Rising Panel Requests Challenge Gains from 2021 Payment Reforms
Demand for Medical Evaluators: Although California’s workers’ compensation system has seen a 16% increase in qualified medical evaluators (QMEs) since 2019, a new report reveals that demand for their services is growing even faster. As a result, the system remains strained despite efforts to attract more physicians.
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 aimed to improve financial incentives and bolster participation among physicians.
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 workers’ compensation disputes grow more intricate and medically complex.
Source: CWCI
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