Report 2019-102 Recommendation 9 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 #9 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 process for tracking QME reports rejected by workers' compensation judges and the Appeals Board for not meeting minimum standards. DWC should consider and include these reports in its annual review of report quality and recommend improvements to the QME system.

1-Year Agency Response

Dear Ms. Howle:

The Labor and Workforce Development Agency has authorized me to provide the requested three hundred and sixty-five day status on the implementation of the State Auditor's recommendations regarding the Department of Industrial Relations' administration of the Qualified Medical Evaluator (QME) program (Report 2019-102), which is administered by the Department's Division of Workers' Compensation (DWC).

The DWC previously submitted a 180-day report on the progress made in implementing the audit recommendations. The one-year progress report details the efforts of the DWC towards that goal since the submission of the 180-day report. Efforts previously documented in the 180-day report will not be repeated here.

The one-year progress report will be uploaded to the website pursuant to your direction. However, this email version is being forwarded to facilitate the submission of exhibits that are essential to evidence compliance.

The DWC has worked diligently to implement fully the audit recommendations that were outstanding as of the 180-day report. Please find below updated responses showing that the status on each of those recommendations is completed.

Please see complete response sent via email and mail

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

DWC provided a policy for tracking rejected QME reports, including providing the total number of requested reports in a calendar year in its annual review of report quality and suggested recommendations to improve the QME system. To the extent that DWC follows its policy, it will implement our recommendation.

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: Partially Implemented

DWC provided a policy for tracking rejected QME reports. However, it has not included in the policy that it will consider including these reports in its annual review of report quality and recommend improvements to the QME system.

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 worksheets for tracking rejected QME reports, it did not provide evidence that it established and implemented written policies. DWC provided its tracking sheet for rejected reports. However, DWC still needs to create and implement written policies--as we recommended--for tracking QME reports rejected by worker's compensation judges and the Appeals Board for not meeting minimum standards. DWC should also consider and include these reports in its annual review of report quality and recommend improvements to the QME system.

All Recommendations in 2019-102

Agency responses received are posted verbatim.