The Division of Workers’ Compensation (DWC) announced the release of a comprehensive RAND research report evaluating the effectiveness and long-term sustainability of California’s workers’ compensation Medical-Legal process. The study, conducted by RAND and funded by the California Department of Industrial Relations (DIR), provides a data-driven assessment of the Qualified Medical Evaluator (QME) system and its critical role in resolving workers’ compensation disputes.
A 2019 State audit of the QME system produced several recommendations aimed at increasing the availability of Medical-Legal evaluators within California’s workers’ compensation system. In 2024, DWC adopted regulations intended to improve the functioning of the QME process.
This RAND study was commissioned to assess whether the current Medical-Legal process continues to fulfill its original legislative intent and remains sustainable in its current form. The research examined several key questions, including ten high level questions:
1. Is there a mismatch between the supply and demand of QMEs across specialties and geographic areas?
2. What is the best way to recruit and retain QMEs?
3. How have recent changes to the QME reimbursement structure impacted overall costs to the workers’ compensation system, and should additional changes be considered?
4. What have been the impacts of structural changes to QME selection, and should additional changes be considered?
5. How can medical record delivery to QMEs be improved?
6. How has the quality of Med-Legal reports changed since 2012, and what is the best way to ensure the quality of QME reports?
7. Are the time frames built into the QME process appropriate and being met?
8. Are remote telehealth/remote health evaluations being used appropriately, and should any changes regulating their use be considered?
9. How have litigation practices in the Med-Legal system changed since 2012?
10. What role have medical management companies (MMCs) played in the Med-Legal process?
The findings are expected to help inform future rulemaking efforts aimed at improving the Medical-Legal evaluation system. Some examples of the findings contained in the 172 page report include:
The RAND report stated “[O]ur first high-level recommendation is to increase the number of QMEs with office locations in rural areas and in underrepresented specialties.”
It went on to say “we noted substantial increases in the number of follow-up reports and depositions from 2020 to 2021. A follow-up report or deposition generally means that the QME report did not address all of the Med-Legal questions in a case. This could sometimes, but not always, arise from an issue with report quality.”
And on the topic of medical management companies the report stated “MMCs can be a valuable resource to the Med-Legal system, performing key administrative functions that allow QMEs to maintain multiple offices. This, in turn, allows IWs to receive QME evaluations closer to their home. Some MMCs also provide mentorship and report review, which, if done well, could contribute to improved quality of reports. MMCs also may help recruit new QMEs.”
RAND has posted its report, Qualified Medical Evaluators and the Medical-Legal Process in California Workers’ Compensation, on its website.