11 Labor code sections relevant to QME’s 6 Flashcards
What actions can either party take if they request a medical evaluation under sections 4060 4061 or 4062?
If either party requests a medical evaluation under Sections 4060 4061 or 4062 they may submit a prescribed form to the administrative director requesting the medical director to assign a panel of three qualified medical evaluators.
What are the three sections that pertain to requesting a medical evaluation?
The three sections pertaining to requesting a medical evaluation are Section 4060 Section 4061 and Section 4062.
What is an agreed medical evaluator?
An agreed medical evaluator is a medical professional that both the employer and employee agree upon to conduct a medical evaluation regarding the employee’s injury or treatment typically to resolve disputes in a workers’ compensation case.
What might an employer or related entities provide details on for the employee’s treatment review?
The employer or related entities may provide details on the alternative therapy recommended and the development or manufacture of the principal drug device or therapy proposed by the employee’s treating physician.
What is the significance of a panel of three qualified medical evaluators in the workers’ compensation process?
The significance of a panel of three qualified medical evaluators is to ensure an impartial and thorough evaluation of the employee’s medical condition and treatment options helping to resolve disputes or questions related to treatment in a fair manner.
What happens if the employer violates the restriction on seeking an agreed medical evaluator when the employee is unrepresented?
If the employer violates this restriction it may lead to procedural issues in the workers’ compensation claim potentially resulting in the evaluation being deemed invalid or causing further legal disputes.
What is the time frame in which an employee must submit the form after the employer has provided it?
The employee must submit the form within 10 days after the employer has furnished the form and requested its submission.
What must the party submitting the request form designate?
The party submitting the request form must designate the specialty of the physicians that will be assigned to the panel.
What action must an employee take within 10 days of the issuance of a panel of qualified medical evaluators?
The employee must select a physician from the panel to prepare a medical evaluation schedule the appointment and inform the employer of the selection and appointment.
What happens if the employee does not inform the employer of their physician selection within 10 days?
If the employee does not inform the employer of the selection within 10 days then the employer may select a physician from the panel to prepare a medical evaluation.
What is the consequence if the employee informs the employer of their selection within the 10-day time frame?
If the employee informs the employer of the selection within 10 days the process continues with the selected physician preparing the medical evaluation.
What is Section 139.2 related to?
Section 139.2 pertains to the procedures and requirements for the submission of medical evaluation forms between the employer and employee.
In the context of Section 139.2 who is responsible for scheduling the appointment with the selected physician?
The employee is responsible for scheduling the appointment with the selected physician.
What happens if the employer provides the form to the employee but the employee fails to submit it within the specified time?
If the employee fails to submit the form within 10 days the employer is allowed to submit the form on behalf of the employee.
What must an employer do if they select a physician for evaluation according to the subdivision?
The employer must arrange the appointment with the selected physician.
What should an employer do upon receiving written notice of appointment arrangements from an employee?
The employer shall furnish payment of the estimated travel expense.
What opportunity must the evaluator provide the employee during the appointment?
The evaluator must give the employee a brief opportunity to ask questions concerning the evaluation process and the evaluator’s background.
What must an unrepresented employee do during the evaluation unless they have good cause not to participate?
The unrepresented employee shall participate in the evaluation as requested by the evaluator.
What constitutes ‘good cause’ for an employee to discontinue the evaluation?
Good cause includes evidence of evaluator bias against the employee based on race sex national origin religion or sexual preference or evidence that the evaluator has made inappropriate requests.
What are the implications for an employee if they have concerns about the evaluator’s bias?
If an employee has concerns about the evaluator’s bias they may have good cause to discontinue participation in the evaluation.
Why is it important for the employer to furnish payment of estimated travel expenses?
It is important to ensure that the employee can attend the evaluation without financial burden promoting access and fairness in the evaluation process.
What types of bias should an employee be vigilant about concerning the evaluator?
An employee should be vigilant about bias related to race sex national origin religion or sexual preference.
What should be the first step taken by the employer to prepare for an evaluation?
The first step is to arrange the appointment with the selected physician.
How does the process protect the rights of employees being evaluated?
The process protects employee rights by requiring a fair chance to question the evaluator and allowing withdrawal in cases of bias.
What happens if an unrepresented employee declines an unnecessary medical examination?
If an unrepresented employee declines to proceed with the evaluation he or she has the right to a new panel of three qualified medical evaluators to select one for a comprehensive medical evaluation.
What are the consequences if the appeals board determines an employee did not have good cause for declining evaluation?
If the appeals board determines that the employee did not have good cause to decline the evaluation the cost of the evaluation will be deducted from any award the employee receives.
If an employee has received a comprehensive medical-legal evaluation and later gets an attorney what is their entitlement?
If an employee has already received a comprehensive medical-legal evaluation under this section and then becomes represented by an attorney they are not entitled to an additional evaluation.
What is the effective date for the rules surrounding comprehensive medical evaluations related to injury disputes?
The rules state that whenever a comprehensive medical evaluation is required for a dispute arising from an injury or claimed injury it applies to cases occurring on or after January 1 2005.
How should a comprehensive medical evaluation be obtained if an employee is represented by an attorney?
When an employee is represented by an attorney the comprehensive medical evaluation must be obtained only as provided in the applicable regulations or guidelines.
What is the significance of a ‘comprehensive medical evaluation’ in the context of medical examinations for employees?
A comprehensive medical evaluation is an in-depth assessment used to resolve disputes related to an injury claim. It is crucial in determining the legitimacy of claims and the need for further medical procedures.
Who is responsible for selecting the medical evaluator when an employee opts for a new panel?
The employee is responsible for selecting one medical evaluator from a newly provided panel of three qualified evaluators.
What is the potential financial implication for an employee if they do not comply with the medical evaluation requirements?
If the employee is found to have declined an evaluation without good cause they may have the costs of the evaluation deducted from any workers’ compensation award they obtain.
What protections are afforded to unrepresented employees regarding unnecessary medical examinations?
Unrepresented employees have the right to decline unnecessary medical examinations and can request a new panel of evaluators for a fair assessment.
What constitutes ‘good cause’ for not proceeding with a medical evaluation?
The term ‘good cause’ typically refers to a valid reason that justifies the employee’s decision to decline the evaluation though specific definitions can depend on legal standards or interpretations.
What is the process to initiate a medical evaluation as per Sections 4060 4061 or 4062?
Either party can commence the selection process for an agreed medical evaluator by making a written request that includes at least one proposed physician. The parties must then seek agreement on a physician to prepare a report addressing the disputed issue.
What is the time frame for the parties to reach an agreement on a proposed medical evaluator?
The parties have 10 days from the first written proposal to agree on a proposed medical evaluator. An additional extension of up to 20 days may be mutually agreed upon.
What happens if the parties cannot reach an agreement within the specified time frame regarding the medical evaluator?
If no agreement is reached within the 10-day period or any extended period not exceeding 20 days either party may request the assignment of a three-member panel of qualified medical evaluators for a comprehensive medical evaluation.
Are the agreed medical evaluators required to be qualified medical evaluators?
No the agreed medical evaluator does not need to be a qualified medical evaluator.
What information must the party submitting the request for a three-member panel provide?
The party submitting the request must designate the specialty of the medical evaluator and also specify the specialty of the medical evaluator requested by the other party if that information is known.
What are the key sections referenced for requesting a medical evaluation?
The key sections referenced are Section 4060 Section 4061 and Section 4062.
What is the purpose of the agreed medical evaluator in the context of this procedure?
The purpose of the agreed medical evaluator is to prepare a report that resolves the disputed medical issue between the parties.
In the event of a dispute over the medical evaluation how is it resolved?
It is resolved through the selection of an agreed medical evaluator or if that fails a three-member panel of qualified medical evaluators is assigned.
What does ‘comprehensive medical evaluation’ entail?
A comprehensive medical evaluation involves a thorough examination and assessment of the medical issues in dispute conducted by a panel of qualified medical evaluators.
Can either party propose multiple physicians for the medical evaluation process?
Yes either party can propose one or more physicians in their written request for an agreed medical evaluator.
What is the responsibility of the party submitting the request form in a medical evaluator selection process?
The party submitting the request form shall serve a copy of the request form on the other party.
What is the time frame within which the parties must confer to agree upon a medical evaluator after assignment of the panel?
The parties must confer and attempt to agree upon an agreed medical evaluator within 10 days of the assignment of the panel by the administrative director.
What happens if the parties do not agree on a medical evaluator by the 10th day?
If the parties have not agreed on a medical evaluator from the panel by the 10th day each party may strike one name from the panel.
How is the remaining medical evaluator selected after strikes are made?
The remaining qualified medical evaluator after both parties have struck one name shall serve as the medical evaluator.
What occurs if a party fails to strike a name from the panel within the designated time frame?
If a party fails to exercise the right to strike a name from the panel within three working days the other party may select any physician who remains on the panel to serve as the medical evaluator.
Can the administrative director influence the selection process of the medical evaluator?
Yes the administrative director may prescribe the form manner or both by which the parties shall conduct the selection process.
Who is responsible for arranging the appointment for the medical evaluation?
The represented employee shall be responsible for arranging the appointment for the medical evaluation.
