2 Timelines (2 hrs.) Flashcards
Master the timelines rules for QME events
New Injury
How much time does an employer have to provide the employee with a DWC1 form for a new claim?
1 business day
What is the timeframe for an employee to file a WC claim to receive benefits?
within 30 days of DOI
By when must an objection to a medical determination by a treating physician be made?
within 20 days of PTP report receipt if represented, 30 days if unrepresented
When can a claims admin submit a QME form 105?
if employee has not submitted the form within 10 days after the form was given to him/her by the employee
If the request for a panel QME is not issued within ____ working days in an unrepresented case the employee can obtain an evaluation from any QME in the area.
20
How many days does the unrepresented worker have to select a physician and make an appointment after the panel is issued before the claims administrator can do so?
10
How many days do the claims administrator/represented worker have to strike a name from a panel?
10
Within how many days must a QME make an appointment with an employee?
Within 90days of initial request, can be extended to 120 days with written request. If not scheduled within 90 days, a new QME Dr. panel can be requested.
How many days does the QME have to submit the QME appointment notification form (form 110)? What info must it include?
5 business days; if an interpreter is needed
Once scheduled, A QME appointment cannot be cancelled less than _____ days by any party without good cause; if cancelled, it but be rescheduled within _____ calendar days and cannot be more than ___ calendar days from the initial request unless agreed upon
6 business days; 30; 90
What is the process for sending records to a QME?
records must first be served to the opposing party 20 days before it is provided to the QME; if the opposing party objects to sending non-medical records within 10 days of its receipt, it will not be provided to the QME
How long do parties have after an appointment to get requested records to QME before QME is allowed to finish report without them? How long does QME have to finish report, regardless of records received?
10 days; 30 days
How long does a QME have to identify a conflict of interest?
5 days from becoming aware of the conflict. For example the person was a former patient, family member, etc.
What is the minimum allowable facetime for a QME exam for a neuromusculoskeleton evaluation?
20 minutes
For how long can a QME be unavailable? When does that QME need to notify the Medical Director of that fact?
14-90 days; 30 days prior
How long does a QME have to complete supplemental reports?
60 days from written notice
By when must workers temporary disability payments after employers knowledge of the claim (unless the employer contests the claim)
14 days
How long does a PTP have to file a doctors first report
5 days
How long does a physician have to contact a local health officer for suspected or diagnosed pesticide poisoning?
24 hours
How many days does an employer have to contest a work comp claim?
90
When a QME receives a request to schedule an evaluation, the QME must issue a QME Appointment Notification Form to all parties within
5 working days
A QME must retain QME reports for how many years?
5
Temporary disability benefits/payments from 2005 forward can last for:
104 weeks
When an IW contacts a QME to make an appointment, the QME must set the appointment within how many days of the contact?
60 days
Within how many days, does the PTP have to send the Doctor’s First Report of Occupational Illness or Injury to the involved parties?
5 days of the initial examination
The ‘QME Appointment Notification Form’ should be sent:
Within 5 business days after scheduling the patient for the evaluation
A PQME or Agreed PQME who cancels a scheduled appointment shall:
Reschedule the appointment within 30 calendar days
