The California Division of Workers’ Compensation (DWC) recently announced that the proposed Qualified Medical Evaluator (QME) Emergency Regulation found in California Code of Regulations Section 46.3 became effective on January 18, 2022 and will expire on July 19, 2022.

The DWC adopted CCR §46.3 to allow physicians to perform Medical-Legal evaluations remotely via telehealth. CCR §46.3 was adopted in response to the continued COVID-19 pandemic.

The DWC also announced that the regulation may be extended in accordance with Government Code §11346.1(h) for up to a total of 180 additional days.

Med-Legal Telehealth Under CCR §46.3

A physician may perform a Medical-Legal evaluation via telehealth. For medical-legal evaluations performed via telehealth, the physician must use an approved electronic means of creating a virtual meeting between the physician and the injured worker.

The emergency regulation mandates that the telehealth evaluation must utilize:

1. video-conferencing,
2. video-calling, or
3. such similar technology that allows each party to see and converse with the other via video and audio connection.

Per the emergency regulation, a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) may complete a Medical-Legal evaluation through telehealth when a hands-on physical examination is not necessary.

For a telehealth evaluation, the emergency regulations demand that all of the following additional conditions are true:

• There is a medical issue in dispute which involves whether or not the injury is AOE/COE (Arising Out of Employment / Course of Employment), or the physician is asked to address the termination of an injured worker’s indemnity benefit payments or address a dispute regarding work restrictions.
• There is agreement in writing to the telehealth evaluation by the injured worker, the carrier or employer, and the QME. Agreement to the telehealth evaluation cannot be unreasonably denied. If a party to the action believes that agreement to the telehealth evaluation has been unreasonably denied under this section, they may file an objection with the Worker’s Compensation Appeals Board, along with a Declaration of Readiness to Proceed to set the matter for a hearing.
• The telehealth evaluation is conducted by means of a virtual meeting consistent with appropriate and ethical medical practices, as determined by the QME and the relevant medical licensing board.
• The QME attests in writing that the evaluation does not require an in person physical exam.

Physicians can find the full text of emergency regulation CCR §46.3 here. We encourage physicians who wish to perform a Medical-Legal evaluation via telehealth to review the regulation in its entirety.

As always, we do our best to publish recent developments that are relevant to our clients and readers. That said, we encourage everyone to sign up for Newslines to receive the latest updates directly from the DWC.

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