June 4, 2025 | MedLegalNews.com – SACRAMENTO, CA — California is taking decisive action to address the long-standing problem of inconsistent and often inadequate Qualified Medical Evaluator (QME) reports within its workers’ compensation system. These reports, crucial for determining benefits and resolving disputes, have frequently fallen short of the “substantial medical evidence” standard, leading to unnecessary delays, legal wrangling, and increased costs.
Assemblymember Wallis has championed Assembly Bill (AB) 1293, a new law designed to fundamentally reshape the medical-legal evaluation process. The bill aims to enhance communication, ensure report clarity. This will elevate the overall quality of medical evidence, ultimately benefiting injured workers, employers, and the entire system.
Standardizing the Medical-Legal Process
Effective January 1, 2027, AB 1293 mandates that the Administrative Director of the Division of Workers’ Compensation (DWC) implement key reforms:
- All parties will use a standardized Joint Medical Evaluation Request Form to communicate with a panel QME before an evaluation. The goal is to ensure that QMEs receive comprehensive and consistent information from all sides, laying the groundwork for a more thorough and well-informed assessment.
- A Template QME Report Form: This significant development will provide a structured outline for QME reports. It incorporates all necessary statutory and regulatory requirements for a complete report that constitutes substantial evidence. Also, by establishing a clear framework, the DWC aims to reduce omissions, inconsistencies, and subjective interpretations that have historically plagued QME reports. Although the template is a vital tool, experts recognize that using it alone does not guarantee a report’s completeness, accuracy, or legal compliance.
Furthermore, AB 1293 requires the Administrative Director to establish a formal process by January 1, 2027. Parties can submit medical-legal reports they allege are inaccurate or incomplete for the medical director’s review. This new mechanism fosters greater accountability and provides a pathway to address problematic reports more efficiently.
Addressing the Root of the Problem: Quality and Education
The impetus behind AB 1293 stems from the recognition that a significant number of QME reports have been of poor quality. This contributes to inflated costs within the system. Additionally, deficiencies often include inadequate physical examinations, inconsistent application of the AMA Guides, inappropriate impairment ratings, and a general lack of clarity that hinders the dispute resolution process.
In parallel with this legislative action, there’s a strong emphasis on enhanced education and training for QME physicians. Although existing regulations require specific training for QMEs, ongoing concerns about report quality highlight the need for stronger, targeted education. Recent 2024 updates expanded the mandatory report-writing course to 16 hours, adding anti-bias training and workers’ compensation case law review. Moreover, AB 1293 will further reinforce the need for continuous professional development. This ensures QMEs maintain expertise and uphold top medical-legal reporting standards.
The passage of AB 1293 represents a critical step toward improving the efficiency and fairness of California’s workers’ compensation system. To achieve these goals, the state standardizes communication, provides clear report guidelines, and establishes processes to address deficiencies, thereby improving medical evidence quality, reducing litigation, and ensuring injured workers receive timely, appropriate benefits.