11 Labor code sections relevant to QME’s 4 Flashcards
What information must be contained in the notice provided to the injured employee regarding medical evaluations?
The notice must describe the administrative procedures available to the injured employee and inform them of their right to consult an information and assistance officer.
What is the potential implication of being represented by an attorney when pursuing disability benefits?
Choosing to be represented by an attorney may not lead to a larger award but the attorney’s fee will be deducted from any benefits awarded unless the individual is determined to be ineligible for the award. It is a voluntary decision that might not be necessary for receiving benefits.
What must accompany the notice required by subdivision d?
The notice required by subdivision d must be accompanied by the form prescribed by the administrative director for requesting the assignment of a panel of qualified medical evaluators.
What must employers provide to employees after the last payment of temporary disability indemnity?
Employers must provide the employee with a notice that either states that no permanent disability indemnity will be paid because the employer alleges that the employee has no permanent disability or provides relevant information as prescribed by the administrative director.
What is Section 138.4 related to in terms of employee benefits?
Section 138.4 relates to the requirements for employers when providing notices and forms to employees regarding disability benefits and assessments.
What does subdivision d pertain to in the context of disability benefits?
Subdivision d pertains to the notification process for employees regarding their eligibility for disability benefits and the accompanying required forms to facilitate the process.
What are qualified medical evaluators and why are they important?
Qualified medical evaluators are healthcare professionals designated to assess an employee’s medical conditions related to disability claims. They are important because their evaluations help determine the level of benefits an employee may receive.
What is the role of the administrative director in the context of disability benefits?
The administrative director prescribes forms and procedures that employers must follow regarding notification and documents related to disability benefits including the assignment of qualified medical evaluators.
Why might someone choose not to hire an attorney for their disability benefits claim?
Someone might choose not to hire an attorney because they believe they can effectively navigate the process on their own or they may wish to avoid the deduction of attorney fees from their potential benefit award.
What is a panel of qualified medical evaluators?
A panel of qualified medical evaluators is a group of healthcare professionals who have been approved to conduct medical evaluations for individuals seeking benefits for disabilities.
What information is essential to include in the notice provided by employers after temporary disability indemnity?
The notice must clearly state whether or not permanent disability indemnity will be paid along with the justification for the employer’s stance on the employee’s permanent disability status.
What is the role of an employer regarding permanent disability indemnity in case of an employee injury?
The employer must determine the amount of permanent disability indemnity that is payable and advise the employee of that amount as well as the basis for the determination. The employer is also responsible for providing a notice that includes how the employee may obtain a formal medical evaluation if they disagree with the determination.
What should the notice from the employer regarding permanent disability indemnity include?
The notice should include information on the employee’s ability to obtain a formal medical evaluation if there is disagreement with the employer’s position and it must be accompanied by a form prescribed by the administrative director for requesting a panel of qualified medical evaluators unless the employee is represented by an attorney.
What happens if the employer determines that permanent disability indemnity is payable?
If the employer determines that permanent disability indemnity is payable they must inform the employee of the determined amount the basis for this determination and whether there is a need for continuing medical care.
What is indicated in the notice if the employee’s medical condition is not yet permanent and stationary?
The notice should indicate that permanent disability indemnity may be payable but the amount cannot be determined at that time due to the employee’s medical condition not being permanent and stationary.
What are subdivisions c or d in relation to obtaining a formal medical evaluation?
Subdivisions c or d refer to sections that outline the process for obtaining a formal medical evaluation for employees who disagree with the employer’s determination regarding their disability.
What is the significance of the form prescribed by the administrative director?
The form prescribed by the administrative director is significant because it facilitates the request for an assignment of a panel of qualified medical evaluators which is essential for addressing disputes regarding the employer’s assessment of the employee’s disability.
What is meant by ‘permanent and stationary’ medical condition?
A ‘permanent and stationary’ medical condition refers to a state where the employee’s medical condition has stabilized and is not expected to improve or deteriorate further allowing for a proper evaluation of permanent disability.
Who is responsible for defining the process for requesting qualified medical evaluators?
The administrative director is responsible for defining the process and providing the forms necessary for requesting an assignment of qualified medical evaluators.
What should an employee do if they disagree with the employer’s assessment of their disability?
If an employee disagrees with the employer’s assessment they should follow the procedures outlined in the notice to obtain a formal medical evaluation and if necessary utilize the prescribed form to request a panel of qualified medical evaluators.
How does the employer communicate the implications of determining the amount of permanent disability indemnity?
The employer communicates the implications by advising the employee of the determined amount of permanent disability indemnity the rationale behind this determination and whether any ongoing medical care is necessary.
What must the notice to the employee regarding their medical condition include?
The notice shall advise the employee that their medical condition will be monitored until it is deemed permanent and stationary after which an evaluation will be performed to determine the existence and extent of permanent impairment and limitations.
What is the purpose of evaluating an employee’s permanent impairment and limitations?
The evaluation is conducted for the purpose of rating permanent disability and to determine the need for continuing medical care.
What will happen once the medical condition is permanent and stationary?
The employer will advise the employee of the permanent disability indemnity amount they have determined to be payable.
What should an employer do within 14 days if they later determine that no permanent impairment or limitations exist?
They must provide the employee with a notice indicating their position regarding the absence of permanent impairment or limitations.
What should the employer do if they conclude that permanent disability indemnity is payable after initially determining otherwise?
The employer must provide the employee with the notice specified in paragraph 1 within 14 days of making the determination.
What is subdivision a of paragraph 1 b concerning the notices required in this situation?
Each notice required by subdivision a must describe the administrative processes involved.
What does the term ‘permanent and stationary’ signify in the context of medical conditions?
‘Permanent and stationary’ indicates that the employee’s medical condition has stabilized and is unlikely to improve or worsen allowing for a proper evaluation of disability.
What role does the employer play in the evaluation of permanent disability and medical conditions?
The employer is responsible for advising the employee on the status of their medical condition conducting necessary evaluations and determining the amount of permanent disability indemnity.
What are the implications if an employer does not provide the required notices as outlined?
Failure to provide the required notices may impact the employee’s understanding of their medical and disability status and could lead to complications in receiving appropriate indemnity or medical care.
Why is it important for the employee to be informed about their permanent disability indemnity?
It is essential for the employee to understand their rights and benefits regarding permanent disability indemnity for financial planning and ensuring continuous medical care if needed.
What procedures are available to an injured employee regarding representation?
Injured employees have the right to consult an information and assistance officer or an attorney regarding their workers’ compensation claims.
What important notice should be given to employees considering hiring an attorney?
Employees should be informed that hiring an attorney is a voluntary choice. They may or may not receive a larger award and if represented by an attorney the attorney’s fee will be deducted from any award for disability benefits received.
What is the employee’s right regarding representation in disability claims?
The decision to be represented by an attorney is entirely the employee’s decision and is voluntary. It may not be necessary to receive benefits.
What happens if parties do not agree on a permanent disability rating based on the treating physician’s evaluation and the employee is represented by an attorney?
If the parties do not agree to a permanent disability rating a medical evaluation to determine permanent disability shall be obtained as provided in Section 4062.2.
What occurs if the parties do not agree on a permanent disability rating and the employee is not represented by an attorney?
The specific procedures or evaluations to be followed in this scenario are not provided in the text suggesting the need for further information or legal guidance.
What is Section 4062.2 referring to in the context of workers’ compensation?
Section 4062.2 pertains to obtaining a medical evaluation to determine permanent disability when there is a disagreement on the rating of that disability.
What must an employer do upon receiving a request from an attorney regarding a panel of medical evaluators?
The employer shall immediately provide the employee with a form prescribed by the medical director to request assignment of a panel of three qualified medical evaluators.
Who can request a comprehensive medical evaluation to determine permanent disability?
Either party the employee or the employer may request a comprehensive medical evaluation to determine permanent disability.
What is the procedure for obtaining a comprehensive medical evaluation to determine permanent disability?
The evaluation shall be obtained only by the procedure provided in Section 4062.1.
What happens after a qualified medical evaluator evaluates an unrepresented employee?
The qualified medical evaluator must serve the comprehensive medical evaluation and the summary form on the employee employer and the administrative director.
Can an unrepresented employee or employer submit additional evaluations? If so what type?
Yes the unrepresented employee or the employer may submit the treating physician’s evaluation for the calculation of a permanent disability rating.
What is the timeframe for the administrative director to calculate the permanent disability rating after receiving the comprehensive medical evaluation?
Within 20 days of receipt of the comprehensive medical evaluation the administrative director shall calculate the permanent disability rating.
According to which section is the permanent disability rating calculated?
The permanent disability rating is calculated according to Section 4660.
What documents must the administrative director serve after calculating the permanent disability rating?
The administrative director must serve the rating on both the employee and the employer.
What role does the medical director play in the context of medical evaluations for permanent disability?
The medical director prescribes the form for requesting the assignment of a panel of qualified medical evaluators.
What are the qualifications of the evaluators assigned to assess a comprehensive medical evaluation?
The evaluators assigned must be qualified medical evaluators.
What must happen before submitting a medical evaluation concerning an unrepresented employee?
It must first be submitted to a workers’ compensation judge by the administrative director.
What sections of law pertain to potential apportionment of an employee’s permanent impairment?
Sections 4663 and 4664.
What can a workers’ compensation judge do if the proposed apportionment is inconsistent with the law?
The judge may refer the report back to the qualified medical evaluator for correction or clarification.
What is the timeframe for an unrepresented employee or employer to request reconsideration of the recommended rating?
Within 30 days of receipt of the rating.
Who can request additional information from the treating physician or medical evaluator?
Either the unrepresented employee or the employer.
What are the criteria for requesting additional information or reconsideration of the medical evaluation?
Issues not addressed or not completely addressed in the original comprehensive medical evaluation or evaluations not prepared according to specified procedures.
What does subdivision j of Section 139.2 entail?
It outlines procedures for preparing medical evaluations.
What is the role of the administrative director in medical evaluations for unrepresented employees?
The administrative director submits the medical evaluation to the workers’ compensation judge and may also handle requests for reconsideration.
In what situation do Sections 4663 and 4664 apply?
They apply when there are questions about apportionment of an employee’s permanent impairment or limitations.
What happens if an employee is represented as opposed to unrepresented regarding the medical evaluation process?
The rules may diverge and the passive involvement in reconsideration requests may differ depending on representation status.
What is the purpose of a comprehensive medical evaluation in a workers’ compensation context?
To assess an employee’s permanent impairment and any limitations that may apply.
What is the significance of submitting comprehensive medical evaluations to a workers’ compensation judge?
It ensures that any apportionment is legally consistent and proper before final decisions are made.
What must be included in a request for reconsideration of a rating?
The request must be in writing specify the reasons why the rating should be reconsidered and be served on the other party.
What actions does the administrative director take if the comprehensive medical evaluation is incomplete or non-compliant?
The administrative director shall return the report to the treating physician or qualified medical evaluator for appropriate action as instructed.
