Report 2019-102 Recommendation 7 Responses

Report 2019-102: Department of Industrial Relations: Its Failure to Adequately Administer the Qualified Medical Evaluator Process May Delay Injured Workers' Access to Benefits (Release Date: November 2019)

Recommendation #7 To: Industrial Relations, Department of

To ensure that DWC monitors and reviews QME report quality and timeliness and to ensure the efficient resolution of workers' compensation claims, DWC should, by April 2020, develop and implement a process for annually reporting to DWC's administrative director its findings on the quality and timeliness of QME reports and recommended improvements to the QME system.

1-Year Agency Response

The written plan for reviewing continuously the quality and timeliness of QME reports, as described in Recommendation # 6, includes an annual reporting requirement to the DWC administrative director. (See Exh. M.)

The medical-legal report quality committees will produce a summary of report quality four times a year. These reports will be provided to the QME Discipline Unit after each quarterly committee meeting. The QME Discipline Unit will review and prepare a memorandum within 30 days following each quarterly meeting and the QME Discipline attorneys will finalize the committee memorandum for inclusion in the report to the Executive Medical Director.

By December 15th of each year, the QME Discipline attorneys will prepare a memorandum on QME report quality, the tally of QME reports rejected by workers' compensation judges, and QME report timeliness for review by the Executive Medical Director. The Executive Medical Director will review the memorandum and have available for his/her review all the reports that the QME Discipline attorneys reviewed in preparation of the memorandum. Upon completion of the review and editing, the Executive Medical Director will submit a final summary as part of the annual report, to the Administrative Director by the end of each year.

Please see the full response submitted to the State Auditor on November 18, 2024 for complete details.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

DWC provided an internal process for reviewing the quality and timeliness of medical-legal reports, which includes reporting on findings to the administrative director annually. To the extent that DWC follows through with annually reporting its findings to DWC's administrative director, it will implement our recommendation.

6-Month Agency Response

DWC 180-Day Status on the Recommendation: Completed with partial implementation in 2020 and full implementation in 2021.

Each year by November 15th, the QME Discipline attorneys will receive a report regarding the timeliness of medical-legal reporting. The attorneys will review the report and based on that review, a memorandum will be prepared outlining what, if any, recommended changes are needed.

The medical-legal report quality committee will produce a summary of report quality four times a year. These reports will be provided to the QME Discipline team after each quarterly committee meeting. The QME Discipline team will review and prepare a memorandum within 30 days following each quarterly meeting and provide it to the QME Discipline attorneys.

By December 20th of each year, the QME Discipline attorneys will prepare a memorandum on report quality and timeliness for review by the Medical Director. The Medical Director will review the memorandum, and have available for his review all the reports that the QME Discipline attorneys reviewed in preparation of the memorandum. Upon completion of the review and editing, the Medical Director will submit a final summary to the Administrative Director by January 15th of each year.

Annually, the DWC will post on its website recommended QME continuing education courses based on the findings of these report quality and timeliness reviews. The, DWC is also working to amend title 8 California Code of Regulation section 55 to include additional educational requirements as agreed to in various stakeholder meetings. See Exhibit G. However, this proposed regulatory amendment is currently pending while DWC assesses options for holding public hearings.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

In conjunction with its efforts to develop a plan for evaluating the quality of QME reporting, the DWC is also formulating a process for annual reporting of its findings.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2019-102

Agency responses received are posted verbatim.