Medical Unit
The Medical Unit performs a variety of services related to delivery of medical benefits in the workers' compensation system. It establishes policy and guidelines for the treatment and evaluation of injured workers. The unit examines and appoints physicians to be qualified medical evaluators (QMEs), who in turn examine injured workers to help determine the level of benefits they receive. It also certifies and oversees groups -- medical provider networks (MPNs) and health care organizations (HCOs) -- that provide care to injured workers. The unit reviews utilization review (UR) plans and handles UR complaints and investigations jointly with the Audit Unit. The unit oversees the independent medical review (IMR) and independent bill review (IBR) programs used to resolve disputes about medical treatment and medical-legal billing. It also assists the DWC administrative director with other issues affecting providers in the workers' compensation system, such as setting medical fee schedules, and undertakes medical care studies.
Medical Unit Programs:
- e-billing
- Health care organizations (HCO)
- Independent Bill Review (IBR)
- Independent medical review (IMR)
- Medical provider network (MPN)
- Medical treatment utilization schedule (MTUS)
- Medical treatment utilization schedule - drug formulary
- Official medical fee schedule (OMFS)
- Qualified medical evaluator (QME)
- Standardized paper billing
- Utilization review (UR)
Online physician education courses
now Available
Resources:
Database:
- Electronic Reporting System for Doctor’s First Report of Injury
- Online QME Form 106 Panel Request
For injuries on or after 1/1/05, online only as of Oct. 1, 2015 - Qualified medical evaluator (QME) database
- Areas of Expertise by QME Specialty for MD and DO Physicians Performing QME Evaluations
- Areas of Expertise by QME Specialty for Non-MD/DO
Frequently asked questions:
- FAQs on QMEs for injured workers
- FAQs on QMEs for insurers
- FAQs on QMEs for physicians
- FAQs about independent bill review (IBR)
- FAQs about independent medical review (IMR)
Forms
- Additional panel request - for use when requesting an additional QME panel - QME regulation 31.7
- Replacement panel request - for use when requesting a replacement QME panel - QME regulation 31.5
- Request For QME panel under Labor Code Section 4062.1 - Unrepresented - QME 105 Instructions
- Solicitud De Panel De Evalua dor Medicó Calificado - Empleado sin representación legal Instrucciones
- Request For QME panel under Labor Code Section 4062.2 - for injuries occurring prior to 1/1/05 - Represented Instructions
NOTE: For injuries on or after 1/1/05, online only as of Oct. 1, 2015. No paper submissions postmarked after Sept. 3, 2015. - QME 106
more QME forms
| Medical Unit Office: | |
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| Mailing Address: DWC - Medical Unit P.O. Box 71010 Oakland, CA 94612 |
Street Address: DWC - Medical Unit 1515 Clay Street, 18th floor Oakland CA 94612 |
| Telephone Number: 510-286-3700 or 800-794-6900 |
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| PLEASE NOTE: ALL PACKAGES, CERTIFIED MAIL AND PRIORITY MAIL MUST BE SENT TO THE STREET ADDRESS ONLY |
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What's New
- DWC Posts Adjustments to Official Medical Fee Schedule Inpatient Hospital Section to Conform to Medicare Changes
- DWC Posts Additional Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)
- DWC Issues Notice of 2nd 15-Day Public Comment Period for Rulemaking Action to Adopt Revisions to the Official Medical Fee Schedule (Pharmaceuticals)