Report 2019-102 Recommendation 8 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 #8 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, create written policies and implement a consistent process for ensuring that workers' compensation judges and the Appeals Board inform DWC of QME reports they rejected for not meeting minimum standards.

6-Month Agency Response

DWC 180-Day Status on the Recommendation: Completed.

DWC provided the workers' compensation judges with a form Order to ensure that both the QME and the DWC are served with any judicial findings rejecting a medical-legal report. If the DWC cannot determine if the QME was served with the order, the DWC has prepared a form letter to send to the QME. See the following:

Exhibit H: Order Rejecting Medical Report (section 139.2(d)(2)) form for Judges

Exhibit I: Memorandum to Judges Re Protocol for Use of section 139.2(d)(2)

Order form

Exhibit J: DWC Policy for Tracking Reports Rejected by a Judge

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

DWC provided written policies to ensure that workers' compensation judges and the Appeals Board inform DWC of QME reports they rejected for not meeting minimum standards. DWC also provided an example of a notification of a rejected report using the new process. To the extent that judges follow this process, the department will have implemented the recommendation.

60-Day Agency Response

The DWC provided the workers' compensation judges with a form Order to ensure that both the QME and the DWC are served with any judicial finding rejecting a medical-legal report. If the DWC cannot determine if the QME was served with the order, the DWC has prepared a form letter to send to the QME. The DWC is tracking rejected reports. (Exhibit F.)

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

Although DWC provided copies of documents for judges to use when rejecting QME reports, it did not provide evidence that it established and implemented policies. DWC provided a template order that judges could use to notify DWC of a QME's rejected report. DWC also provided a template letter that it can use to notify the QME that a judge rejected their report and that if a QME has more than five evaluations rejected, DWC may deny the QME's reappointment. However, DWC still needs to create and implement written policies--as we recommended--to ensure that judges and DWC staff use the templates consistently.

All Recommendations in 2019-102

Agency responses received are posted verbatim.