While telehealth has become more common in Qualified Medical Evaluator (QME) practices—especially in psychiatry and psychology—QMEs who will only conduct evaluations via telehealth may be putting their QME certification at risk. Under California’s workers’ compensation regulations, telehealth is permitted only when all parties agree to a telehealth evaluation in writing. Without this written agreement from all required parties, the QME must be available for an in-person evaluation at the QME office location.
QMEs who have a policy to only perform evaluations by telehealth, and who refuse to perform in-person evaluations when parties do not approve telehealth, may unintentionally violate state rules and risk discipline or removal as a QME.
🔍 The Written Consent Rule
Under 8 CCR § 46.3(a)(2)(D), telehealth may only be used to perform a QME evaluation if all parties agree in writing. Parties include:
- The injured worker
- The claims administrator or defense attorney
- The applicant’s attorney, if the worker is represented.
Even if the QME prefers telehealth, the evaluation cannot proceed via telemedicine unless all parties explicitly consents in writing. Are you ensuring that you have authorization in writing from all parties before proceeding with a telehealth evaluation?
❗ Refusing to Evaluate = A Regulatory Violation
Here’s where the risk escalates: 8 CCR § 35(c) limits the number of times a QME can decline to perform an evaluation to three refusals per 12-month period. Any refusal to evaluate a panel-assigned case—whether due to scheduling availability or lack of telehealth agreement—counts toward this limit.
If a QME refuses to evaluate an injured worker simply because the evaluation cannot be done via telehealth, this counts as a case refusal. Once a QME exceeds three refusals in a calendar year, they are in violation of DWC regulations and may face disciplinary consequences.
In practice, this means that QMEs who insist on telehealth-only, and refuse any in-person evaluations, can quickly be in violation of the regulations.
⚖️ Why This Matters for Compliance
The ability to accept and complete panel appointments is a core obligation of all QMEs. The DWC Medical Director expects QMEs to maintain active evaluation locations and provide services that comply with all procedural and regulatory requirements. By failing to offer an in-person option—or by proceeding to perform a telehealth evaluation without written consent—QMEs may be deemed noncompliant with their duties under 8 CCR § 34, § 36, and § 35.
🔗 The Bottom Line
California QME regulations are clear: without written consent from all parties, telehealth is not permitted. QMEs who structure their practice as telehealth-only are at serious risk of exceeding the three-refusal limit, making them susceptible to disciplinary action and putting their QME status in jeopardy.
✅QME Best Practices: Hybrid Availability
To remain compliant and minimize risk, QMEs should:
- Be available for in-person evaluations at a listed location if agreement for telehealth is not obtained.
- Always confirm telehealth consent in writing from all parties before performing a telehealth evaluation.