11. Labor code sections relevant to QME’s 1 Flashcards
What is the role of the administrative director regarding qualified medical evaluators (QMEs) according to Labor Code Section 139.2?
The administrative director is responsible for appointing qualified medical evaluators in various specialties required for evaluating medical-legal issues. Appointments are made for two-year terms.
What qualifications must a physician meet to be appointed or reappointed as a qualified medical evaluator in California?
A physician must be licensed to practice in California and demonstrate that they meet the following requirements: paragraphs 1 2 6 and 7. If the physician is a medical doctor doctor of osteopathy doctor of chiropractic or psychologist they must also meet applicable requirements in paragraphs 3 4 or 5.
What are the paragraphs that a physician must meet for appointment as a qualified medical evaluator?
The physician must meet the requirements in paragraphs 1 2 6 and 7 and for medical doctors and other specified physicians they must also satisfy the requirements outlined in paragraphs 3 4 or 5.
What is the examination requirement for physicians prior to their appointment as a qualified medical evaluator?
Prior to their appointment the physician must pass an examination that is written and administered by the administrative director which is designed to demonstrate their competence in evaluating medical-legal issues.
How often are the appointments of qualified medical evaluators made according to Labor Code Section 139.2?
The appointments of qualified medical evaluators are made for two-year terms.
Define ‘qualified medical evaluator’ as per California Labor Code.
A qualified medical evaluator is a physician who has been appointed by the administrative director to evaluate medical-legal issues and meet specific qualifications and examination requirements.
What happens if a physician fails to meet the requirements to be a qualified medical evaluator?
If a physician does not meet the requirements outlined for appointment as a qualified medical evaluator they cannot be appointed or reappointed thereby disqualifying them from serving in that capacity.
What is the purpose of the evaluation conducted by a qualified medical evaluator?
The purpose of the evaluation conducted by a qualified medical evaluator is to address medical-legal issues which are often related to issues such as injury assessment and determining the extent of physical impairment.
What sections of the Labor Code relate to the definitions and responsibilities of a qualified medical evaluator?
Labor Code Section 139.2 specifically addresses the appointment and requirements of qualified medical evaluators.
As of January 01 2023 which section of the Labor Code outlines the qualifications for qualified medical evaluators?
As of January 01 2023 Labor Code Section 139.2 outlines the qualifications for qualified medical evaluators.
What is the requirement for physicians seeking appointment as qualified medical evaluators on or after January 1 2001?
Physicians must complete a course on disability evaluation report writing approved by the administrative director before their appointment.
What is the minimum duration of instruction required for the disability evaluation report writing course specified by the administrative director?
The course must include 12 or more hours of instruction.
What is one of the eligibility criteria for a physician to be appointed as a qualified medical evaluator?
A physician must devote at least one-third of their total practice time to providing direct medical treatment or have served as an agreed medical evaluator on eight or more occasions in the 12 months prior to applying.
What type of medical degree must a physician possess to qualify as a qualified medical evaluator?
A physician must be a medical doctor (MD) or a doctor of osteopathy (DO).
Which board certifications are recognized for physicians applying to be qualified medical evaluators?
Physicians must be board certified in a specialty by a board recognized by the administrative director.
Is there an examination required for reappointment of physicians within the workers’ compensation system?
No physicians shall not be required to pass an additional examination as a condition of reappointment.
What is meant by ‘agreed medical evaluator’ in the context of workers’ compensation?
An agreed medical evaluator is a physician who has been mutually selected and agreed upon by the parties involved in a workers’ compensation case to assess the medical condition of an injured worker.
What roles does the administrative director play in the approval of the disability evaluation report writing course?
The administrative director specifies the curriculum to be covered by disability evaluation report writing courses and approves the courses for physician appointment.
What options does a physician have to fulfill the practice time requirement for becoming a qualified medical evaluator?
A physician can either devote at least one-third of their total practice time to providing direct medical treatment or serve as an agreed medical evaluator on eight or more occasions in the 12 months before applying.
Why is it important for physicians to receive training in disability evaluation report writing?
Training in disability evaluation report writing ensures that physicians can effectively communicate their medical findings and evaluations in a manner that meets the legal and procedural standards of the workers’ compensation system.
What are the eligibility criteria for a medical evaluator by the Medical Board of California or the Osteopathic Medical Board of California?
- Successfully completed a residency training program accredited by the Accreditation Council for Graduate Medical Education or its osteopathic equivalent. 2. Was an active qualified medical evaluator on June 30 2000. 3. Holds qualifications deemed equivalent to board certification in a specialty by the administrative director and either the Medical Board or the Osteopathic Medical Board of California.
What is the significance of the date June 30 2000 for qualified medical evaluators?
The date June 30 2000 is significant because it marks the cutoff for being an active qualified medical evaluator in California to qualify under certain eligibility criteria set by medical boards.
What requirements must a doctor of chiropractic meet to be certified in California workers’ compensation evaluation?
A doctor of chiropractic must be certified in California workers’ compensation evaluation by a provider recognized by the administrative director. The certification program must include instruction on disability evaluation report writing that meets specific standards.
What are the qualifications required for psychologists to meet the standards set by the administrative director for medical evaluation?
- Board certification in clinical psychology by a board recognized by the administrative director. 2. Alternatively qualifications that demonstrate a recognized level of expertise in clinical psychology.
What is the role of the Accreditation Council for Graduate Medical Education (ACGME)?
The Accreditation Council for Graduate Medical Education (ACGME) is responsible for accrediting residency training programs for physicians ensuring those programs meet specific educational standards that prepare residents for the practice of medicine.
How does the Medical Board of California determine equivalence to board certification for specialties?
The equivalence to board certification is determined by the administrative director in conjunction with either the Medical Board of California or the Osteopathic Medical Board of California which assesses the qualifications presented.
What is the function of the administrative director concerning medical evaluators?
The administrative director oversees the certification and training of medical evaluators sets standards for workers’ compensation evaluation certifications and recognizes training providers.
Can a psychologist who does not hold board certification still qualify as a medical evaluator?
Yes a psychologist can qualify as a medical evaluator if they meet alternative qualifications that demonstrate expertise in clinical psychology and are recognized by the administrative director.
What is the educational requirement for licensure by the Board of Psychology according to Section 2914 of the Business and Professions Code?
A doctoral degree in psychology or a doctoral degree deemed equivalent for licensure by the Board of Psychology.
How many years of postdoctoral experience are required for licensure under the Board of Psychology?
A minimum of five years’ postdoctoral experience in the diagnosis and treatment of emotional and mental disorders.
What experience is needed to serve as an agreed medical evaluator prior to January 1 1990?
The individual must have served as an agreed medical evaluator on eight or more occasions.
What is a key requirement related to conflicts of interest for licensure by the Board of Psychology?
The individual must not have a conflict of interest as determined under the regulations adopted by the administrative director.
What kind of additional standards may be imposed for licensure by the Board of Psychology?
Any additional medical or professional standards adopted pursuant to paragraph 6 of subdivision j of the regulations.
What type of physicians can the administrative director appoint according to the regulations?
The administrative director shall adopt standards for the appointment of physicians who are retired or who hold teaching positions.
What is the role of the administrative director in relation to the Board of Psychology’s licensure requirements?
The administrative director is responsible for adopting relevant regulations and standards for the appointment of licensed professionals and ensuring they meet the qualifications outlined in the Business and Professions Code.
What does postdoctoral experience in psychology typically involve?
Postdoctoral experience generally involves providing clinical services engaging in research activities and potentially supervising or mentoring other professionals in the diagnosis and treatment of emotional and mental disorders.
Why is it important for medical evaluators to be free of conflicts of interest?
It is important to ensure that evaluations are objective unbiased and solely in the interest of patient care and legal fairness avoiding any personal or financial interests that could affect their judgment.
What are the qualifications necessary for a physician to serve as a qualified medical evaluator (QME) according to subdivision b?
A physician must meet specific qualifications detailed in subdivision b which ensures they are competent to evaluate workers’ compensation cases but the text does not list them explicitly.
Can a physician whose full-time practice is limited to forensic evaluation of disability be appointed as a QME?
No a physician whose full-time practice is limited to the forensic evaluation of disability shall not be appointed as a qualified medical evaluator.
What must a qualified medical evaluator do if they wish to be reappointed?
Upon request a qualified medical evaluator shall be reappointed if they meet the qualifications of subdivision b and comply with specific criteria.
List the criteria that must be met for a qualified medical evaluator to be reappointed.
- The evaluator must be in compliance with all applicable regulations and evaluation guidelines adopted by the administrative director. 2. The evaluator must have no more than five evaluations considered by a workers’ compensation administrative law judge rejected in a contested hearing during the most recent two-year period of serving as a QME.
What happens if a qualified medical evaluator has more than five evaluations rejected within two years?
If a qualified medical evaluator has more than five of their evaluations rejected by a workers’ compensation administrative law judge or appeals board during the most recent two years they would not be eligible for reappointment.
What is the relevance of a workers’ compensation administrative law judge’s decision in evaluating a QME’s performance?
The workers’ compensation administrative law judge’s decision is relevant as it can affect the QME’s eligibility for reappointment based on the number of rejected evaluations.
What is a ‘contested hearing’ in the context of workers’ compensation?
A contested hearing is a legal proceeding where disputes regarding workers’ compensation claims are resolved often involving challenges to the evaluations or decisions made in the claims process.
How often must the evaluation guidelines for QMEs be updated and adopted?
The frequency for the update and adoption of evaluation guidelines is not specified in the text but they should comply with current applicable regulations.
Who has the authority to adopt evaluation guidelines for qualified medical evaluators?
The administrative director has the authority to adopt evaluation guidelines for qualified medical evaluators.
What is the purpose of having qualifications and evaluation guidelines for QMEs?
The purpose is to ensure that the medical evaluations provided are reliable meet a standard of quality and are performed by qualified professionals to uphold the integrity of the workers’ compensation system.
What criteria allows a medical evaluator’s report to be rejected by the administrative law judge or the appeals board?
A qualified medical evaluator’s report can be rejected if it fails to meet the minimum standards for those reports as established by the administrative director or the appeals board.
What must the workers’ compensation administrative law judge or the appeals board provide upon rejecting a medical evaluator’s report?
Upon rejection of the report the judge or appeals board must make a specific finding that the report does not meet established standards and must give notice to both the medical evaluator and the administrative director.
How is the rejection of a qualified medical evaluator’s report treated regarding the count of qualifying rejections?
Any rejection of the report shall not be counted as one of the five qualifying rejections until the specific finding has become final and the time for appeal has expired.
What requirement must a medical evaluator meet concerning continuing education for impairment evaluation?
A qualified medical evaluator must have completed at least 12 hours of continuing education in impairment evaluation or workers’ compensation-related medical dispute evaluation within the previous 24 months.
What disciplinary actions must a qualified medical evaluator NOT have faced in their most recent term?
The medical evaluator must not have been terminated suspended placed on probation or otherwise disciplined by the administrative director during their most recent term.
What does a ‘specific finding’ entail when a qualified medical evaluator’s report is rejected?
A specific finding is a formal determination made by the workers’ compensation administrative law judge or the appeals board indicating that the medical evaluator’s report does not meet the criteria set forth by the administrative director or the appeals board.
What is the role of the administrative director concerning qualified medical evaluator statuses?
The administrative director sets the minimum standards for medical evaluator reports oversees compliance and has the authority to discipline evaluators based on performance and adherence to regulations.
What is the role of the administrative director regarding the reappointment of an evaluator?
The administrative director has the discretion to reappoint or deny reappointment of an evaluator if they do not meet specific criteria as outlined in regulations.
Under what conditions can the administrative director suspend or terminate a qualified medical evaluator during their term?
The administrative director may suspend or terminate a qualified medical evaluator without a hearing if: 1. The evaluator’s license to practice in California is suspended revoked or terminated by the relevant licensing authority. 2. The evaluator has failed to pay the required fee in a timely manner as defined in subdivision n.
What must the administrative director provide to a physician upon request regarding termination or reappointment?
The administrative director shall furnish the physician with a written statement detailing the reasons for termination or for denying appointment or reappointment.
What happens if an evaluator fails to comply with the fee requirements?
If an evaluator fails to timely pay the fee required by the administrative director it can lead to suspension or termination of their appointment.
What can lead to the revocation or suspension of an evaluator’s license?
An evaluator’s license may be suspended or revoked by the relevant licensing authority preventing them from practicing.
Can the administrative director deny reappointment without providing a rationale?
No the administrative director must provide a written statement of reasons for denying reappointment or terminating the evaluator upon request.
Is a hearing required for the suspension or termination of a qualified medical evaluator under certain conditions?
No the administrative director can suspend or terminate an evaluator without a hearing if the evaluator’s license is suspended or if the required fee has not been paid.
What is the role of a qualified medical evaluator?
A qualified medical evaluator is responsible for conducting comprehensive medical evaluations in workers’ compensation cases. They assess the medical status of injured employees and provide an impartial opinion regarding their condition and ability to return to work.
