April 28, 2025 | JacobiJournal.com — Demand for medical evaluators in California’s workers’ compensation system continues to climb, revealing a growing gap between available resources and case volume. Although the state has seen a 16% increase in qualified medical evaluators (QMEs) since 2019, the latest report shows that the demand for medical evaluators is rising at an even faster pace. This imbalance is leaving injured workers, employers, and claims administrators grappling with longer delays in the resolution of disputes.
Evaluator Numbers Rise After Payment Structure Reform
According to an analysis by the California Workers’ Compensation Institute (CWCI), the number of state-certified evaluators climbed from 2,561 in 2019 to 2,972 in 2024. Much of this growth followed the 2021 overhaul of California’s medical-legal fee schedule.
Previously, medical-legal evaluations operated under a complex three-tiered payment system. However, reforms introduced a flat fee model with additional compensation for record reviews and certain specialties. These changes were designed to improve financial incentives and attract more physicians to meet the rising demand for medical evaluators statewide.
Demand Surges Despite More Evaluators
Nevertheless, panel requests — which are filed when disputes arise over issues like injury causation, disability levels, or treatment plans — grew even faster than the evaluator pool. Between 2019 and 2024, panel requests jumped by 17%, and from 2021 to 2024 alone, they surged by 32.7%, CWCI reported.
Thus, while the evaluator workforce expanded, the intensified demand has undercut availability gains, leaving injured workers and claims administrators grappling with longer wait times.
Specialty Shortages Create Additional Strains
The report further highlights that although some specialties added more evaluators, they still struggled to meet rising panel demands. For example:
- Internal medicine evaluators grew by 28%, yet demand for their services increased even faster.
- Neurology, psychiatry, chiropractic, and psychology all saw disproportionate rises in panel requests per evaluator.
Worryingly, psychology was the only specialty where evaluator numbers actually declined, dropping 8% over the six-year span.
These specialty shortages signal deeper systemic pressures, particularly in mental health-related evaluations where claims complexity often requires specialized expertise.
Outlook: Reform Efforts Must Continue
The CWCI analysis underscores that payment structure reforms, while necessary, are not sufficient on their own. Additional measures may be needed to ensure timely access to qualified evaluators, especially as the demand for medical evaluators continues to grow and workers’ compensation disputes become more intricate and medically complex.
Source: CWCI
FAQs: Demand for Medical Evaluators in California
Why is the demand for medical evaluators increasing in California?
Disputes over injury causation, disability, and treatment plans have surged, driving a sharp rise in panel requests for qualified medical evaluators.
Which specialties face the biggest shortages in California’s workers’ comp system?
Specialties like psychology, neurology, psychiatry, and internal medicine face high demand, with psychology evaluator numbers actually declining.
How is California addressing the shortage of medical evaluators?
Reforms to the medical-legal fee schedule aim to improve participation, but experts say additional measures are needed to meet growing demand.
What impact does the shortage of evaluators have on injured workers?
Limited access to evaluators often leads to longer wait times, delaying case resolutions and potentially prolonging recovery periods for injured workers.
Where can I find official information about this?
The California Division of Workers’ Compensation (DWC) provides official updates, guidelines, and resources for medical evaluators at the Department of Industrial Relations website.
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