After a thorough evaluation of an injured worker and review of medical records made immediately available, it would be understandable to assume that a QME’s work is done. A thorough QME, however, has about a 1:1 ratio of initial evaluations and supplemental reports!
In the California Workers’ Compensation system, a supplemental report is simply a report requested without an in-person evaluation. By definition, it must be requested only after an applicant has been initially evaluated by that QME. The deadline for submission is 60 days from the date of the cover letter or declaration. These requests are most often accompanied by any new medical records that were unavailable to the QME at the time of the initial evaluation, though there may not be any additional records to review. Essentially, they can be any question from an attorney. Communication between either party with a QME outside of reports served to all parties is ex parte communication and is illegal, so even simple clarifications must be submitted to the QME as a supplemental report request.
A QME should liberally abstain from premature opinions in an initial report, and request any medical records or diagnostic studies that are missing from the initial record submitted. It is rare that an initial evaluation and the records submitted are sufficient to make the nuanced medicolegal conclusions required of a QME report. Often, determinations are deferred until further records, further evaluation, or further treatment have been completed and submitted for review. Conclusions may be reached only once the injured worker is at maximal medical improvement. Supplemental reports can be requested by the parties for various reasons.
New Information
After the initial evaluation, ongoing medical procedures, consultations, or diagnostic tests might reveal new details about the patient’s condition. These include additional imaging, studies, lab results, or special consultations that were not available at the time of the initial evaluation. These may be submitted to the QME by parties with or without a request from the physician. If the parties do not specifically wish for the applicant to be re-evaluated, for instance, when less than a year has passed since the prior evaluation, these are submitted in the form of a supplemental report request.
Clarification
At times, portions of a report require further explanation or clarification. A supplemental report can be requested by the parties with a request to elaborate further on particular points, offer additional reasoning behind conclusions, or address any questions raised by the involved parties. This is never done in casual communication, but must follow all the required documentation of a formal QME supplemental report in order to comply with the law regarding Ex parte communications. For a QME, this is often preferable to verbal testimony in the form of a deposition.
Changes in Condition
Until an applicant is determined to be at maximal medical improvement, the passage of time and benefits of available treatment will change the clinical picture. Worsening or improvement of signs and symptoms with or without treatment, new or compensatory injuries, or complications of treatment could arise. These changes can impact the medicolegal conclusions such as impairment, apportionment, and need for immediate or future medical care. While attorneys may request conclusions based on medical records, we at OrthoLegal strongly recommend requesting a re-evaluation in order to change the medicolegal conclusions when there have been significant changes to an applicant’s condition, in order to have an updated physical examination for the purpose of rating as well as an update in the history directly from the applicant.
Late Record Receipt
All medical records to be reviewed in conjunction with an evaluation are due at the time of the evaluation. Any records received after that time cannot have been reviewed in advance of the evaluation and are considered late. These may be reviewed in a separate report rather than in the report of the in-person evaluation. Allowance has been made for physicians to have ample time to review records, so the due date for this supplemental report is 60 days from the date of receipt of the records. Determinations of legal conclusions should be deferred in the initial report so that the records may be reviewed.
Billing for a supplemental report allows for more payment for the same volume of records received. Whereas an in-person evaluation allows for billing additionally for any records received over 200 pages, a supplemental report allows for billing any records beyond 50 pages.
Supplemental reports allow a QME to review records that were not available at the time of initial evaluation or allow to answer questions in the form of interrogatories from the parties. These reports take into account any new developments or information that may have arisen since outside of an in-person evaluation. The existence of supplemental reports allows a QME to defer on any premature conclusions and request further evaluation, treatment, and records prior to making medicolegal determinations. Should you ever have any questions regarding your first supplemental, your team at OrthoLegal is always happy to assist.