Personnel warns QME delays will frustrate new 75‑day decision window for presumptive sworn claims

The Personnel Department told the Personnel and Hiring Committee that recent state changes and statewide doctor scheduling delays are creating practical barriers to meeting a shortened decision timeline for presumptive sworn workers' compensation claims.

Tyrone Spears, chief of workers' compensation at the Personnel Department, said the state reduced the statutory decision window for presumptive claims from 90 to 75 days. Personnel staff told the committee that the change is difficult to meet because Qualified Medical Evaluator (QME) appointments can be delayed for months and medical‑legal reports can take another 45–90 days to produce.

Key points from staff and committee exchange: - Medical access and scheduling are the main bottlenecks. Personnel staff said QMEs and other specialists are scheduling four to six months out, and that obtaining the medical‑legal report can extend the timeline further. - Personnel said medical care is provided without interruption. For cancer claims the department has used group health plan coverage to avoid interrupting treatment and then reimburses the health plan if the workers' compensation claim is later accepted. For other injuries the city covers treatment during the delay up to the statutory threshold for medical payments, and then converts employee time back to workers' compensation pay if the claim is accepted. - Wage replacement is the primary delay that affects employees; while medical care can continue, employees often must use accrued sick or vacation time until claims are accepted. Staff said catastrophic leave banks, long‑term disability and other departmental supports can help employees who exhaust ordinary leave.

When the chair asked whether the city can meet the new 75‑day standard, personnel staff responded bluntly: the reduced window “just further compound[s] the problem” because scheduling and outside‑medical resources are outside the city's control.

Action: after discussion the committee moved to note and file the Personnel Department report. Councilmember McCosker, Councilmember Rodriguez and Councilmember Hutt voted to note and file the item.

Ending: staff said they will continue standing coordination meetings with department management and occupational safety teams and are available to answer questions from departments and bargaining units as claims are processed.