California Medical Evaluators Leads the Way Advocating for QMEs Throughout California

By, Dauglas Stoddard

CME’s efforts to push back against the recent WCAB proposed regulation changes made headlines as the #1 story on WorkComp Central today. Gabor Vari, CEO of California Medical Evaluators, has been a strong advocate for QME rights and is quoted several times in the article voicing his concerns about the WCAB proposed regulation changes.

Vari feels that the proposed changes to Regulation 10451.1 would result in taking away the rights of QMEs to be heard on a non-IBR petition prior to resolution of the case if the Defense elects not to file a Declaration of Readiness to proceed. Such language could embolden carriers to underpay or deny medical-legal bills, a practice which is already rampant and unchecked.

Carriers routinely deny legitimate bills from QMEs or AMEs for bogus reasons that include providing a service on a denied claim or that the QME or AME was not in the medical provider network. The only recourse providers have now is to file a non-IBR petition and DOR. These bad-faith denials will undoubtedly increase if providers stop having the right to be heard prior to resolution of the case.

In addition, Vari is convinced that this change would result in more doctors leaving the QME system and fewer doctors wanting to become QMEs. Demand for QME doctors already far outpaces supply. According to a recent audit, the number of QMEs has fallen to 2,500 from 4,000 in 2006 while the demand for QME services has increased from 65,000 in 2006 to 135,000 in 2017.

The system cannot afford to lose more QME doctors, and this misguided change to the regulations would worsen the unprecedented shortage of QMEs today. Since there are not enough QMEs, the administration should be making changes to retain and attract QMEs into the system rather than altering the rules to make it more difficult for them to get paid.

Vari has felt so strongly about opposing these regulation changes that he has encouraged all QMEs in the system to participate in the WCAB’s public forum in hopes that the changes will not happen if there is enough resistance.

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