July 1, 2024

3 Most Common Reporting Flaws and Ways to Avoid Them

by John Kamin
Defense Attorney and Partner at Bradford & Barthel

Inaccurate job descriptions, failure to discuss significant records, and conclusory reasoning are three of the most frequent problems that occur in QME reports, all of which are entirely avoidable.
There are many qualified medical evaluators in the California workers’ compensation system who have good intentions and are capable of writing good reports, but there are few mistakes that are easy to make that lead to additional confusion, reporting, depositions, and litigation. In this post, we will address the most common things that are easy to overlook and how to write better reports.


The Problem
: Applicants with an axe to grind definitely will exaggerate their job duties to a panel-qualified medical evaluator. This especially applies to applicants who have filed post-termination claims and are eager to do whatever they can to create liability for the employer who fired them.
For example, one applicant who was an ex-con, who used as many as 10 different names and identities, told a well-meaning orthopedic surgeon QME that he lifted boxes that weighed 100 lbs. approximately 200 times a day during an 8-hour shift. Obviously, that’s a lot of heavy lifting.
What wasn’t so obvious was that was really far from the truth. The applicant was actually lifting 25-lb boxes most of the day, and 40-lb boxes the rest of the day. Anything more than 50-lbs., two employees were supposed to lift together.
When the QME learned this he changed his reporting. The difference between the two

The Solution: Your humble blogger recently received a report from a QME who avoided this trap – he noticed a discrepancy between the applicant’s job duties that he wrote down, and what the applicant said. The good doctor then verbally asked the applicant multiple detailed questions about the applicant’s daily job duties. This impacted his reporting significantly.
In short, the applicant had been working a desk job for 7 years and got promoted to the low-impact desk job after doing some heavier work. The QME’s questioning led him to identify the correct job duties and job description, and both parties agreed that his reporting was accurate. That helped get the case set for trial and the parties reached a reasonable settlement.


The Problem
: The defendant sends a QME 500 to 2,000 pages of subpoenaed records (SDT records), which the QME reviews, yet fails to mention in the discussion section of their report. This leads defendant adjusters and employers wondering if the QME even received the subpoenaed records showing concurrent employment or preexisting injuries.
As a result, I, the defense attorney, will have to request a supplemental report or set the QME’s deposition.
For example, a QME reviewed 650 pages of subpoenaed records showing a preexisting industrial injury for the same body part at issue in our case, yet wrote in his report that applicant denied any preexisting injuries or any prior employment whatsoever. The client immediately wondered if the QME just billed us for those records and didn’t actually review them.

The Solution: QMEs can avoid this problem by mentioning very important facts in their discussion section of their report. For instance, this might include preexisting injuries, concurrent employment, subsequent employment, or facts that are contrary to applicant’s narrative.
The parties don’t necessarily need tons of text dedicated to that – the QME just needs to acknowledge that they reviewed records that are contrary to the applicant’s narrative in their discussion paragaphs, or alternatively in the causation or apportionment sections.
This also isn’t to say that QMEs need to go deep into the weeds of subissues and intricacies – but failure to mention a preexisting injury to the primary body part at issue in the discussion section will leave defense attorneys such as myself with no alternative but to set a QME’s deposition or request a supplemental report.


The Problem:
Failure to explain complex subjects in greater detail is a common problem in QME reporting.
For instance, some sections of the AMA Guides require certain objective criteria (ex: examination tests, diagnostics, etc) as precursors before a med-legal evaluator can use a higher level of impairment. When we review the report, the QME gave the higher level of impairment, but failed to mention that they observed the aforementioned criteria in the “examination” or “diagnostics” sections of the report.
When its clear that precursor criteria is missing, defendants will often ask their attorneys to either set a doctor deposition or obtain supplemental reporting.

The Solution: If the AMA Guides require criteria A, B, and C as precursors to the QME’s preferred level of impairment, a QME would be well-served by mentioning those criteria in the impairment section of the report, or the examination section of the report.
Other categories that sometimes require more detailed discussions are causation, apportionment, work restrictions, or future medical care. While topics like work restrictions may seem a little mundane, it can quickly create problems if the restrictions are not adequately explained.

Got a question about workers’ compensation defense issues or med-legal reporting? Feel free to contact John Kamin. Mr. Kamin is a workers’ compensation defense attorney and partner at Bradford & Barthel’s Woodland Hills location, where he monitors the recent legislative affairs as the firm’s Director of the Editorial Board. Mr. Kamin previously worked as a journalist for WorkCompCentral, where he reported on work-related injuries in all 50 states. Please feel free to contact John at jkamin@bradfordbarthel.com or at (818) 654-0411.