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.
