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Posted on: Nov 25, 2019

The California State Auditor released a report last week exposing the failures in the administration of the Qualified Medical Evaluator (QME) process by the Division of Workers' Compensation (DWC) and the harmful impact this negligence has had on the health of injured workers and increased delays.

This problem has been escalating for years, and while we hope the new audit will help spur some renewed focus on addressing these issues, the report only amounts to the tip of the iceberg.

The audit rightfully characterizes the decline in QMEs in correlation to the increase in requests for their services as a problem, but what is actually going on with the QME process is much worse than what is reflected in the report. While it is true the gross number of QMEs currently available to provide medical evaluations to injured workers is woefully inadequate, solely increasing numbers will not address the significant problem of the lack of much-needed medical specialists on the QME list and their geographic availability.

The report states, "...from fiscal year 2013-14 to fiscal year 2017-18, the number of QMEs in otolaryngology (head and neck surgeons) decreased by 32 percent-from 38 to 26 QMEs-while the number of requests in this specialty increased significantly, from 914 to 1,484-a 62 percent increase. Further, although the number of physical medicine and rehabilitation specialist QMEs decreased by 21 over this time period, from 132 to 111, the number of panel requests more than doubled from 3,810 to 7,939."

However, these numbers don't tell the story of injured workers who often have to travel hundreds of miles to be seen by a QME specialist as there are none available on the list in their area, or who can't even find a specialist to evaluate some of the more catastrophic injuries a worker could face. For instance, there are only three oncologist QMEs on the list in the state of California to review cancer cases, and a minimum of five are required for a list to issue. Neuropsychologists tasked with evaluating traumatic brain injuries have been removed from the QME list entirely.

The unavailability of QMEs often exacerbates the condition of the worker, leading to further complications and additional medical needs from delays.

As the audit correctly surmises, delays have real costs for both the employer and the injured worker. But while employers get hit with the cost of having a worker out on medical leave, injured workers are often left in financial ruin and on the verge of homelessness.

A third of middle-income Americans don't have the ability to cover a $400 emergency, 4 in 10 California households spend more than 30 percent of their income on housing, and 1 in 5 spend more than 50 percent. Another telling fact: over 40 percent of people experiencing chronic homelessness have some form of physical disability.

Workers' compensation has been enshrined in California's constitution for over 100 years, but the system has been failing workers as of late.

We hope this audit will help in moving efforts forward to mandate oversight of the Administrative Director's administration of the QME process and better protect injured workers to help them avoid financial ruin as a result of delays in the system.