As described by the California Department of Industrial Relations (DIR), Qualified Medical Evaluators (QMEs) are trained physicians who have been certified by our state’s Division of Workers’ Compensation to examine and evaluate injured workers. In general, QMEs are brought in to resolve outstanding questions about the nature/severity of an employee’s injury.
All parties to a workers’ compensation claim must follow strict rules and regulations when communicating with a Qualified Medical Evaluator. Communications are subject to the requirements of California Labor Code Section 4062.3. Here, our Fresno workers’ compensation defense attorneys highlight the key things that insurers, claims administrators, and employers should know about California’s Labor Code Section 4062.3.
California Labor Code Section 4062.3: Strict Timeliness Requirement
A Qualified Medical Evaluator needs information to make an assessment. Both parties—a worker and insurer/administrator/employer handling the claim—have a right to submit relevant information to the QME. However, there are strict timeline requirements for submitting such information.
Under California Labor Code Section 4062.3(b), the information that either party wants to provide to the Qualified Medical Evaluator should be “served on the opposing party 20 days before the information is provided to the evaluator.” After service, the opposing party has 10 days to object to the proposed information. If the opposing party fails to object in time, then the information in question can be assessed and reviewed by the QME.
Additionally, under Labor Code Section 4062.3(e), communications with a QME before an evaluation occurs must be “served on the opposing party 20 days in advance of the evaluation.” Once the medical evaluation has already taken place, then any subsequent communication with the QME should be served to the opposing party concurrently.
Know the Difference Between Information and Communication Under Labor Code Section 4062.3
Under California Labor Code Section 4062.3, the terms ‘information’ and ‘communication’ have distinct definitions. The term information includes substantial medical and non-medical documents, records, and reports. Among other things, information includes:
- The records prepared and maintained by employee’s treating physician or physicians, and
- The medical and non-medical records that are relevant to the evaluation.
Labor Code Section 4062.3 defines information as substantive to the Qualified Medical Evaluation itself. In contrast, the term communication covers things that are not directly substantive to the QME medical assessment. For example, a communication may include things like the scheduling of an appointment and the availability of certain records.
Why it Matters: Labor Code Section 4062.3 requires that substantive information must be served to the opposing party before being sent to the QME. Non-substantive communication only needs to be served to the other party at the same time it is being sent to the QME.
Schedule a Confidential Consultation With Our Workers’ Compensation Defense Attorneys
At Yrulegui & Roberts, our Fresno workers’ compensation lawyers are effective, and reliable advocates for our clients. If you have any questions or concerns about Labor Code Section 4062.3, we are more than ready to help. Contact us today for a strictly confidential, no commitment consultation. We provide workers’ compensation defense legal services throughout the entire region, including in Fresno, Sacramento, Elk Grove, Modesto. San Luis Obispo, Santa Maria, Clovis, Hanford, Mariposa, and San Andreas.
