Calif. settles with eight doctors in ‘underground regulations’ case


The California Division of Workers Compensation on Thursday settled with eight doctors who accused regulators of relying on “underground regulations” to its medical billing rules to deny their reappointment as qualified medical evaluators, an attorney representing the doctors confirmed Friday.

The division has “entered into meaningful and substantial settlements with our firm’s (eight) QME clients. Of great significance is that each settlement agreement states that the DWC will no longer be enforcing (four) billing categories that we argued, successfully, were underground regulations,” attorney Nicholas Roxborough, a Los Angeles-based partner at Roxborough, Pomerance, Nye & Adreani L.L.P. wrote in an email to Business Insurance.

Officials with the California Department of Industrial Relations did not return requests for comment.

In September 2017, several doctors sought a writ of mandate asking the California DIR, California DWC to cease and desist from enforcing improperly adopted regulations and to reappoint them as QMEs, which they were denied, according to documents in Dr. Timothy C. Howard, et al. v. California Department of Industrial Relations, et al.

Neither had ever received billing complaints from the DWC, according to documents.

QMEs are appointed for two-year terms in specialties required for the evaluation of medical issues. The DWC is obligated to reappoint QMEs who meet all the educational and other standards set forth by California Labor Code section 139.2 and who have not violated certain regulations after a due process hearing, according to case documents.

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