To ensure fairness in California’s Workers’ Compensation system, strict rules govern communications between parties and medical evaluators, including Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs). Central to this framework is the prohibition against ex parte communication, which prevents one party from influencing or appearing to influence the evaluator without the other party’s knowledge.
What Is Ex Parte Communication?
Ex parte communication refers to any written or oral communication by one party or its representative with the evaluator, conducted outside the presence or knowledge of all parties. This restriction exists to preserve the evaluator’s neutrality and prevent any perception of bias.
What Information Can Be Shared with Evaluators?
Both the injured worker and the claims administrator (or the employer, if no claims administrator is involved) can submit information to the evaluator. However, the type of information and the process for sharing it are carefully regulated to maintain transparency.
Evaluators may receive medical records from the injured worker’s treating physicians, as well as prior medical records relevant to the disputed issues. Correspondence summarizing the treating physician’s opinions or outlining the compensability issues in question is also permitted, provided opposing counsel receives this letter at least 20 days before the evaluation for approval.
Importantly, all materials must be shared with all parties at least 20 days before they are sent to the evaluator, allowing time to raise objections if needed.
Communication with Evaluators
To ensure transparency, California law requires most communications with QMEs or AMEs to be written and simultaneously provided to all parties. Exceptions exist for non-substantive matters, such as scheduling appointments or clarifying missed evaluations. However, any attempt to discuss substantive issues outside of these boundaries is strictly forbidden.
If a party disputes the inclusion of certain non-medical records, those materials cannot be shared with the evaluator unless a Workers’ Compensation Administrative Law Judge approves their use. Additionally, both the claims administrator and the injured worker’s attorney must provide detailed logs of the documents being submitted, ensuring a clear record of what the evaluator receives.
In the event that a party fails to provide the QME any relevant medical record which the QME deems necessary to perform a comprehensive medical-legal evaluation, the QME may contact the treating physician or other health care provider to obtain such record(s). All communications must be in writing and copied to all parties involved, per Labor Code §4062.3.
Consequences of Ex Parte Communication
Violations of the rules governing ex parte communication can have serious consequences. If an improper interaction occurs, the aggrieved party can request a new QME panel or proceed with the current evaluator if they choose. The party responsible for the violation may also face financial penalties, including covering the costs incurred by the other side. In severe cases, they could even be charged with contempt by the Workers’ Compensation Appeals Board (WCAB).
Compliance with these rules is crucial. Even unintentional violations can compromise the neutrality of the evaluation process, delaying the resolution of the claim, increasing costs for all parties, and risking disciplinary action. Whether you are a QME, injured worker, employer, or representative, understanding these safeguards is essential to navigating the Workers’ Compensation process effectively.