Sending Out an SOS
The California Division of Workers' Compensation back in May issued
an announcement ("Newsline") in which the division acknowledged that delays have returned in assigning QME panels. The DWC vowed to identify and correct them. The early blame points to lack a staffing at the Medical Unit.
The wait for a panel of three physicians to evaluate an injured work was five months in April, according to an email the DWC sent our Sacramento-based reporter, Greg Jones.
"Division spokeswoman Erika Monterroza said the Medical Unit was issuing panels within 30 days until July 2012, but is now about five months behind in processing requests," Greg wrote April 29 in a WorkCompCentral story.“The subsequent delay in issuance of panels occurred after overtime and student assistant work was no longer available,” she explained. “The current backlog for represented cases is back to the end of November 2012.”
In talking with people in the legal system, I've been told there are not enough QMEs to assign. Could that be slowing down the panel process, too? Wouldn't recruiting more doctors to become QMEs be a reasonable place to start?
There are between 3,000 and 4,000 QMEs across the spectrum of medical specialties. The exact number is probably somewhere in the middle. Unrepresented injured workers are getting their panel QMEs more quickly than do represented claimants, the DWC admits. Attorneys are frustrated and judges are empathetic. Neither has the authority to intervene.
Even though the majority of California's population live in metro areas, the state is expansive. Our state extends 350 miles from east to west, and stretches 780 miles from the Oregon border to Mexico. Alpine County is the smallest in terms of population (1,208 residents), yet it covers 738 square miles. Sierra County has 3,555 people scattered over 953 square miles of land. Modoc has 9,449 people in a county of nearly 4,000 square miles.
The rural areas are always in need of more QMEs, especially physicians who specialize in orthopedics, internal medicine and neurology. However, the metro areas could use more QME panelists, too.
Getting back to the question, "Would having more QMEs speed the process," there is a way to find out. If more medical treaters applied to become QMEs, we'd have an answer.
Getting back to the question, "Would having more QMEs speed the process," there is a way to find out. If more medical treaters applied to become QMEs, we'd have an answer.
Long story short. There is a QME state-administered exam Oct. 19. This is an opportunity for medical treaters who want to expand their practices to disability evaluation of California injured workers. The test is being administered once in 2013; there is time to apply and prepare.
The fee schedule and rules for QME evaluations are straightforward. Getting paid should be, too.
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| Calling all qualified treaters in workers' comp. |
If becoming a QME is something that interests you, great. The system would benefit from having more physicians on QME Panels. Follow these steps if you decide to answer the call for more evaluators.
Timeline
1. ASAP - Download the application to become a QME
2. By Sept. 12: Postmark application to qualify for the exam.
3. Wait for the DWC to confirm you are eligible.
4. Pay the $125 fee.
4. Pay the $125 fee.
5. Start studying for the Oct. 19 exam. DWC will email study guides.
6. Consider taking a pre-exam study course. WorkCompCentral offers two next month.
6. Consider taking a pre-exam study course. WorkCompCentral offers two next month.
7. Oct. 19 - sit for the exam at Northern and Southern California locations.
Call (510) 286-3700 or e-mail QMETest@dir.ca.gov for further assistance.
A Credit to California Physicians
WorkCompCentral will begin offering Continuing Medical Education coursework to California physicians through a newly struck partnership with the American Academy of Disability Evaluating Physicians.
AADEP's alliance with WorkCompCentral will allow physicians and QMEs who enroll and complete the disability-evaluation courses to receive both QME and CME credit for selected seminars, webinars or online courses. The American Academy of Disability Evaluating Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
A series of monthly webinars from WorkCompCentral in conjunction with AADEP will debut on Sept. 17. "The Physicians’ Assessment Tool Series"will begin with Dr. Mark Hyman, president of the American Academy of Disability Evaluating Physicians, discussing:
Part I: “Activities of Daily Living (ADL) Questionnaires"
Part II: “Pain Questionnaires” on Oct. 15.
Start times: 4:15 p.m. Pacific Time.
The cost to attend is $69 for a single session, $109 for both. Register by calling the WorkCompCentral Education office, 805-484-0333, ext. 121.
The American Academy of Disability Evaluating Physicians is accredited by the ACCME to provide 2.0 AMA PRA Category 1 credits™ for the two-part webinar series, hosted by Dr. Hyman.
WorkCompCentral is an approved provider of continuing education for Qualified Medical Evaluators through the California Division of Workers' Compensation.
AADEP is a society dedicated to serving physicians involved in disability management. Its activities include ongoing teaching of the management of disabled patients, impairment and disability evaluation to physicians and other health care providers, and educating attorneys, regulators, legislators and others involved in the care of the disabled. AADEP also coordinates research in disability management.
Pot Law's Impact on Illinois Employers
The medical marijuana law signed Aug. 1 by Gov. Pat Quinn will have a relatively small impact on the daily operations of employers, despite some new protections for medical users, employment and workers' compensation defense attorneys say.
Attorneys told WorkCompCentral that employers have been calling for advice on whether they will have to tolerate stoned employees or allow workers to smoke in the workplace because of the "Compassionate Use of Medical Cannabis Pilot Program Act. "
First of all, we are telling them, 'Do not panic,'" said Caryl Flannery, a partner with the Smith Amundsen law firm's St. Louis office. "There are a lot of protections for employers in this law. On a day-to-day basis, probably not much will change for most employers. "
The crux of the law says that you cannot refuse to hire, terminate or take punitive action against a user based on their status," Flannery said. "So you cannot say, 'You are a medical marijuana user, I am not going to hire you.'"
Businesses, such as trucking companies, that are subject to federal transportation regulations, are concerned about whether the law will conflict with federal licensing provisions. Flannery said that employers who are required to follow federal law may continue to maintain drug-free workplaces, because marijuana is still a Class 1 drug under federal law. She said that reasoning should apply to businesses who are subject to federal licensing provisions, employers who are directly regulated by the federal government and companies that must follow federal guidelines to fulfill federal contracts.
Editor's note: Read the full article at WorkCompCentral.com. A subscription it required to access the news content.
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| Bethany Hamilton, pro surfer |
'Soul Surfer' to Keynote Dana Point Conference Oct. 2-4
Professional surfer Bethany Hamilton, who was the inspiration for the biography and movie "Soul Surfer," is a keynote speaker at the 2013 California Workers' Compensation & Risk Conference in Dana Point, Calif.
Her motivational presentation, sponsored by Sedgwick, is part of the three-day conference of 95 expert speakers and leaders from the California workers' comp system. The conference runs Oct. 2-4 at the St. Regis Hotel in Dana Point. There also will be networking events, including a Monte Carlo Night, and an autograph session with Bethany Hamilton, whose left arm was bitten by a shark.
The opening keynote session will focus on the California reforms for 2013 and include a cross-section of voices and perspectives. The moderator for this discussion is Mark Walls, who started the Work' Comp Analysis Group on LinkedIn, which is the largest social-network group of its kind for the workers' comp industry. The voices on the panel are:
Opening Keynote Session: "SB 863 – 10 months later, what works and what doesn’t" (Employers and Stakeholders)
* Max Koonce, Sr. Director, Risk Management (Wal-Mart)
* Mark Webb, Vice President & General Counsel (Pacific Compensation Insurance Company)
* Martin Brady, Executive director (Schools Insurance Authority)
* Steve Cattolica, Director of Government Relations for the California Society of Industrial Medicine and Surgery (
* Richard (Jake) Jacobsmeyer, Esq., (Shaw, Jacobsmeyer, Crain& Claffey PC)
* Robert G Rassp, Esq.(Author, "Lawyer's Guide to the AMA Guides and CA Workers' Compensation 2013 Lexis Nexis Matthew Bender & Co.), (Chairman of the Board of Directors, Friends Research Institute, Baltimore MD)
A second keynote session about SB 863 involves Christine Baker, the director of the Department of Industrial Relations and senior management and industry leaders.
- Keynote Session: "SB 863… 10 months later…. Update from the Director of the Department of Industrial Relations" presented by DIR Director Christine Baker.
- CEOs & Stakeholders “Open Mic” Q & A Panel: This session will feature E- and C-suite leaders, senior management and industry stakeholders from top TPAs and carriers identifying emerging trends that are of great importance to employers in California. David North (Sedgwick), Robert Darby (Berkshire Hathaway Homestate Companies), Rich Friesenhahn (AIG), Barbara Luck (XL Group) and Kevin Finn (The Hartford) & Pamela Ferrandino, National Casualty Practice Leader, Placement (Willis North America) are invited panelists.
Twenty continuing education credit hours are available for California claims professionals, attorneys and insurance brokers.
A charity golf tournament is scheduled for Oct. 1. Email Kristi Hanson at kristihanson@cwcriskconference.org to register for the tournament. Conference and hotel pricing are available at www.cwcriskconference.org.
AMA Redefines Obesity, and Ups the Ante
Have you heard about this one yet? The American Medical Association decided to reclassify obesity as a “disease” rather than a “condition." A just-released study predicts the change could be costly for employers.The California Workers’ Compensation Institute reports that historically obesity has been a comorbidity issue that’s largely gone unreported because it had not interfered with treatment for most injuries.
“The result could be an increasing number of claims that include obesity as a comorbidity, as well as an increase in cases in which obesity is claimed as a compensable consequence of injury in the same way that sleep disorders, sexual dysfunction and psychological disorders became commonplace prior to the passage of SB 863,”
CWCI President Alex Swedlow, who coauthored the research paper, said for the majority of injuries, such as minor wounds or abrasions, it doesn’t matter whether or not a worker is obese. It can be an issue with more significant injuries such as damage to the joints or spine.
“Obesity is a comorbidity issue and doesn’t happen very often,” Swedlow said. “Now, what’s happened, is they’ve essentially medicalized about one-third of the workforce and it raises the specter of the issue of obesity and creates a question mark as to whether or not this will influence the likelihood of obesity as a compensable consequence or as a primary injury.”
Although rarely a complicating issue in workers’ compensation claims, CWCI has identified obesity as one of the top 10 cost drivers for the past three years. Swedlow said in the few cases in which obesity is an issue, “it really contributes to adverse development.”
According to the research paper, a review of more than 1 million claims from accident years 2005 through 2010 found obesity was a comorbidity in just 5,597 cases, or 0.5% of the sample size. About 24% of all obesity comorbidity claims are for back problems without spinal cord involvement – typically sprains and strains – and 10% are for degenerative, infective and metabolic joint disorders. Of the claims without an obesity comorbidity, only 14% are for nonspecific back injuries and 2.5% are for joint disorders.
Additionally, claims with obesity comorbidities are 4.5 times more likely to involve an attorney and 3.7 times more likely to have a prescription for opioids. All told, average total benefits for claims with obesity comorbidities are 81.3% higher than for claims without an obesity comorbidity.
Making News in August
TX: High Court Denies Review to Impairment-Rating Dispute
FL: Investigators Arrest 5 in Staffing Company Probe
NC: Calls Growing for McCrory to Veto Regulatory Reform Bill
CA: Whistleblowers Allege Massive Spinal Fusion Scheme
NY: Counties Say Schedule Loss Awards an Emerging Cost Drive
PA: Lawmaker Seeking Mandatory Use of Coordinated Care Networks
PA: Insurers Predicting 1,500 Fire Departments Will Migrate to SWIF
NY: SWCB Taps Deloitte for Major Systems Overhaul
FL: Repackaged Drug Deal Struck in Legislative Hallway
Nation: Obamacare Top Issue at WCI Conference in Orlando
NJ: Labor Officials Revamp PEO Regs
News articles mentioned in our newsletter are available for subscribers or single purchase at workcompcentral.com
Regulations Catch Interpreters Off Guard
The California DWC has permanent regulations regarding the standards interpreters must meet for legal proceedings and medical exams. The new rules took effect earlier than expected on Aug. 13.
The new regulations state that:
* Interpreters must be certified in order to be paid for services provided during a legal proceeding or a medical appointment.
*. Interpreters for medical appointments must qualify for certification by passing an exam administered by either the Certification Commission for Healthcare Interpreters or the National Board of Certification for Medical Interpreters.
* Interpreters can also be provisionally certified, indicating they are qualified to provide services when a certified interpreter is not available.
The regulations are posted at the DWC web site.
Events in Your Area
-- The California Self-Insurers Association will hold its Fall Educational Conference on Sept. 20 at the Marriott Hotel in Walnut Creek, Calif.
- The California Workers' Compensation & Risk Conference, Dana Point, Oct. 2-4. Charity golf tournament, 20 CEs, exhibitors, nightly networking events.
-- The Illinois Self-Insurers Association's annual workers' compensation seminar is being held on Oct. 3-4 at the Lincolnshire Marriott Resort at 10 Marriott Drive in Lincolnshire, Ill.
-- The Minnesota Department of Labor & Industry is accepting registrations for its 2013 Workers' Compensation Summit, to be held Sept. 12 at the Crowne Plaza Hotel in St. Paul.
-- The North Carolina Rate Bureau has scheduled its 36th annual meeting for Oct. 16 in Greensboro, N.C.
-- Target Markets Program Administrators Association will host its 13th Annual Summit in Scottsdale, Ariz., from Oct. 21-23. The summit at the Westin Kierland Resort & Spa is expected to draw 750 program business professionals.
- The 11th Annual California Workers' Comp Forum, Oct. 24-25, Hard Rock Cafe, San Diego. Keynote speaker: CWCI President Alex Swedlow.
-- The Virginia Workers' Compensation Commission is planning a meeting for attorneys on Oct. 16 in Charlottesville, Va. The meeting will be held at the DoubleTree Hilton Hotel, 990 Hilton Heights Road in Charlottesville; phone: 434-973-2121.
- The National Workers' Compensation & Disability Conference and Expo, Nov. 20-22, Mandalay Bay Resort, Las Vegas.
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