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==REMOTE MEDICAL TREATMENT EXAMINATIONS AND MEDICAL-LEGAL APPOINTMENTS==
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On March 19, 2020, Gov. Gavin Newsom issued an executive order in response to COVID-19 requiring all individuals living in California to stay home or at their place of residence, except for what are deemed to be essential activities.  Although health-care providers and hospital personnel are part of the essential workforce, not all medical services are essential. The California Coronavirus (COVID-19) Response website states, "Non-essential medical care like eye exams, teeth cleaning, and elective procedures must/should be cancelled or rescheduled. If possible, health care visits should be done remotely."<ref>See https://covid19.ca.gov/stay-home-except-for-essential-needs/.</ref>
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Employers generally view all workers' compensation doctors' visits as essential. Medical visits are necessary to determine whether an employee should remain off work, and if not, whether their work restrictions can be accommodated. Otherwise, employees could use the COVID-19 to extend their disability.
+
==Remote Medical Treatment Examinations and Medical-Legal Appointments==
  
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Many employees, on the other hand, may feel their workers' compensation doctors' visits are not essential during the COVID-19 pandemic, particularly if their condition hasn't change. Even employees who believe the visits are essential, such as when they need to renew their medications, may fear contracting the coronavirus during their doctors' visits.  
+
On March 19, 2020, Gov. Gavin Newsom issued an executive order in response to COVID-19 requiring all individuals living in California to stay home or at their place of residence, except for what are deemed to be essential activities. Although health-care providers and hospital personnel are part of the essential workforce, not all medical services are essential. The California Coronavirus (COVID-19) Response website states, "Non-essential medical care like eye exams, teeth cleaning, and elective procedures must/should be cancelled or rescheduled. If possible, health care visits should be done remotely."<ref>See https://covid19.ca.gov/stay-home-except-for-essential-needs/.</ref>
  
−
Because of COVID-19, the Division of Workers' Compensation (DWC) issued a Newsline encouraging all parties to consider creative solutions for providing care to injured workers. The DWC specifically noted that the increased use of telehealth (also called telemedicine) for medical treatment might be appropriate.<ref>See the DWC's March 19, 2020 Newsline at: https://www.dir.ca.gov/DIRNews/2020/2020-21.html.</ref>
+
Employers generally view all workers' compensation doctors' visits as essential. Medical visits are necessary to determine whether an employee should remain off work, and if not, whether his or her work restrictions can be accommodated. Employers don't want COVID-19 restrictions to extend a worker's disability unnecessarily.
  
−
===TELEHEALTH FOR MEDICAL TREATMENT APPOINTMENTS===
+
Many employees, in contrast, might feel that such appointments are not essential during the COVID-19 pandemic, particularly if their condition hasn't changed. Even employees who believe that the visits are essential, such as when they must renew a prescription, might fear contracting the coronavirus during a doctor visit.
  
−
Per Business and Professions Code § 2290.5(a)(6), telehealth is defined as "the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care." Telehealth enables a physician to use video conferencing, video calling or other similar technology to evaluate a patient. The appeals board has recognized that telehealth services may be used to treat injured workers.<ref>'Oranje v. Crestwood Behavioral Health'' (2014) 2014 Cal. Wrk. Comp. P.D. LEXIS 602.</ref> For further discussion on the use of telehealth, see Sullivan on Comp [[7.3|Section 7.3 Scope of Care –– Applied Cases]].
+
COVID-19 prompted the Division of Workers' Compensation to issue a Newsline encouraging all parties to consider creative ways to provide care to injured workers. The DWC specifically noted that the increased use of telehealth (also called telemedicine) for medical treatment might be appropriate.<ref>See the DWC's Newsline of March 19, 2020 at: https://www.dir.ca.gov/DIRNews/2020/2020-21.html.</ref>
  
−
Normally, before treating via telehealth, a physician must obtain consent from the injured worker. Business and Professions Code § 2290.5(b) states that "the health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented." However, on April 3, 2020, Governor Newsom issued an executive order suspending the requirement to obtain verbal and written consent before the use of telehealth services.<ref>The executive order is available at https://www.gov.ca.gov/wp-content/uploads/2020/04/4.3.20-EO-N-43-20-text.pdf.</ref>
+
==Telehealth for Medical Treatment Appointments==
  
−
Additionally, on April 13, 2020, the DWC adopted changes to the fee schedule to encourage the  use of telehealth during the COVID-19 public health emergency.<ref>See the DWC's April 13, 2020 Newsline at https://www.dir.ca.gov/DIRNews/2020/2020-31.html.</ref> Essentially, the fee schedule was modified for physician services on or after April 15, 2020 to equalize the payment for a service whether provided in a physician’s office or through telehealth using real time audio and video telecommunications. Thus, the DWC encouraged the use of telehealth by making payment the same regardless of whether the evaluation is conducted in person or via telehealth.  
+
Business and Professions Code § 2290.5(a)(6) defines telehealth as "the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care." Telehealth enables a physician to use video conferencing, video calling or other similar technology to evaluate a patient. The Workers' Compensation Appeals Board has recognized that telehealth services may be used to treat injured workers.<ref>''Oranje v. Crestwood Behavioral Health'' (2014) 2014 Cal. Wrk. Comp. P.D. LEXIS 602.</ref> For further discussion on the use of telehealth, see "Sullivan on Comp" [https://app.sullivanoncomp.com/soc/index/title/7.3 Section 7.3 Scope of Care –– Applied Cases]. For a complete discussion on the timing of medical appointments and required reporting, see "Sullivan on Comp" [https://app.sullivanoncomp.com/soc/index/title/7.13 Section 7.13 Primary Treating Physician].
  
−
===TELEHEALTH FOR MEDICAL-LEGAL EXAMINATIONS===
+
Normally, before treating via telehealth, a physician must obtain consent from the injured worker. BPC 2290.5(b) states: "[T]he health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented." On April 3, 2020, however, Gov. Newsom issued an executive order suspending the requirement to obtain verbal and written consent before the use of telehealth services.<ref>The executive order is available at https://www.gov.ca.gov/wp-content/uploads/2020/04/4.3.20-EO-N-43-20-text.pdf.</ref>
  
−
Although telehealth services are permissible to treat an injured worker, they are normally not permissible for medical-legal evaluations. This is because qualified medical evaluators (QMEs) have specified "face to face time" requirements for medical-legal evaluations. California Code of Regulations, tit. 8, § 49(b) defines "face to face time" as "only that time the evaluator is present with an injured worker." So QMEs are required to be physically present for specified time periods during an injured worker's examination (see Sullivan on Comp [[14.44|Section 14.44 Evaluation Requirements and Rights]]).
+
On April 13, 2020, the DWC adopted changes to the fee schedule to encourage the use of telehealth during the COVID-19 public health emergency.<ref>See the DWC's Newsline of April 13, 2020 at https://www.dir.ca.gov/DIRNews/2020/2020-31.html.</ref> Essentially, the fee schedule was modified for physician services on or after April 15, 2020 to equalize the payment for a service whether provided in a physician’s office or through telehealth using real-time audio and video telecommunications. So the DWC encouraged the use of telehealth by making payment the same regardless of whether the evaluation is conducted in person or via telehealth.
  
−
On March 28, 2020, however, the DWC issued a Newsline finding that "it may be beneficial for parties to allow telehealth for QME evaluations when an in-person physical examination is not necessary."<ref>See the DWC's March 28, 2020 Newsline containing the announcement at: https://www.dir.ca.gov/DIRNews/2020/2020-26.html.</ref> The DWC "strongly recommends" that all of these conditions apply to a telehealth evaluation to promote the health and safety of all parties:
+
On May 27, 2020, the DWC also gave notice that the American College of Occupational and Environmental Medicine (ACOEM) and MDGuidelines have released a Coronavirus (COVID-19) Clinical Practice Guideline.<ref>See the DWC's Newsline of May 27, 2020 at https://www.dir.ca.gov/DIRNews/2020/2020-46.html.</ref> The DWC supports this guidance and plans to adopt and incorporate the ACOEM guideline into the medical treatment utilization schedule (MTUS). But because the evidence-based management of COVID-19 is fluid and evolving, guidelines are published frequently, so the DWC will wait to adopt and incorporate the ACOEM's COVID-19 guideline into the MTUS until the frequency of updates slows to the point at which the formal adoption process can be completed.
 +
 
 +
In the meantime, treatment recommendations pertaining to COVID-19 should follow the MTUS medical evidence search sequence found in the California Code of Regulations, Title 8, § 9792.21.1. This regulatory sequence requires a search of the most current version of ACOEM guidance and is discussed further in "Sullivan on Comp" [https://app.sullivanoncomp.com/soc/index/title/7.31 Section 7.31 Utilization Review — Medical Treatment Utilization Schedule].
 +
 
 +
==Telehealth for Medical-Legal Examinations==
 +
 
 +
Although telehealth services are permissible for treating an injured worker, normally they are not permitted for medical-legal evaluations. Qualified medical evaluators (QMEs) are required to conduct medical-legal evaluations face-to-face. California Code of Regulations, Title 8, § 49(b) defines "face to face time" as "only that time the evaluator is present with an injured worker." So it seems that QMEs must be physically present for specified time periods during an injured worker's examination, unless a video conference somehow could be seen to meet this definition (see "Sullivan on Comp" [https://app.sullivanoncomp.com/soc/index/title/14.44 Section 14.44 Evaluation Requirements and Rights]).
 +
 
 +
The Division of Workers' Compensation (DWC) noted that the QME program in California does not qualify as part of the critical infrastructure workforce under the Healthcare and Public Health Sector guidelines of the U.S. Department of Homeland Security. So the medical-legal services were not exempt from the governor’s stay-at-home order.
 +
 
 +
QME evaluations, however, serve a vital role in the workers' compensation system. They are needed to resolve disputes regarding injured workers' entitlement to workers' compensation benefits and their ability to return to work.
 +
 
 +
On March 28, 2020, the DWC issued a Newsline noting that "it may be beneficial for parties to allow telehealth for QME evaluations when an in-person physical examination is not necessary."<ref>See the DWC's Newsline of March 28, 2020 containing the announcement at: https://www.dir.ca.gov/DIRNews/2020/2020-26.html.</ref> At the time, the DWC made a "strong recommendation" regarding how parties should proceed with QME evaluations via telehealth.
 +
 
 +
On May 14, 2020, the Office of Administrative Law approved emergency regulations from the Division of Workers' Compensation (DWC) on the medical-legal process. The emergency regulations were drafted to address the ongoing need for medical-legal evaluations and to prevent a backlog resulting from the stay-at-home order. The regulations are intended to help injured workers and employers move their claims toward resolution while still allowing both injured workers and doctors to observe the stay-at-home order.<ref>See the DWC's Newsline of Oct. 13, 2020 at: https://www.dir.ca.gov/DIRNews/2020/2020-90.html.</ref>
 +
 
 +
The original emergency regulations regarding medical-legal telehealth visits expired on Jan. 11, 2022. A new emergency regulation became effective Jan. 18, 2022 and was extended through  Jan. 18, 2023.<ref>See the DWC's Newsline of Oct. 19, 2022 at: https://www.dir.ca.gov/DIRNews/2022/2022-87.html.</ref> A permanent regulation was adopted effective Feb. 2, 2023.
 +
 
 +
Per CCR 46.3(a), a remote health evaluation by a QME, AME, or other medical-legal evaluation may be performed through the use of electronic means of creating a virtual meeting between the physician and the injured worker where both can see and hear each other, even though they may not be in the same physical space or site. The regulations define "remote health" as "remote visits via video-conferencing, video-calling, or such similar technology that allows each party to see and converse with the other via a video and audio connection. The evaluation must be conducted with the same standard of care as in person visit and must comply with all relevant state and federal privacy laws."
 +
 
 +
Per CCR 46.3(a)(2), a QME or AME could complete a medical-legal evaluation through telehealth when a hands-on physical examination was not necessary and all of these conditions are met:
  
 
<ol>
 
<ol>
−
<li>The injured worker is able to participate in the telehealth evaluation without violating the stay-at-home order.</li>
+
<li>There is a medical issue in dispute that involves whether the injury is AOE/COE, or the physician is asked to address the termination of an injured worker’s indemnity benefit payments, or address a dispute regarding work restrictions.</li>
−
<li>The medical issue in dispute is determined to be essential to an injured worker’s benefits and must be addressed no later than May 1, 2020. The dispute must involve:
+
<li>There is agreement in writing to the remote health evaluation by the injured worker, the carrier or employer and the evaluator.</li>
−
<ol type="a">
+
<li>The remote health evaluation conducted by means of a virtual meeting is consistent with appropriate and ethical medical practices and the AMA guides 5th edition, as determined by the QME and the relevant medical licensing board.</li>
−
<li>an evaluation relating to whether or not the injury is arising out of employment/course of employment (AOE/COE);</li>
+
<li>The evaluator attests in writing that the evaluation does not require a physical exam.</li>
−
<li>termination of an injured worker’s indemnity benefit payments; or</li>
 
−
<li>work restrictions.</li></ol></li>
 
−
<li>There is written agreement between the injured worker, carrier or employer, and the QME.</li>
 
−
<li>The telehealth evaluation is consistent with appropriate medical practices and ethical considerations.</li>
 
−
<li>The QME attests that the evaluation of the injured worker can be done effectively and safely by way of a telehealth evaluation and does not require an in-person physical examination.</li>
 
 
</ol>
 
</ol>
  
−
The DWC is encouraging all parties to assess whether medical-legal evaluations requiring an in-person physical evaluations should be canceled or postponed as part of the stay-at-home response to COVID-19. It also instructs that a reasonable interpretation of compliance with the stay-at-home order could mean that medical-legal, face-to-face evaluations should be postponed or canceled, if they require the injured worker or others to travel and interact with anyone outside of their immediate household.
+
For purposes of QME remote health evaluations, the medical office listed on the panel selection form for the QME is deemed the site of the remote health evaluation. For all other remote evaluations, the physician's medical office that's within a reasonable geographic distance from the injured worker’s residence will be deemed the site of the remote evaluation (CCR 46.3(b)).
  
−
The Newsline clarifies that "[a]n in-person physical examination is necessary if the injured employee’s relevant health issues are such that a physical examination done in person has significant likelihood to contribute to the examiner’s ability to formulate an accurate diagnosis, or to more accurately gauge the outcome of treatment already provided. In such an instance, parties should evaluate whether the evaluation can be cancelled or postponed. If such circumstances do not require an in-person examination, then a telehealth visit should be allowed."
+
Under former emergency CCR 46.3, an agreement to a telehealth evaluation could not be unreasonably denied.<ref>See ''Ceballos v. Access to Independence of San Diego,'' 2022 Cal. Wrk. Comp. P.D. LEXIS 81.</ref> That language no longer appears in the current regulations.
  
−
The issue with canceling or postponing a QME evaluation is that the administrative regulations contain time limits on when a QME evaluation must take place. Cal. Code Regs., tit. 8, § 31.3(e) generally requires an evaluation to be scheduled within 60 days of an appointment request. Reg. § 34(e) also provides that if a QME cancels an evaluation, the rescheduled appointment may not be more than 60 days from the date of the initial request for an appointment, unless the parties agree in writing to accept a date beyond the 60-day limit. Reg. § 31.5(a)(2)(a)(11) allows a party to request a replacement panel if an evaluation is not timely scheduled (see Sullivan on Comp [[14.40|Section 14.40 Appointments and Cancellations]]).
+
==Electronic Service of Medical-Legal Reports==
  
−
The Newsline of March 28, 2020 notes that strict adherence to the time limits for scheduling, canceling or rescheduling a medical-legal evaluation may be impractical or impossible during this public health crisis. Nevertheless, it states, "The issue of whether a medical-legal report is admissible or constitutes substantial medical evidence is determined in accordance with applicable laws and is not altered by these emergency measures."
+
Originally, California Code of Regulations, Title 8, Section 36.7 was adopted as an emergency regulation to allow medical-legal reports to be served electronically. Later, it was adopted on a permanent basis. For a detailed discussion on the rules for serving medical-legal reports, see "Sullivan on Comp" [https://app.sullivanoncomp.com/soc/index/title/14.47 Section 14.47 Service of Comprehensive Medical-Legal Reports].
  
−
Given the health crisis taking place in California and the rest of the world, parties should not use the technicalities in the law to gain an advantage. Residents across the state are being asked to stay home to protect the most vulnerable people, and the WCAB probably will not view efforts to use COVID-19 to game the system favorably.
+
CCR 36.7 explains that electronic service may be performed directly by the physician, by an agent of the physician, or through an electronic service provider. It permits electronic service of a medical-legal report, but only if the parties agree and a written confirmation of that agreement is made. At the time of giving consent to electronic service, a party or entity must provide the party’s electronic address to receive electronic service.
  
−
For any QME evaluation scheduled in April 2020, the evaluator should be consulted to determine whether a face-to-face visit is necessary. If not, the parties should agree to allow the evaluation to proceed via telehealth. If so, the QME should be asked whether the evaluation can be performed safely face-to-face. If it cannot, the parties should agree to postpone the evaluation pending further guidance from federal, state and local public health agencies.  
+
The medical-legal report or other papers must be transmitted to an email address maintained by the person or entity on whom it is served, using the most recent address provided to the physician by the party who consented to accept service electronically.
  
 +
Service is deemed complete at the time of transmission. Any period of notice and any right or duty to act or make any response within any period or on a date certain after service of the document will be extended by two business days.
  
 +
All the terms of CCR 36 and CCR 36.5 apply except that the reports may be served electronically. Mandatory form 122 may be replaced by an affidavit of proof of electronic service for medical-legal reports. A provider must maintain an original copy of all documents electronically served.
  
 +
==See Also==
  
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*[[Remote Depositions]]
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==References==
  
 
<references/>
 
<references/>
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Latest revision as of 20:42, 22 January 2024

< Previous Table of Contents Next >

Remote Medical Treatment Examinations and Medical-Legal Appointments

On March 19, 2020, Gov. Gavin Newsom issued an executive order in response to COVID-19 requiring all individuals living in California to stay home or at their place of residence, except for what are deemed to be essential activities. Although health-care providers and hospital personnel are part of the essential workforce, not all medical services are essential. The California Coronavirus (COVID-19) Response website states, "Non-essential medical care like eye exams, teeth cleaning, and elective procedures must/should be cancelled or rescheduled. If possible, health care visits should be done remotely."[1]

Employers generally view all workers' compensation doctors' visits as essential. Medical visits are necessary to determine whether an employee should remain off work, and if not, whether his or her work restrictions can be accommodated. Employers don't want COVID-19 restrictions to extend a worker's disability unnecessarily.

Many employees, in contrast, might feel that such appointments are not essential during the COVID-19 pandemic, particularly if their condition hasn't changed. Even employees who believe that the visits are essential, such as when they must renew a prescription, might fear contracting the coronavirus during a doctor visit.

COVID-19 prompted the Division of Workers' Compensation to issue a Newsline encouraging all parties to consider creative ways to provide care to injured workers. The DWC specifically noted that the increased use of telehealth (also called telemedicine) for medical treatment might be appropriate.[2]

Telehealth for Medical Treatment Appointments

Business and Professions Code § 2290.5(a)(6) defines telehealth as "the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care." Telehealth enables a physician to use video conferencing, video calling or other similar technology to evaluate a patient. The Workers' Compensation Appeals Board has recognized that telehealth services may be used to treat injured workers.[3] For further discussion on the use of telehealth, see "Sullivan on Comp" Section 7.3 Scope of Care –– Applied Cases. For a complete discussion on the timing of medical appointments and required reporting, see "Sullivan on Comp" Section 7.13 Primary Treating Physician.

Normally, before treating via telehealth, a physician must obtain consent from the injured worker. BPC 2290.5(b) states: "[T]he health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented." On April 3, 2020, however, Gov. Newsom issued an executive order suspending the requirement to obtain verbal and written consent before the use of telehealth services.[4]

On April 13, 2020, the DWC adopted changes to the fee schedule to encourage the use of telehealth during the COVID-19 public health emergency.[5] Essentially, the fee schedule was modified for physician services on or after April 15, 2020 to equalize the payment for a service whether provided in a physician’s office or through telehealth using real-time audio and video telecommunications. So the DWC encouraged the use of telehealth by making payment the same regardless of whether the evaluation is conducted in person or via telehealth.

On May 27, 2020, the DWC also gave notice that the American College of Occupational and Environmental Medicine (ACOEM) and MDGuidelines have released a Coronavirus (COVID-19) Clinical Practice Guideline.[6] The DWC supports this guidance and plans to adopt and incorporate the ACOEM guideline into the medical treatment utilization schedule (MTUS). But because the evidence-based management of COVID-19 is fluid and evolving, guidelines are published frequently, so the DWC will wait to adopt and incorporate the ACOEM's COVID-19 guideline into the MTUS until the frequency of updates slows to the point at which the formal adoption process can be completed.

In the meantime, treatment recommendations pertaining to COVID-19 should follow the MTUS medical evidence search sequence found in the California Code of Regulations, Title 8, § 9792.21.1. This regulatory sequence requires a search of the most current version of ACOEM guidance and is discussed further in "Sullivan on Comp" Section 7.31 Utilization Review — Medical Treatment Utilization Schedule.

Telehealth for Medical-Legal Examinations

Although telehealth services are permissible for treating an injured worker, normally they are not permitted for medical-legal evaluations. Qualified medical evaluators (QMEs) are required to conduct medical-legal evaluations face-to-face. California Code of Regulations, Title 8, § 49(b) defines "face to face time" as "only that time the evaluator is present with an injured worker." So it seems that QMEs must be physically present for specified time periods during an injured worker's examination, unless a video conference somehow could be seen to meet this definition (see "Sullivan on Comp" Section 14.44 Evaluation Requirements and Rights).

The Division of Workers' Compensation (DWC) noted that the QME program in California does not qualify as part of the critical infrastructure workforce under the Healthcare and Public Health Sector guidelines of the U.S. Department of Homeland Security. So the medical-legal services were not exempt from the governor’s stay-at-home order.

QME evaluations, however, serve a vital role in the workers' compensation system. They are needed to resolve disputes regarding injured workers' entitlement to workers' compensation benefits and their ability to return to work.

On March 28, 2020, the DWC issued a Newsline noting that "it may be beneficial for parties to allow telehealth for QME evaluations when an in-person physical examination is not necessary."[7] At the time, the DWC made a "strong recommendation" regarding how parties should proceed with QME evaluations via telehealth.

On May 14, 2020, the Office of Administrative Law approved emergency regulations from the Division of Workers' Compensation (DWC) on the medical-legal process. The emergency regulations were drafted to address the ongoing need for medical-legal evaluations and to prevent a backlog resulting from the stay-at-home order. The regulations are intended to help injured workers and employers move their claims toward resolution while still allowing both injured workers and doctors to observe the stay-at-home order.[8]

The original emergency regulations regarding medical-legal telehealth visits expired on Jan. 11, 2022. A new emergency regulation became effective Jan. 18, 2022 and was extended through Jan. 18, 2023.[9] A permanent regulation was adopted effective Feb. 2, 2023.

Per CCR 46.3(a), a remote health evaluation by a QME, AME, or other medical-legal evaluation may be performed through the use of electronic means of creating a virtual meeting between the physician and the injured worker where both can see and hear each other, even though they may not be in the same physical space or site. The regulations define "remote health" as "remote visits via video-conferencing, video-calling, or such similar technology that allows each party to see and converse with the other via a video and audio connection. The evaluation must be conducted with the same standard of care as in person visit and must comply with all relevant state and federal privacy laws."

Per CCR 46.3(a)(2), a QME or AME could complete a medical-legal evaluation through telehealth when a hands-on physical examination was not necessary and all of these conditions are met:

  1. There is a medical issue in dispute that involves whether the injury is AOE/COE, or the physician is asked to address the termination of an injured worker’s indemnity benefit payments, or address a dispute regarding work restrictions.
  2. There is agreement in writing to the remote health evaluation by the injured worker, the carrier or employer and the evaluator.
  3. The remote health evaluation conducted by means of a virtual meeting is consistent with appropriate and ethical medical practices and the AMA guides 5th edition, as determined by the QME and the relevant medical licensing board.
  4. The evaluator attests in writing that the evaluation does not require a physical exam.

For purposes of QME remote health evaluations, the medical office listed on the panel selection form for the QME is deemed the site of the remote health evaluation. For all other remote evaluations, the physician's medical office that's within a reasonable geographic distance from the injured worker’s residence will be deemed the site of the remote evaluation (CCR 46.3(b)).

Under former emergency CCR 46.3, an agreement to a telehealth evaluation could not be unreasonably denied.[10] That language no longer appears in the current regulations.

Electronic Service of Medical-Legal Reports

Originally, California Code of Regulations, Title 8, Section 36.7 was adopted as an emergency regulation to allow medical-legal reports to be served electronically. Later, it was adopted on a permanent basis. For a detailed discussion on the rules for serving medical-legal reports, see "Sullivan on Comp" Section 14.47 Service of Comprehensive Medical-Legal Reports.

CCR 36.7 explains that electronic service may be performed directly by the physician, by an agent of the physician, or through an electronic service provider. It permits electronic service of a medical-legal report, but only if the parties agree and a written confirmation of that agreement is made. At the time of giving consent to electronic service, a party or entity must provide the party’s electronic address to receive electronic service.

The medical-legal report or other papers must be transmitted to an email address maintained by the person or entity on whom it is served, using the most recent address provided to the physician by the party who consented to accept service electronically.

Service is deemed complete at the time of transmission. Any period of notice and any right or duty to act or make any response within any period or on a date certain after service of the document will be extended by two business days.

All the terms of CCR 36 and CCR 36.5 apply except that the reports may be served electronically. Mandatory form 122 may be replaced by an affidavit of proof of electronic service for medical-legal reports. A provider must maintain an original copy of all documents electronically served.

See Also

References

  1. ↑ See https://covid19.ca.gov/stay-home-except-for-essential-needs/.
  2. ↑ See the DWC's Newsline of March 19, 2020 at: https://www.dir.ca.gov/DIRNews/2020/2020-21.html.
  3. ↑ Oranje v. Crestwood Behavioral Health (2014) 2014 Cal. Wrk. Comp. P.D. LEXIS 602.
  4. ↑ The executive order is available at https://www.gov.ca.gov/wp-content/uploads/2020/04/4.3.20-EO-N-43-20-text.pdf.
  5. ↑ See the DWC's Newsline of April 13, 2020 at https://www.dir.ca.gov/DIRNews/2020/2020-31.html.
  6. ↑ See the DWC's Newsline of May 27, 2020 at https://www.dir.ca.gov/DIRNews/2020/2020-46.html.
  7. ↑ See the DWC's Newsline of March 28, 2020 containing the announcement at: https://www.dir.ca.gov/DIRNews/2020/2020-26.html.
  8. ↑ See the DWC's Newsline of Oct. 13, 2020 at: https://www.dir.ca.gov/DIRNews/2020/2020-90.html.
  9. ↑ See the DWC's Newsline of Oct. 19, 2022 at: https://www.dir.ca.gov/DIRNews/2022/2022-87.html.
  10. ↑ See Ceballos v. Access to Independence of San Diego, 2022 Cal. Wrk. Comp. P.D. LEXIS 81.


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