March 31, 2025 – AB 1293, introduced by Assembly member Wallis, proposes important updates to California’s workers’ compensation system, specifically targeting how Qualified Medical Evaluators (QMEs) operate. The bill aims to improve both the clarity and efficiency of the QME process, ensuring more standardized communication and reporting.
Background: How the Current QME System Works
California’s workers’ compensation system, managed by the Division of Workers’ Compensation (DWC), compensates employees for work-related injuries. When there is a dispute about an injury or medical issue in a claim, a Qualified Medical Evaluator provides an impartial medical-legal evaluation to help resolve the matter.
Qualified Medical Evaluators play a vital role in the decision-making process. Their evaluations often influence benefit eligibility, apportionment, and permanent disability determinations. To ensure fairness and consistency, the state outlines specific guidelines for how Qualified Medical Evaluators must conduct evaluations and communicate with involved parties.
Currently, any communication with a panel QME before the evaluation must be in writing and served on the opposing party at least 20 days in advance. Any communication sent after the evaluation must also be in writing and shared with the other party at the same time it is sent to the QME.
What AB 1293 Proposes
AB 1293 introduces new requirements for evaluations with a date of service on or after January 1, 2027, aiming to streamline communication and enhance how Qualified Medical Evaluators perform and submit reports.
Joint Medical Evaluation Request Form
The Administrative Director must create and provide a standardized joint request form. All parties will use this form when contacting a panel QME before an evaluation. This step ensures consistency, reduces administrative delays, and minimizes confusion.
Standardized QME Report Template
A new report template will be developed to help Qualified Medical Evaluators meet all legal and regulatory requirements. This ensures that QME reports qualify as substantial medical evidence and improves their overall quality and credibility.
Regulatory Guidelines
The Division of Workers’ Compensation must implement formal regulations by January 1, 2027. These regulations will provide detailed guidance on using the new forms and maintaining compliance throughout the QME process.
Why AB 1293 Matters
AB 1293 modernizes and strengthens California’s QME system. By standardizing forms and improving communication, the legislation supports more efficient evaluations and defensible reporting from Qualified Medical Evaluators across the state.
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