defense law firm is committed to providing solutions-based representation to clients. If you have any questions about the state’s temporary QME COVID-19 regulations, we are here to provide guidance. Contact us today for your confidential initial case review. We have office locations in Fresno, Sacramento, and Bakersfield.