What Is 8 CCR §31.7: Additional QME Panel in a Different Specialty?

Once an Agreed Medical Evaluator, an Agreed Panel QME, or a panel Qualified Medical Evaluator has issued a comprehensive medical-legal report in a case and a new medical dispute arises, the parties, to the extent possible, shall obtain a follow-up evaluation or a supplemental evaluation from the same evaluator.

What is 8 CCR §31.7?

It is the rule that keeps you with the same medical evaluator for a new dispute, unless specific circumstances justify bringing in a new specialist instead.

This rule picks up after a QME, an Agreed Panel QME, or an Agreed Medical Evaluator (also called an AME) has already finished a full report in your case. It applies to represented and unrepresented workers alike. Each side follows a different path to request an additional panel, covered below.

Do you automatically get a new evaluator for a new medical issue?

No. The default is to go back to the evaluator you already have.

Say a new medical dispute comes up after your evaluator's report is filed. The parties are expected to ask that same doctor for a follow up opinion first. A supplemental opinion works the same way. This keeps one evaluator familiar with your whole case. It also avoids starting over every time a new issue appears. For how fast that follow up opinion must come back, see this site's guide to the supplemental report deadline. That page covers a separate Title 8 timing rule.

When do you qualify for a second specialty panel?

Only when one of four specific good cause reasons applies.

This rule limits an additional panel to four situations:

• A represented worker and the employer agree in writing that a new specialty is needed, and which one.
• An acupuncturist treating the worker refers the parties to the Medical Unit over a disputed disability issue.
• A workers' compensation judge orders the new panel, either naming the specialty or saying which side selects it.
• An unrepresented worker reaches agreement on the new specialty with a DWC Information and Assistance officer.

Outside those four situations, you return to the same evaluator for the new dispute.

How do you request the additional panel?

File Form 31.7 once you have one of the four good cause reasons documented.

Form 31.7 is the request the Medical Director uses to issue the additional panel. A represented worker typically attaches the written agreement described above, or the judge's order. An unrepresented worker needs the Information and Assistance officer's note that the parties agreed on a specialty. This site's guide to QME Forms 105 and 106 covers the paperwork for your first panel request. This additional panel process builds on that first request.

Who pays for the additional evaluation, and how does this connect to the rest of the QME process?

The employer generally pays, the same as for other medical-legal evaluations obtained this way.

Labor Code section 4064 makes the employer pay for each reasonable and necessary medical-legal evaluation obtained through the panel process in Labor Code sections 4060 through 4062. That includes an additional evaluation properly obtained under this rule's good cause process. Once a new specialty evaluator is assigned, Labor Code section 4062.3 still controls how records reach that evaluator. It also bars private contact outside the required written process. A related rule, 8 CCR 31.1, lets either side in a represented case ask a workers' compensation judge to step in if the Medical Director does not act on a panel request within 30 days.

Not sure if you need a new panel or a replacement panel?

An additional panel and a replacement panel solve different problems.

This rule only covers adding a new specialty after a report has already come back. Your real problem might instead be a conflict of interest, a scheduling delay, a move, or another listed defect with the panel or evaluator you currently have. This site's guide to replacing a QME panel or evaluator walks through those separate grounds under Form 31.5. It also explains how that form differs from Form 31.7.

What should you do if a new dispute comes up in your claim?

Document why the dispute needs a different specialty before you ask for a new panel.

Write down what changed, and keep your original evaluator's report. Gather any new medical evidence tied to the new dispute. If you are unrepresented, the DWC Information and Assistance Unit can help you reach an agreement on the record. If you already have a lawyer, or want help deciding whether this rule or a replacement panel fits your situation, call (661) 273-1780 or use the contact form for a free consultation. Yazdchi Law P.C. reviews each workers' compensation matter on its own facts before deciding whether to take it on.