11 Labor code sections relevant to QME’s 3

Question 1

What type of evaluations does the document mention?

Answer 1

Medical-legal evaluations.

Question 2

What might constitute ‘other evaluation procedures’ according to the document?

Answer 2

Any procedure requested by the Insurance Commissioner or deemed appropriate by the administrative director.

Question 3

What is Section 5307.1 associated with?

Answer 3

It relates to the definition and valuation of treatment procedures.

Question 4

Why is adherence to guidelines important in psychiatric evaluations and treatments?

Answer 4

Adherence ensures standardized care facilitates consistent patient management and helps in the legal evaluation process.

Question 5

What are the standards a medical evaluator must meet for appointment reappointment or maintenance of status?

Answer 5

A medical evaluator must meet specific standards set by the administrative director regarding statutory and administrative duties adherence to medical procedures compliance with timeframe standards and the requirements outlined in subdivisions b or c.

Question 6

What actions can the administrative director take against a qualified medical evaluator?

Answer 6

The administrative director may suspend or terminate the privilege of a physician to serve as a qualified medical evaluator based on substantial evidence of violation of duties failure to follow medical procedures non-compliance with timeframes or failure to meet minimum reporting standards.

Question 7

What constitutes a violation of a medical evaluator’s duties?

Answer 7

A violation may include failing to adhere to material statutory or administrative duties neglecting to follow established medical procedures or submitting evaluations that do not meet legal standards.

Question 8

What are subdivisions j and its relevance to medical evaluators?

Answer 8

Subdivision j establishes medical procedures qualifications and timeframe standards that medical evaluators must comply with. Failure to comply can lead to suspension or termination of evaluator privileges.

Question 9

What are the potential consequences for not following timeframe standards as a medical evaluator?

Answer 9

Failure to comply with timeframe standards may result in disciplinary actions by the administrative director including suspension or termination of the evaluator’s status.

Question 10

What is the significance of preparing medical-legal evaluations to the standards established by the administrative director?

Answer 10

Medical-legal evaluations must meet minimum standards set by the administrative director; failure to do so could lead to the evaluator being suspended or their privileges revoked.

Question 11

What are the subdivisions and paragraphs referenced that outline the responsibilities of a medical evaluator?

Answer 11

Subdivisions referenced include b c and j with paragraphs 2 3 4 and 5 of subdivision j specifically detailing the expectations and procedures medical evaluators must follow.

Question 12

What is the role of the administrative director in the oversight of medical evaluators?

Answer 12

The administrative director oversees the appointment and maintenance of medical evaluators ensuring they adhere to established standards and can impose sanctions for non-compliance.

Question 13

What is the process for a medical evaluator to contest a proposed action by the administrative director?

Answer 13

A medical evaluator can contest a proposed action through a hearing process as provided by subdivision 1 where substantial evidence is examined.

Question 14

What is evidence considered ‘substantial’ in the context of evaluating medical evaluators?

Answer 14

Substantial evidence refers to reasonable credible evidence that supports the administrative director’s determination of a medical evaluator’s non-compliance with established standards.

Question 15

Can the administrative director make discretionary decisions regarding a medical evaluator’s privileges?

Answer 15

Yes the administrative director has the discretion to suspend or terminate a medical evaluator’s privileges based on determinations of compliance and evidence of violations.

Question 16

What constitutes material misrepresentation in the context of appointment as a qualified medical evaluator?

Answer 16

Material misrepresentation refers to making false statements or failing to provide truthful information in the application process for appointment or reappointment as a qualified medical evaluator.

Question 17

What are the conditions under which a physician’s privilege to serve as a qualified medical evaluator can be suspended or terminated without a hearing?

Answer 17

A physician’s privilege can be suspended or terminated without a hearing if they either fail to timely pay the required fee or have their license to practice in California suspended or revoked by the licensing authority.

Question 18

What action does the administrative director take if a qualified medical evaluator is cited for a violation?

Answer 18

The administrative director will cite the qualified medical evaluator for a violation and will set a hearing on the alleged violation within 30 days of the citation being served.

Question 19

What violations fall under subdivision k related to qualified medical evaluators?

Answer 19

Subdivision k refers to specific violations that may include making false statements failing to adhere to ethical standards or any actions that compromise the integrity of the medical evaluator process.

Question 20

What is the time frame for setting a hearing after citing a qualified medical evaluator for a violation?

Answer 20

The hearing must be set within 30 days of service of the citation on the qualified medical evaluator.

Question 21

What authority does the administrative director have concerning qualified medical evaluators found in violation of subdivision k?

Answer 21

The administrative director has the authority to terminate or suspend a qualified medical evaluator upon finding a violation listed in subdivision k.

Question 22

What happens if a physician fails to timely pay the required fee as a qualified medical evaluator?

Answer 22

If a physician fails to timely pay the required fee their privilege to serve as a qualified medical evaluator may be suspended or terminated without a prior hearing.

Question 23

What implications does having a license suspended by the licensing authority have on a physician’s ability to serve as a qualified medical evaluator?

Answer 23

Having a license suspended by the relevant licensing authority precludes the physician from practicing and can lead to suspension or termination of their privilege to serve as a qualified medical evaluator without a hearing.

Question 24

What is the significance of the administrative director’s citations against qualified medical evaluators?

Answer 24

Citations from the administrative director indicate violations that can lead to serious repercussions including hearings and potential suspension or termination of the evaluator’s privileges.

Question 25

What authority does the administrative director have concerning qualified medical evaluators?

Answer 25

The administrative director may place a qualified medical evaluator on probation with appropriate conditions such as requiring continuing education or training.

Question 26

What must the administrative director do if a qualified medical evaluator is disciplined?

Answer 26

The administrative director must report the name of the disciplined qualified medical evaluator to the appropriate licensing board.

Question 27

Under what circumstances can the administrative director terminate a physician from the list of medical evaluators?

Answer 27

The administrative director can terminate a physician who has had their licensure terminated by the relevant licensing board who has been convicted of a misdemeanor or felony related to their medical practice or who has been convicted of a crime of moral turpitude.

Question 28

What happens if a physician is suspended or placed on probation by the relevant licensing board?

Answer 28

The administrative director is required to suspend or terminate that physician as a medical evaluator.

Question 29

What reporting requirements exist when a physician is suspended or terminated as a qualified medical evaluator?

Answer 29

If a physician is suspended or terminated a report prepared by that physician must be complete signed and furnished to one of the relevant parties.

Question 30

What is the term ‘moral turpitude’ in relation to medical evaluation?

Answer 30

Moral turpitude refers to conduct that is considered contrary to community standards of justice honesty or good morals and can lead to disciplinary action against medical professionals.

Question 31

What types of educational requirements might be assigned as a condition of probation for a medical evaluator?

Answer 31

Conditions of probation may include requiring the qualified medical evaluator to undergo continuing education or specific training to enhance their medical practice skills and knowledge.

Question 32

Can a suspended physician still practice as a qualified medical evaluator?

Answer 32

No a physician who has been suspended or placed on probation by the relevant licensing board cannot serve as a qualified medical evaluator.

Question 33

What actions might lead to disciplinary actions against qualified medical evaluators?

Answer 33

Actions that could lead to disciplinary measures include misconduct in medical practice non-compliance with licensing regulations or criminal convictions related to medical conduct.

Question 34

Why is it important for the administrative director to report disciplinary actions to licensing boards?

Answer 34

Reporting disciplinary actions ensures accountability maintains the integrity of the medical evaluation process and helps protect the public from unfit practitioners.

Question 35

What is the significance of the date of conviction in relation to the admissibility of prior reports in appeals board proceedings?

Answer 35

Any report from the parties prior to the date of conviction or action of the licensing board shall not be admissible in any proceeding before the appeals board.

Question 36

What is the liability for payment regarding reports incurred by a physician in connection with the report?

Answer 36

There shall be no liability for payment for the report and any expense incurred by the physician in connection with the report.

Question 37

What is the purpose of the fee paid by a qualified medical evaluator?

Answer 37

A qualified medical evaluator shall pay a fee for appointment or reappointment which is determined by the administrative director.

Question 38

How are the fees for qualified medical evaluators determined?

Answer 38

The fees are based on a sliding scale established by the administrative director.

Question 39

Where are the revenues from the fees paid by medical evaluators deposited?

Answer 39

All revenues from fees paid under this subdivision shall be deposited into the Workers' Compensation Administration Revolving Fund.

Question 40

What is the purpose of the revenues in the Workers' Compensation Administration Revolving Fund?

Answer 40

The revenues are available for expenditure upon appropriation by the Legislature and shall not be used for any other purpose other than administration of the programs of the Division of Workers' Compensation related to the provision of medical treatment to injured employees.

Question 41

Can an evaluator request or do anything that is not covered in the current regulations?

Answer 41

No the text indicates that an evaluator shall not request or do unspecified actions that fall outside the established guidelines.

Question 42

What does the code state regarding accepting compensation that could create a conflict of interest for evaluators?

Answer 42

The code prohibits evaluators from accepting any compensation or anything of value from any source that may create a conflict with their duties as an evaluator.

Question 43

Who is responsible for adopting regulations to implement the subdivision related to conflicts of interest for evaluators?

Answer 43

The administrative director after consultation with the Commission on Health and Safety and Workers' Compensation is responsible for adopting regulations to implement this subdivision.

Question 44

What is the focus of California Labor Code Sections 4060-4068?

Answer 44

These sections relate to the determination of medical issues particularly concerning disputes over the compensability of injuries.

Question 45

When does Section 4060 not apply regarding workplace injuries?

Answer 45

Section 4060 does not apply when an injury to any part or parts of the body is accepted as compensable by the employer.

Question 46

Who is liable for comprehensive medical-legal evaluations according to Section 4060?

Answer 46

Neither the employer nor the employee shall be liable for any comprehensive medical-legal evaluation performed by someone other than the treating physician except as otherwise provided in Section 4060.

Question 47

Are reports from treating physicians admissible in disputes over injury compensability?

Answer 47

Yes reports from treating physicians are admissible.

Question 48

In what situation might a medical evaluation be required in the context of workplace injury disputes?

Answer 48

A medical evaluation may be required to determine compensability at any time after the filing of the injury claim.

Question 49

What does 'compensability' mean in the context of labor disputes?

Answer 49

Compensability refers to whether an injury is subject to compensation under workers' compensation law.

Question 50

What is the role of the administrative director in the context of Section 4060?

Answer 50

The administrative director's role includes consulting with the Commission on Health and Safety and Workers' Compensation to adopt regulations that implement the provisions regarding evaluators and conflicts of interest.

Question 51

What is the procedure for obtaining a medical evaluation to determine compensability when the employee is represented by an attorney?

Answer 51

A medical evaluation to determine compensability shall be obtained only by the procedure provided in Section 4062.2.

Question 52

What actions must an employer take if a medical evaluation is needed after the claim form is filed and the employee is not represented by an attorney?

Answer 52

The employer must provide the employee with notice that either the employer requests a comprehensive medical evaluation to determine compensability or that the employer has not accepted liability and the employee may then request a comprehensive medical evaluation.

Question 53

Can either party request a comprehensive medical evaluation to determine compensability?

Answer 53

Yes either party may request a comprehensive medical evaluation to determine compensability.

Question 54

What section outlines the procedure for obtaining a comprehensive medical evaluation?

Answer 54

The evaluation shall be obtained only by the procedure provided in Section 4062.1.

Question 55

What must each notice required under subdivision d include?

Answer 55

Each notice must describe the administrative procedures available to the injured employee and advise the employee of his or her right to consult an information and assistance officer.

Question 56

What role does Section 4062.2 play in the medical evaluation process?

Answer 56

Section 4062.2 provides the specific procedure for obtaining a medical evaluation when the employee is represented by an attorney.

Question 57

What options does an employee have if the employer has not accepted liability for a claim?

Answer 57

If the employer has not accepted liability the employee may request a comprehensive medical evaluation to determine compensability.

Question 58

What does Section 4062.1 detail?

Answer 58

Section 4062.1 details the procedures for obtaining a comprehensive medical evaluation to determine compensability applicable to requests from either party.