11 Labor code sections relevant to QME’s 2 Flashcards
What is the process following a physician’s statement of reasons for non-appointment or termination?
Upon receipt of the physician’s response to the statement of reasons the administrative director reviews the decision regarding the non-appointment or termination of the physician and must notify the physician of the final decision within 60 days.
What agreements must the administrative director establish with medical evaluators?
The administrative director must establish agreements with qualified medical evaluators to ensure that cases assigned to them are evaluated in an expeditious manner allowing for timely assessments.
What is the time frame for assigning three-member panels of qualified medical evaluators?
When requested by an employee or employer the medical director must assign three-member panels of qualified medical evaluators within five working days after receiving the request.
What kind of cases are prioritized for panel assignment of qualified medical evaluators?
Preference in assigning panels will be given to cases in which the employee is not represented by legal counsel.
What happens if a panel of qualified medical evaluators is not assigned within a specific time frame?
If a panel is not assigned within 20 working days the employee may experience delays in the evaluation process which could impact their benefits and return-to-work process.
What section outlines the process for requesting a panel of qualified medical evaluators?
The process for requesting a panel of qualified medical evaluators is outlined in Section 4062.1.
What section outlines the appointment of the medical director responsible for assigning panels?
The appointment of the medical director who is responsible for assigning panels of qualified medical evaluators is outlined in Section 122.
What right does an employee have regarding medical evaluations?
An employee shall have the right to obtain a medical evaluation from any qualified medical evaluator of his or her choice within a reasonable geographic area.
What method does the medical director use to assign panels of qualified medical evaluators?
The medical director shall use a random selection method for assigning panels of qualified medical evaluators.
How does the medical director select qualified medical evaluators?
The medical director shall select evaluators who are specialists of the type requested by the employee.
What advice is given to the employee regarding the selection of a specialist?
The medical director shall advise the employee that he or she should consult with his or her treating physician prior to deciding which type of specialist to request.
What is the purpose of the form promulgated by the administrative director?
The form notifies the employee of the physicians selected for his or her panel after a request has been made pursuant to Section 4062.1 or 4062.2.
What information must the notification form include for each physician on the panel?
The form must include the physician’s name address telephone number specialty number of years in practice and a brief description of his or her education and training.
What sections are referenced in connection with employee requests for a physician panel?
The sections referenced are Section 4062.1 and Section 4062.2.
What is the role of the medical director in the selection of evaluators?
The medical director’s role is to select qualified medical evaluators randomly and ensure they are specialists relevant to the employee’s medical needs.
What is the significance of a ‘reasonable geographic area’ in the context of medical evaluations?
The term ‘reasonable geographic area’ ensures that the employee has access to qualified medical evaluators without being unduly burdened by travel or distance.
Why is it important for the employee to consult with their treating physician before selecting a specialist?
Consulting with the treating physician allows the employee to make an informed decision on which type of specialist is most appropriate for their medical evaluation needs.
What entitlements does an employee have regarding transportation expenses and temporary disability for medical examinations?
An employee is entitled to receive transportation expenses and temporary disability for each day necessary for the examination.
What must be stated clearly on the form regarding consulting rights for employees?
The form must clearly state: ‘You have the right to consult with an information and assistance officer at no cost to you prior to selecting the doctor to prepare your evaluation or you may consult with an attorney.’
What should employees be aware of if their claim goes to court?
If the claim goes to court the workers’ compensation administrative law judge will consider the evaluation prepared by the doctor selected by the employee to decide the claim.
What are the three criteria for selecting qualified medical evaluators?
- Conflict of Interest: The evaluator must not have a conflict of interest in the case as defined by regulations. 2. Certification: The evaluator must be certified. 3. Location: The evaluator must be located in a manner that meets regulatory requirements.
What does the term ‘Conflict of Interest’ refer to in the context of selecting evaluators?
In this context ‘Conflict of Interest’ refers to a situation where the evaluator may have a personal or financial interest that could compromise their objectivity or impartiality in assessing the employee’s claim.
Who compiles the list of qualified medical evaluators?
The medical director is responsible for compiling the list of qualified medical evaluators.
What is the importance of being certified as a medical evaluator?
Certification ensures that the evaluator possesses the necessary qualifications and adheres to the standards required to provide reliable and objective evaluations.