11 Labor code sections relevant to QME’s 3 Flashcards
What type of evaluations does the document mention?
Medical-legal evaluations.
What might constitute ‘other evaluation procedures’ according to the document?
Any procedure requested by the Insurance Commissioner or deemed appropriate by the administrative director.
What is Section 5307.1 associated with?
It relates to the definition and valuation of treatment procedures.
Why is adherence to guidelines important in psychiatric evaluations and treatments?
Adherence ensures standardized care facilitates consistent patient management and helps in the legal evaluation process.
What are the standards a medical evaluator must meet for appointment reappointment or maintenance of status?
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.
What actions can the administrative director take against a qualified medical evaluator?
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.
What constitutes a violation of a medical evaluator’s duties?
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.
What are subdivisions j and its relevance to medical evaluators?
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.
What are the potential consequences for not following timeframe standards as a medical evaluator?
Failure to comply with timeframe standards may result in disciplinary actions by the administrative director including suspension or termination of the evaluator’s status.
What is the significance of preparing medical-legal evaluations to the standards established by the administrative director?
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.
What are the subdivisions and paragraphs referenced that outline the responsibilities of a medical evaluator?
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.
What is the role of the administrative director in the oversight of medical evaluators?
The administrative director oversees the appointment and maintenance of medical evaluators ensuring they adhere to established standards and can impose sanctions for non-compliance.
What is the process for a medical evaluator to contest a proposed action by the administrative director?
A medical evaluator can contest a proposed action through a hearing process as provided by subdivision 1 where substantial evidence is examined.
What is evidence considered ‘substantial’ in the context of evaluating medical evaluators?
Substantial evidence refers to reasonable credible evidence that supports the administrative director’s determination of a medical evaluator’s non-compliance with established standards.
Can the administrative director make discretionary decisions regarding a medical evaluator’s privileges?
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.
What constitutes material misrepresentation in the context of appointment as a qualified medical evaluator?
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.
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?
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.
What action does the administrative director take if a qualified medical evaluator is cited for a violation?
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.
What violations fall under subdivision k related to qualified medical evaluators?
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.
What is the time frame for setting a hearing after citing a qualified medical evaluator for a violation?
The hearing must be set within 30 days of service of the citation on the qualified medical evaluator.
What authority does the administrative director have concerning qualified medical evaluators found in violation of subdivision k?
The administrative director has the authority to terminate or suspend a qualified medical evaluator upon finding a violation listed in subdivision k.
What happens if a physician fails to timely pay the required fee as a qualified medical evaluator?
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.
What implications does having a license suspended by the licensing authority have on a physician’s ability to serve as a qualified medical evaluator?
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.
What is the significance of the administrative director’s citations against qualified medical evaluators?
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.
What authority does the administrative director have concerning qualified medical evaluators?
The administrative director may place a qualified medical evaluator on probation with appropriate conditions such as requiring continuing education or training.
What must the administrative director do if a qualified medical evaluator is disciplined?
The administrative director must report the name of the disciplined qualified medical evaluator to the appropriate licensing board.
Under what circumstances can the administrative director terminate a physician from the list of medical evaluators?
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.
What happens if a physician is suspended or placed on probation by the relevant licensing board?
The administrative director is required to suspend or terminate that physician as a medical evaluator.
What reporting requirements exist when a physician is suspended or terminated as a qualified medical evaluator?
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.
What is the term ‘moral turpitude’ in relation to medical evaluation?
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.
What types of educational requirements might be assigned as a condition of probation for a medical evaluator?
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.
Can a suspended physician still practice as a qualified medical evaluator?
No a physician who has been suspended or placed on probation by the relevant licensing board cannot serve as a qualified medical evaluator.
What actions might lead to disciplinary actions against qualified medical evaluators?
Actions that could lead to disciplinary measures include misconduct in medical practice non-compliance with licensing regulations or criminal convictions related to medical conduct.
Why is it important for the administrative director to report disciplinary actions to licensing boards?
Reporting disciplinary actions ensures accountability maintains the integrity of the medical evaluation process and helps protect the public from unfit practitioners.
What is the significance of the date of conviction in relation to the admissibility of prior reports in appeals board proceedings?
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.
What is the liability for payment regarding reports incurred by a physician in connection with the report?
There shall be no liability for payment for the report and any expense incurred by the physician in connection with the report.
What is the purpose of the fee paid by a qualified medical evaluator?
A qualified medical evaluator shall pay a fee for appointment or reappointment which is determined by the administrative director.
How are the fees for qualified medical evaluators determined?
The fees are based on a sliding scale established by the administrative director.
Where are the revenues from the fees paid by medical evaluators deposited?
All revenues from fees paid under this subdivision shall be deposited into the Workers’ Compensation Administration Revolving Fund.
What is the purpose of the revenues in the Workers’ Compensation Administration Revolving Fund?
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.
Can an evaluator request or do anything that is not covered in the current regulations?
No the text indicates that an evaluator shall not request or do unspecified actions that fall outside the established guidelines.
What does the code state regarding accepting compensation that could create a conflict of interest for evaluators?
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.
Who is responsible for adopting regulations to implement the subdivision related to conflicts of interest for evaluators?
The administrative director after consultation with the Commission on Health and Safety and Workers’ Compensation is responsible for adopting regulations to implement this subdivision.
What is the focus of California Labor Code Sections 4060-4068?
These sections relate to the determination of medical issues particularly concerning disputes over the compensability of injuries.
When does Section 4060 not apply regarding workplace injuries?
Section 4060 does not apply when an injury to any part or parts of the body is accepted as compensable by the employer.
Who is liable for comprehensive medical-legal evaluations according to Section 4060?
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.
Are reports from treating physicians admissible in disputes over injury compensability?
Yes reports from treating physicians are admissible.
In what situation might a medical evaluation be required in the context of workplace injury disputes?
A medical evaluation may be required to determine compensability at any time after the filing of the injury claim.
What does ‘compensability’ mean in the context of labor disputes?
Compensability refers to whether an injury is subject to compensation under workers’ compensation law.
What is the role of the administrative director in the context of Section 4060?
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.
What is the procedure for obtaining a medical evaluation to determine compensability when the employee is represented by an attorney?
A medical evaluation to determine compensability shall be obtained only by the procedure provided in Section 4062.2.
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?
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.
Can either party request a comprehensive medical evaluation to determine compensability?
Yes either party may request a comprehensive medical evaluation to determine compensability.
What section outlines the procedure for obtaining a comprehensive medical evaluation?
The evaluation shall be obtained only by the procedure provided in Section 4062.1.
What must each notice required under subdivision d include?
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.
What role does Section 4062.2 play in the medical evaluation process?
Section 4062.2 provides the specific procedure for obtaining a medical evaluation when the employee is represented by an attorney.
What options does an employee have if the employer has not accepted liability for a claim?
If the employer has not accepted liability the employee may request a comprehensive medical evaluation to determine compensability.
What does Section 4062.1 detail?
Section 4062.1 details the procedures for obtaining a comprehensive medical evaluation to determine compensability applicable to requests from either party.
