Telemedicine, can it work in California’s Workers’ Compensation System?

Many times, it’s difficult to tell the future when it comes to predicting the evolution of our ever evolving workers’ compensation system. However, this time, we may have a peek into the future of delivering timely and sufficient treatment and evaluations to injured workers, in a modern way. Many states are successfully using telemedicine, but California has long since been recognized as a “special” state, known for it’s labyrinth of “tracks” to navigate toward it’s objective to easily deliver reasonable and necessary medical treatment of industrial injuries and return an injured workers to work. There may be a solution on the horizon, or another kink in the tracks.  

Many states are successfully using telemedicine in their workers’ compensation programs. Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology. This topic is ripe for consideration in complicated California because telemedicine has been around for over four decades  and is on track to be  the 2nd fastest growing industry in the US. In fact, telehealth is predicted to grow exponentially over just the next five years according to industry experts.

How can telemedicine work to effectively treat work injuries? Analysts say that earlier intervention leads to lower costs, increased convenience, happier patients and shorter claim durations. The plan could reduce the use of traditional medicine keeping employees on site,  eliminating costly travel and lost productivity. Moreover,  proponents say telemedicine improves communication between employees, employers and physicians, ensuring everyone is on the same page.  Even if telemedicine finds it’s niche in treating work injuries, is it appropriate for panel qualified panel evaluations? In the noteworthy Panel decision Gonzales v. ABM Industries, 2016 Cal. Wrk. Comp. P.D. LEXIS –, the WCAB panel, denying removal, affirmed the WCJ’s order instructing the Medical Director to replace the originally assigned qualified medical evaluator panel in the specialty of pain management, when the original panel included a  qualified medical evaluator who performed evaluations via telemedicine through the use of interactive audio, video, or data communications, and employed an unidentified designee, later revealed to be a chiropractic specialist, to conduct the physical examination portion of the evaluation while he was present only electronically. The WCAB concluded that it was questionable whether such a method of evaluation, where the evaluator was not physically present, complied with 8 Cal. Code Reg. § 49.2, requiring that the evaluation include no less than 20 minutes of “face to face” time, that Labor Code § 4628(a) prohibits any person other than the physician who signs the report from examining the injured worker, that failure of the original panel to identify the person or specialty of the physician actually examining the applicant deprived the parties of the opportunity to make an informed decision regarding the selection of a panel qualified medical evaluator, and that the defendant did not demonstrate that the issuance of a replacement panel caused substantial prejudice or irreparable harm so as to justify removal.  

Our eye is on the pulse of this developing issue that could dramatically change the landscape of the provision of treatment  and potentially qualified medical examinations. We are sure there is more to come on this evolving issue, as the legislature and courts are sure to develop regulations and rules to ensure complete, accurate, and timely treatment and evaluations, if telemedicine becomes the “new normal” in California.  One thing we can predict is that telemedicine could  further complicate the system that already has many feeling unclear as to whether the current system is meeting it’s primary objective in the speedy delivery of treatment and benefits, which should (but not reliably) lead to a shorter claims and litigation process. Proponents may well devise an efficient, reliable and successful system that unravels our state’s intertwined tracks, back to a simple system that takes us from point A to point B, in a straight line… or at least, less resembling that of a pretzel.