Doctor Shortage in California Workers Compensation?

Injured workers in California often wait months or even years to receive the medical evaluations required to get needed treatment, and in some cases to determine how disabled they are as a result of the injury.

The reason? The state lacks enough physicians signed up with the state’s program to serve as experts.

That’s among the findings of a first-ever state audit of California’s Division of Work Comp in Sacramento, which noted that the state has not increased the pay schedule for expert doctors, known as Qualified Medical Evaluators, in 13 years.

Too few physicians are doing the reviews, according to the audit. While requests for the reviews rose by 37 percent from 2013 through 2018, the number of available doctors dropped by 12 percent, according to the audit.

A 2018 review by the Rand Corp. recommended that the fees be restructured to ensure that medical experts are fully compensated for their time on complex cases and produce high quality evaluations.

The State Auditor found that the Division of Workers’ Compensation:

"Failed” to address the shortage of medical experts — there were 2,800 medical evaluators in 2017-2018 and 100,000 new requests for evaluations that same year.

“Inappropriately” disciplined doctors for alleged overbilling issues by not reappointing them, raising “due process concerns.”

Has not ensured that the evaluators’ reports meet quality standards as accurate and complete, and has not tracked how often judges reject those reports as a result.

The division is part of the Department of Industrial Relations, which is charged with enforcing labor laws and protecting workers and employers. It is funded by fees paid by employers statewide.

The division “acknowledged and accepted” the recommendations in the audit, but indicated it was already working on some solutions. Agency representatives refused to answer CalMatters’ questions about the audit, referring instead to its written response to the auditor.

It wrote that it has been working on updating the payment schedule for evaluators since 2017. In August, the agency released a proposal that garnered hundreds of mostly negative public comments. The agency has since revised the proposal, held stakeholder meetings, and in January will hold a public hearing on a final proposal.

Its response also cited a statewide doctor shortage, which makes it hard to recruit doctors to the system.

But the agency also said not all the certified doctors are busy under the current system, and that it intends to change how evaluators are assigned to panels from which workers and their attorneys choose experts. Doctor advocates say that some doctors, such as orthopedists, are more in demand than others, such as chiropractors.

The agency also wrote that it would review its disciplinary procedures and notify doctors earlier in the process if it suspected billing violations.

Now the Legislature is getting involved too. A bill is expected to be heard in committee in January, would require the agency to boost pay for medical evaluators based on inflation since 2006, and provide regular raises as a way to keep and attract doctors to the system.

When injured workers endure lengthy waits, their health may suffer, their condition could worsen, they may lose their financial footing, and some have even lost their homes, according to lawyers representing injured workers.

They provide “your recourse to getting access to benefits once they are denied,” said Dr. Gabor Vari, CEO of California Medical Evaluators, a company that connects injured workers with evaluators. “You may be out of work. You may not be getting any benefits like disability payments. You may not have access to medical care because workers comp is supposed to treat your injury.”

Typically workers require an evaluation when an employer disputes whether an injury is actually work-related, or the worker feels they need more treatment or wants a second opinion regarding temporary or permanent disability.

When a worker, or the worker’s attorney, asks for a medical review, the state provides a list of three experts to choose from, but also requires that the appointment takes place within 60 days. If a doctor can’t do it in that timeframe, the worker will be given a fresh list and the process begins all over again.