DWC posts report on California’s workers’ compensation Medical-Legal process and Qualified Medical Evaluators

NEWSLINE

The Division of Workers' Compensation (DWC) today announced the release of a comprehensive 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:

• Whether the supply of QMEs meets demand across specialties and geographic regions.
• The impact of recent reimbursement changes on overall system costs and QME recruitment.
• The quality of Medical-Legal reports and potential methods to improve their accuracy.
• The appropriateness and impact of remote telehealth evaluations.
• Strategies to improve the timely delivery of medical records to evaluators.

The findings are expected to help inform future rulemaking efforts aimed at improving the Medical-Legal evaluation system.

RAND has posted its report, Qualified Medical Evaluators and the Medical-Legal Process in California Workers' Compensation , on its website.

DIR's Division of Workers' Compensation monitors the administration of workers' compensation claims and provides administrative and judicial services to help resolve disputes related to claims for workers' compensation benefits.