Qualified medical evaluator holding a tablet during an exam

Qualified Medical Evaluators and “Face to Face” Time: Injured Worker’s QME Evaluations and Workers’ Compensation

In order for Injured Workers to prove their claim for Workers’ Compensation Benefits, they may be required to be evaluated by a Qualified Medical Evaluator.

As part of the QME Examination, there is the requirement that the QME have “Face to Face” time with the Injured Worker. This article will discuss the nature of “Face to Face” time and interesting caselaw decision with respect to it.

What Is the Authority for “Face to Face” Time?

A QME is required to spend a minimum amount of “Face to Face” time with the worker. Cal. Code Regs., tit. 8, §§ 49-49.9

What Is “Face to Face” Time?

Per Cal. Code Regs 49(b), “Face to Face time” means only that time the evaluator is present with an injured worker. This includes the time in which the evaluator performs such tasks as taking a history, performing a physical examination or discussing the worker’s medical condition with the worker.”

With respect to “Face to Face time,” there is the notion of what is a basic evaluation. An “Uncomplicated evaluation” means a face to face evaluation in which all of the following are recorded in the medical report: Minimal or no review of records, minimal or no diagnostic studies or laboratory testing, minimal or no research, and minimal or no medical history taking.” Cal. Code Regs 49(h.)

What Is Not Considered as “Face to Face” Time for an Evaluation?

“Face to face time excludes time spent on research, records review, and report writing. Any time spent by the injured worker with clinical or clerical staff who perform diagnostic or laboratory tests (including blood tests or x-rays) or time spent by the injured worker in a waiting room or other area outside the evaluation room is not included in face to face time.” Cal. Code Regs 49(b)

Is There a Minimum “Face to Face” Time for Evaluations?

Yes. There is a minimum “Face to Face” time.

The minimum amount of “face to face” time depends on the nature of the evaluation being conducted and variances below the minimum amount of face to face time stated in the regulation must be explained in the evaluator’s report.

Are There Different Minimum Face to Face Times for Different Medical Specialties?

Yes. There are different “Face to Face” Times for different Medical Specialties.

For Neuromusculoskeletal Evaluations—whether a specific or cumulative injury is involved- shall be no fewer than 20 minutes of face to face time. Twenty minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.2).) Cal. Code Reg tit. 8 § 49 (d) defines a “Neuromusculoskeletal evaluation” as a “the determination of disability due to injury to the central nervous systems, the spine and extremities, and the various muscle groups of the body.”

For Cardiovascular Evaluations—whether a specific or cumulative injury is involved shall no fewer than 30 minutes of face to face time. Thirty minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.4).) Cal. Code Reg tit. 8 § 49 (a) defines a Cardiovascular evaluation as “the determination of disability due to pathological changes of the heart and/or the central circulatory system.”

For Pulmonary Evaluations—whether a specific or cumulative injury is involved shall be no fewer than 30 minutes of face to face time. Thirty minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.6).) Cal. Code Reg tit. 8 § 49(f) defines a Pulmonary evaluation as “the determination of disability due to pathological changes of the lungs and/or other components of the respiratory system.”

For Psychiatric Evaluations—whether a specific or cumulative injury is involved shall be no fewer than 60 minutes of face to face time. Sixty minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.8).) Cal. Code Reg tit. 8 § 49(e) defines a Psychiatric evaluation as “the determination of disability due to psychopathology, by either a psychiatrist or psychologist following the Method of Measurement of Psychiatric Disability set out in section 43 of Title 8 of the California Code of Regulations.”

Any other Evaluations—whether a specific or cumulative injury is involved shall not be fewer than 30 minutes of face to face time. Thirty minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9)

Case Law Concerning “Face to Face” Time

Tele-Evaluations and “Face to Face” Time

The “Face to Face” requirement can be satisfied via Telemedicine. In Cherish Oranje v. Crestwood Behavior Health, 2018 Cal. Wrk. Comp. P.D. LEXIS 513 (Noteworthy Decision), an individual with an ADA accommodation issues was allowed to have “Face to Face” time via telemedicine.

Failure of QME to Do Proper Amount of “Face to Face” Time

A QME Evaluator was replaced when the Injured Worker testified that they spent only 10-15 minutes with QME and the QME represented that they spent 2 hours. Rios vs. El Monte 2016 Cal. Wrk. Comp. P.D. LEXIS 501 (Board Panel Decision)

What If I Need Legal Advice?

If you would like a “free” consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. for more information.

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