October 6, 2025 | SIBTF.org — California’s Qualified Medical Evaluator (QME) system is facing one of its most severe backlogs in years, leaving injured workers and employers stuck in procedural limbo. The delays aren’t just slowing case resolution — they’re driving up cumulative liabilities for the Subsequent Injuries Benefits Trust Fund (SIBTF), where interest accrual and pending awards continue to mount.
Mounting QME Delays Ripple Through the System
Recent administrative reports show that average wait times for QME appointments now exceed 180 days in many regions. These delays, often tied to evaluator shortages and scheduling inefficiencies, have forced countless cases into extended holds.
Because SIBTF payments depend on final medical determinations of disability, each postponed evaluation delays claim closure, increasing exposure to additional payments, penalties, and administrative costs.
“Every extra month a QME report is pending means more interest accruing on cases that should already be resolved,” noted one case manager from Northern California. “It’s not legislative gridlock—it’s administrative paralysis.”
Financial Consequences for the SIBTF
The financial impact is twofold:
- Compounded interest on delayed awards. The longer cases remain unresolved, the more the Fund accrues in statutory interest obligations.
- Increased legal activity. Applicants’ attorneys are filing for penalties and expedited hearings, which in turn further strain the Division of Workers’ Compensation (DWC) calendar.
This feedback loop magnifies the SIBTF’s fiscal exposure, converting operational delays into measurable financial loss.
Why the Backlog Persists
Analysts cite a combination of retirements, evaluator attrition, and uneven regional assignment systems as major drivers of the backlog. Many QMEs are managing excessive caseloads, leading to months-long delays for even initial assessments.
Despite efforts by the DWC to expand the QME panel system, the rate of new evaluator certification has not kept pace with attrition, leaving the process under sustained pressure.
Administrative Solutions on the Table
State officials are now considering hybrid tele-evaluation programs and digital case-tracking tools to reduce the bottleneck. However, implementation could take months—time that the SIBTF may not have as its exposure continues to rise.
Learn more: Visit the Division of Workers’ Compensation for official guidance and updates on QME scheduling improvements.
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Read More from SIBTF.org:
- SIBTF Regulatory Changes 2025: Public Comment Period Opens
- Catastrophic Injury Cases Face New Hurdles Under AB 1329
- Regional Disparities: SIBTF Claim Patterns Differ Across California
FAQs: Delayed QME Evaluations
What is a Qualified Medical Evaluator (QME)?
A QME is a state-certified physician who evaluates an injured worker’s condition to determine disability ratings and apportionment in workers’ compensation cases.
How do delayed QME evaluations affect SIBTF exposure?
Each delay prolongs claim closure, increasing accrued interest, administrative costs, and potential legal penalties against the Fund.
What causes QME scheduling backlogs?
Backlogs stem from evaluator shortages, retirements, limited regional availability, and outdated scheduling systems within the DWC.
How can these delays be mitigated?
Expanding the QME roster, adopting telehealth evaluations, and implementing digital scheduling platforms can significantly reduce wait times.
What is SIBTF?
The Subsequent Injuries Benefits Trust Fund (SIBTF) helps California workers who suffer a new workplace injury and already had a prior disability. It offers supplemental compensation when combined impairments severely limit earning capacity.