Non-English-speaking injured workers in California’s Workers’ Compensation system face avoidable challenges due to the lack of certified interpreters during critical stages of their cases. This growing concern, recently highlighted by Language Access for Injured Workers (LAIW), has serious implications for the integrity of medical-legal evaluations and the rights of injured workers.
The Issue at Hand
Certified Medical Interpreters (CMIs) have stringent certification requirements, including both written and oral exams in languages for which certification exams are offered. These include Spanish, Russian, Korean, Cantonese, Mandarin, American Sign Language, and Vietnamese. According to California regulations, only fully certified interpreters may be used in medical and legal settings.
LAIW has identified a troubling trend where insurance carriers send unvetted interpreters to medicolegal evaluations and other critical events during the pendency of Workers’ Compensation cases. Many uncertified interpreters at best hold only a preliminary credential as Hub-CMI (“Hub” indicates the initial certification before specialization but does not allow for medicolegal interpretation), having passed a baseline competency exam; at worst, they may be a family member or simply someone from the community who speaks the language. Hub-CMI interpreters are on the pathway to becoming CMIs if they complete the requirements. However, a Hub-CMI performing medicolegal interpretation services would be akin to a medical intern practicing independently without a medical license.
Real-World Implications
A recent incident highlighted by LAIW involved Carrie Catena, a fully certified National Board Certified Spanish Medical Interpreter, who encountered a HUB-CMI interpreter misrepresenting her credentials at a QME office in Van Nuys. Ms. Catena intervened, clarified the HUB-CMI interpreter’s preliminary status, and ultimately provided the necessary interpretation services herself. Similar incidents in Simi Valley and Los Angeles indicate that this issue of non-qualified interpreters encroaching into medicolegal evaluations is widespread.
The Impact on QMEs
The accuracy and credibility of QME evaluations are paramount, as they significantly influence the outcome of Workers’ Compensation claims. The use of non-certified interpreters can jeopardize this process in several ways:
- Miscommunication: Non-certified interpreters have not been proven to have necessary proficiency to accurately convey complex medical information between the QME and the injured worker, leading to misunderstandings that can affect the evaluation.
- Legal Non-Compliance: The use of non-certified interpreters contravenes California regulations, potentially rendering the medicolegal reports invalid. This non-compliance can lead to disputes and delays in the resolution of claims.
- Compromised Rights: Injured workers have the right to a fair evaluation and representation. Using interpreters who do not meet certification standards undermines this right and can result in unfair treatment.
- Unprofessional conduct: the misrepresentation of the HUB-CMI’s certification is unprofessional in and of itself, and does not lend itself to professional behavior as an interpreter. Any QME who has worked with an unprofessional interpreter understands well that the presence of such a person in an evaluation will distract from the injured worker, while a qualified and professional interpreter will facilitate communication.
Steps to Mitigate the Issue
LAIW has raised this issue with several bodies, including the National Board of Certified Medical Interpreters, the California Applicants’ Attorneys Association (CAAA), the California Society of Industrial Medicine & Surgery, and the Administrative Director of the Division of Workers’ Compensation (DWC). Steps that can be taken to address this problem include the following:
- Verify Credentials: Attorneys, QMEs, and their staff must diligently verify the credentials of interpreters to avoid rejection of their reports, which will lead to nonpayment. Ensuring that interpreters are fully certified helps protect the integrity of the evaluation process and the rights of injured workers.
- Raise Awareness: Legal and medical professionals should be informed about the differences between HUB-CMIs and fully certified interpreters. Awareness can prevent the use of unqualified interpreters and uphold the standards of the Workers’ Compensation system.
- Advocate for Change: Taking a stand against the use of non-certified interpreters is crucial. Advocacy efforts can push for stricter enforcement of regulations and better protection of non-English speaking workers’ rights.
Rare languages may be unsupported by the State of California and may not have available interpreters. Examples of languages where only uncertified interpreters are available include Samoan, non-ASL sign languages, and some lesser spoken dialects of Central America and Asia. In this event, thorough documentation of the lack of State Certified Interpreters is required, and the QME will be required to put forth greater effort to ensure that the interpreter is well-instructed and properly oriented to the proceedings of a medicolegal evaluation.
An introductory conversation with an uncertified interpreter should include basic instructions. The QME should instruct the interpreter to interpret exactly what the applicant says and not to edit or summarize any information to maintain the accuracy of the evaluation. The interpreter should be instructed to use first-person language and not provide their own opinions, advice, or answers to the applicants’ questions. There should not be any side conversations with the applicant during the session; all communication should be interpreted for the QME to maintain transparency. If side-bar conversations occur, the QME must intervene and redirect the conversation to pure interpretation. If there are any non-verbal cues or body language that may be significant, the interpreter should convey these to the QME as they can provide additional context to the communication. Lastly, complex medical terminology or concepts should be explained in simpler terms by the QME and the interpreter when necessary.
Ensuring that only fully certified interpreters are used in medical-legal evaluations protects the rights of injured workers and upholds the integrity of the evaluation process. By being vigilant and proactive, attorneys, QMEs, and their management companies can help address this critical issue and support the broader fight for equal access to justice for all workers.
References
- “Language Access for Injured Workers.” California Applicants’ Attorneys Association. Accessed July 31, 2024. https://www.caaa.org/?pg=latestnews&blAction=showEntry&blogEntry=110791.