While it’s difficult to guarantee any profession is entirely impervious to fluctuations in the market, the role of a Qualified Medical Evaluator (QME) has characteristics that make it resilient during economic downturns. There might even be an increase in workplace-related injuries as companies strive to maintain productivity with fewer resources during economic challenges. Most recently, the COVID-19 pandemic significantly impacted Workers’ Compensation. There was in fact an increased demand for the services of QMEs, contrary to expectations during the work-from-home era, despite a decrease in the labor force and needs for physical labor.
Impact of COVID-19 on the California Workers’ Compensation System
Senate Bill 1159, enacted during the pandemic, played a significant role in facilitating access to benefits for workers at high risk of COVID-19 exposure. The legislation helped establish that COVID-19 is a work-related illness, making it easier for frontline workers and those exposed to outbreaks to access the benefits they need. In the 18 months following the beginning of 2020, COVID-19 claims accounted for an average of 15% of all Workers’ Compensation claims in California, equating to a staggering 142,033 claims (1). Furthermore, COVID-19 claims constituted a majority (55%) of all claims with injury dates in December 2020 (1). Figure 1 highlights the surge in Workers’ Compensation claims in California that occurred at the height of the pandemic:
Figure 1. COVID-19 and non–COVID-19 Claim Volumes, by Month of Injury
The COVID-19 pandemic led to the largest and most sudden increase in the unemployment rate in decades. A combination of layoffs and lockdown restrictions predisposed workers to an increased risk of musculoskeletal disorders due to working in non-ergonomic home environments, sedentariness, as well as limited access to healthcare facilities for chronic conditions (2). Studies have shown that these restrictions had a negative impact on musculoskeletal health including the lower back, neck, wrist, hip, ankle and shoulder (2). In California in 2021, there were nearly 200,000 Workers’ Compensation claims associated with fractures, strains and/or tears (3). Furthermore, essential workers who continued to work on-site during the pandemic faced altered work environments and safety protocols, leading to an increased risk of musculoskeletal injuries. There was also a redistribution of workers into manual labor jobs which notoriously have a higher risk for musculoskeletal injuries, specifically construction and manufacturing.
At the height of the pandemic, emergency regulations were put into place in Workers’ Compensation that provided flexibility to the process but also ensured the safety of the injured workers and QMEs. Telehealth evaluations were introduced for QMEs and AMEs in cases where physical examinations were not necessary, mainly for psych and neurology specialties. Regulations were put into place that extended the time that a physician could reschedule calendared QME evaluations as well as the time period in which an appointment could be scheduled after the date of an appointment request. No failed appointment fee would be charged to the applicant if their failure to show for an evaluation was due to COVID-19. QME reports were allowed extensions by 15 days, reports and required documents were able to be served digitally without preauthorization, and initial QME evaluations were able to take place at any office that was certified for qualified medical evaluations as long as all parties agreed to the action.
Recession-Proof Career: The Role of QMEs
QMEs played a key role in assessing the medical aspects of Workers’ Compensation claims during the pandemic. This further highlights the notion that these cases persist regardless of economic condition and may even trigger additional claims. Even if unemployment is high, there remains a consistently high volume of cases from workers, including post termination claims regarding cumulative trauma resulting from their prior employment. Employees facing potential layoffs may also see Workers’ Compensation as a means to alleviate the financial uncertainty of unemployment and report injuries that they had previously been afraid to report due to potential loss of the job. The QME process identifies retaliatory and baseless claims in addition to supporting reasonable claims, and a good QME will identify motivation behind the claim. Widespread layoffs trigger reporting of both supported and unsupported claims. Ultimately, when causation is not a medical question but rather a legal one, the QME defers to the judge or Trier of Fact.
Healthcare-related professions often demonstrate resilience during economic downturns because health issues do not adhere to economic cycles. Being part of the healthcare system, QMEs benefit from this stability. Furthermore, the need for impartial medical assessments provided by QMEs remains consistent. Both workers and employers rely on these assessments to ensure fair and objective evaluations of injuries and disabilities.
It’s important to note that the overall demand for Workers’ Compensation services may be influenced by regional economic factors, changes in legislation, or shifts in industry practices. Opting for a career in QME work generally provides a resilient and financially rewarding source of ancillary income, demonstrating a capacity to withstand economic instability.
References:
- Quigley, Denise D., Michael Dworsky, Nabeel Qureshi, Shannon Prier, and Courtney A. Gidengil, COVID-19’s Impacts on California’s Workers’ Compensation System: Evaluating the Effects of Senate Bill 1159. Santa Monica, CA: RAND Corporation, 2022. https://www.rand.org/pubs/research_briefs/RBA1430-1.html.
- Gebrye, T., Niyi-Odumosu, F., Lawoe, J. et al. The impact of COVID-19 related lockdown restrictions on musculoskeletal health: a systematic review. Rheumatol Int 43, 2011–2019 (2023). https://doi.org/10.1007/s00296-023-05406-2
- Workers’ Compensation Information System. State of California Department of Industrial Relations. [Online] https://www.dir.ca.gov/dwc/wcis/WCIS_tables/Tables1-3/WCIS_Reports-Table1-3.html
