Telehealth for Workers’ Compensation

The Division of Workers’ Compensation (DWC) in the CA.Department of Industrial Relations https://www.dir.ca.gov/dwc/dwc_home_page.htm, is there to provide care for injured workers during the COVID-19 pandemic.

DWC encourages all parties to consider creative solutions appropriate to providing care to injured workers and is considering increasing the use of telehealth services to help provide medical treatments.

The California Business and Profession Code section 2290.5 requires that the healthcare provider initiating the use of telehealth shall inform the patient on the use of telehealth and then obtain verbal or written consent from the patient.

DWC is currently evaluating the use of telemedicine for “Qualified Medical Examination” (QME) evaluations and will continue to do so. The use of telemedicine for a QME evaluation may be appropriate when all parties can agree that there is a medical issue in dispute.

The dispute needs to involve whether or not the injury is “Arising out of Employment (AOE)/Course of Employment (COE)”. All parties including the physician then have to agree to a telemedicine evaluation in order to resolve the dispute.

In another state situation, Texas, Governor Greg Abbott https://www.tdi.texas.gov has declared COVID-19 a statewide public health disaster and as a result, healthcare providers are urged to expand the use of technology to provide care while limiting community spread.

Texas DWC rules allow for the billing and reimbursement of certain telemedicine and telehealth services related to workers’ compensation. Injured employees may receive these services regardless of their geographic location.

As for the requirement for payment in Texas, an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the injured employee must be used.

The state requires telemedicine services must be within the healthcare provider’s scope of practice and licensing requirement, adhere to the rules of the healthcare provider’s licensing board, meet the standard of care requirements, and adhere to DWC rules as related to telemedicine and telehealth.

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