The QME Race: A 60-Second Seminar in Workers’ Compensation Claims Handling

A most bizarre event occurs in workers’ compensation whenever there is a need for a QME panel.  The parties race each other to determine who will be first to request a panel.  All too often applicant attorneys request chiropractic panels regardless of the injury, whether it involves a foot, an ear or even a heart problem.  In fact, chiropractors are requested with such frequent regularity that employers are actually racing against applicant attorneys to be first to request a panel, because the winner of the race is allowed to select the medical specialty of the evaluator.  In our blog today we will provide a tip on how employers can win the race.

The very first step in the QME process is to identify the earliest date in which a panel may be requested.  For example, if an objection to a PTP report is filed in a represented claim, then pursuant to LC 4062.2 the very first day that a panel may be requested is “no earlier than the first working day that is at least 10 days … after the date of mailing of an objection pursuant Section 4062” (The 10 days limit is often extended to comply with the 5, 10, or 20-days mailbox rule).  Any QME panel request submitted prior to the eligible date is invalid and subject to automatic dismissal. 

Once the earliest date to request a panel is identified, now the race begins to see which side will act first.  Here is a shortcut to help win the race.  If for instance, the earliest date to request a panel request is Wednesday, June 8^th, then submit a computerized request a few seconds past 5:00pm on Tuesday, June 7^th.  Many claims professionals do not realize that any request submitted after 5:00pm counts as if submitted the following work-day.  Therefore, a request submitted one second after 5pm on Tuesday counts as if submitted on Wednesday.  We further recommend that this submission strategy be incorporated in an administrator’s repertoire of claims handling procedures.  Unfortunately, it won’t take long before applicant attorneys learn of this shortcut and copy the administrator’s actions.  In fact, some attorneys have already done so.  It now truly becomes an exciting race to see who can submit their request immediately after 5:00pm the day before eligibility opens.

Interestingly enough, a request submitted at 4:59:59 or earlier is premature and will not count.  Should this occur, one cannot just can’t wait 1 or 2 seconds and hit the re-send button.  Instead, the computer requires the entire request form be completely filled out again, thus wasting valuable time, especially if you are in a race.  In the event a premature request is submitted, it would be a wise idea to have a second or possibly a third computer on stand-by, ready to go with all the information already typed in, where a new request can be submitted immediately just by clicking the send button.  It truly becomes a challenge to see who will win the QME panel race, especially when both sides are watching the clock to submit a submit a request exactly at one second past 5pm.  We at F&B wish to emphasize that this is a race well worth winning, as thousands of dollars are often at stake based on the medical specialty of the QME physician.