11 Labor code sections relevant to QME’s 5 Flashcards
What happens after receiving the final comprehensive medical evaluation and summary form from the treating physician or qualified medical evaluator?
The administrative director shall recalculate the permanent disability rating according to Section 4660 and serve the rating the comprehensive medical evaluation and the summary form on both the employee and employer.
What is the role of a comprehensive medical evaluation in the context of permanent disability ratings?
A comprehensive medical evaluation from the treating physician agreed medical evaluator or qualified medical evaluator can resolve issues that may require an employer to take specific actions regarding permanent disability ratings.
What section of the law determines how the recalculation of the permanent disability rating is conducted?
The recalculation of the permanent disability rating is conducted according to Section 4660.
What parties must receive the recalculated permanent disability rating and related documents?
Both the employee and the employer must receive the recalculated permanent disability rating the comprehensive medical evaluation and the summary form.
What action must an employer take to provide compensation according to the text?
The employer must commence the payment of compensation or promptly commence proceedings before the appeals board to resolve the dispute.
What options do the employee and employer have regarding the findings and award related to compensation?
They can agree to stipulated findings and award as provided under Section 5702 compromise and release the claim under Chapter 2 commencing with Section 5000 of Part 3 or if the employee wishes commute the award under Chapter 3 commencing with Section 5100 of Part 3.
Before an appeals board approves an agreement or commutation what must they determine?
The appeals board must determine whether the agreement or commutation is in the best interests of the employee and whether the proper procedures have been followed in determining the permanent disability rating.
What is the role of the administrative director regarding the notification of the employee when service of any rating occurs?
The administrative director shall promulgate a form to notify the employee of the options specified the potential advantages and disadvantages of each option and the procedure for disputing the rating.
What sections outline the potential procedures for compromise and release of claims?
Chapter 2 commencing with Section 5000 of Part 3 outlines the compromise and release of claims.
What section outlines the commuting of awards for employees?
Chapter 3 commencing with Section 5100 of Part 3 outlines the commuting of awards.
What must be considered regarding the permanent disability rating before any agreement is made?
It must be ensured that the proper procedures have been followed in determining the permanent disability rating.
What kind of issues are mentioned as being related to the process described in the text?
No specific issues are given in the text but it is implied that various disputes or disagreements regarding the compensation process may arise.
What must occur before a declaration of readiness to proceed regarding permanent impairment and limitations resulting from an injury?
A medical evaluation by a treating physician or an agreed or qualified medical evaluator must first occur.
Can evaluations of permanent impairment and limitations from an injury be obtained outside the guidelines of Section 4062.1 or 4062.2?
No evaluations obtained in violation of the established prohibitions except evaluations by treating physicians shall not be admissible in any proceeding before the appeals board.
What is the primary role of the treating physician in the context of an injured worker?
The treating physician is primarily responsible for managing the care of the injured worker and must render opinions on all medical issues necessary to determine eligibility for benefits.
What are Section 4062.1 and 4062.2 related to in this context?
Section 4062.1 and 4062.2 are guidelines that outline the proper procedures for obtaining medical evaluations of permanent impairment and limitations.
What is the consequence of obtaining medical evaluations in violation of the established prohibitions?
Such evaluations shall not be admissible in any proceedings before the appeals board.
Who may render opinions on medical issues regarding an injured worker’s eligibility?
Opinions may be rendered by the treating physician or a physician designated by the treating physician following the rules set by the Administrative Director.
What is the role of the Administrative Director in the medical evaluation process?
The Administrative Director issues rules that guide the opinions on medical issues necessary for determining an injured worker’s eligibility.
What is the significance of a declaration of readiness to proceed in a workers’ compensation case?
It indicates that the injured worker is ready to move forward with their case particularly regarding disputes related to permanent impairment and limitations.
In what context would a treating physician’s evaluation be advisable?
A treating physician’s evaluation is critical to determine permanent impairments and necessary limitations following an injury to guide further proceedings.
What type of medical evaluations are specifically exempt from the admission prohibition?
Evaluations prepared by the treating physician or physicians are exempt from this prohibition.
What should be done if there is more than one treating physician for an injured worker’s care?
A single report shall be prepared by the physician primarily responsible for managing the injured worker’s care incorporating the findings of various treating physicians.
What happens if either party has an objection to a medical determination made by the treating physician?
The objecting party must notify the other party in writing of the objection within 20 days of receipt of the report if the employee is represented by an attorney or within 30 days if the employee is not represented by an attorney.