2 Timelines (2 hrs.)

Question 1

New Injury

How much time does an employer have to provide the employee with a DWC1 form for a new claim?

Answer 1

1 business day

Question 2

What is the timeframe for an employee to file a WC claim to receive benefits?

Answer 2

within 30 days of DOI

Question 3

By when must an objection to a medical determination by a treating physician be made?

Answer 3

within 20 days of PTP report receipt if represented, 30 days if unrepresented

Question 4

When can a claims admin submit a QME form 105?

Answer 4

if employee has not submitted the form within 10 days after the form was given to him/her by the employee

Question 5

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.

Answer 5

20

Question 6

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?

Answer 6

10

Question 7

How many days do the claims administrator/represented worker have to strike a name from a panel?

Answer 7

10

Question 8

Within how many days must a QME make an appointment with an employee?

Answer 8

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.

Question 9

How many days does the QME have to submit the QME appointment notification form (form 110)? What info must it include?

Answer 9

5 business days; if an interpreter is needed

Question 10

Once scheduled, A QME appointment cannot be cancelled less than _____ days by any party without good cause.

Answer 10

6 business days

Question 11

What is the process for sending records to a QME?

Answer 11

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

Question 12

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?

Answer 12

10 days; 30 days

Question 13

How long does a QME have to identify a conflict of interest?

Answer 13

5 days from becoming aware of the conflict. For example the person was a former patient, family member, etc.

Question 14

What is the minimum allowable facetime for a QME exam for a neuromusculoskeleton evaluation?

Answer 14

20 minutes

Question 15

For how long can a QME be unavailable? When does that QME need to notify the Medical Director of that fact?

Answer 15

14-120 days/year; 30 days prior

Question 16

How long does a QME have to complete supplemental reports?

Answer 16

60 days from written notice

Question 17

After employers knowledge of the claim (unless the employer contests the claim), temporary disability payments must be made within…

Answer 17

14 days

Question 18

How long does a PTP have to file a doctors first report

Answer 18

5 days

Question 19

How long does a physician have to contact a local health officer for suspected or diagnosed pesticide poisoning?

Answer 19

24 hours

Question 20

How many days does an employer have to contest a work comp claim?

Answer 20

90

Question 21

When a QME receives a request to schedule an evaluation, the QME must issue a QME Appointment Notification Form to all parties within

Answer 21

5 working days

Question 22

A QME must retain QME reports for how many years?

Answer 22

5

Question 23

Temporary disability benefits/payments from 2005 forward can last for:

Answer 23

104 weeks

Question 24

When an IW contacts a QME to make an appointment, the QME must set the appointment within how many days of the contact?

Answer 24

90 days

Question 25

Within how many days, does the PTP have to send the Doctor’s First Report of Occupational Illness or Injury to the involved parties?

Answer 25

5 days of the initial examination

Question 26

The ‘QME Appointment Notification Form’ should be sent:

Answer 26

Within 5 business days after scheduling the patient for the evaluation

Question 27

A PQME or Agreed PQME who cancels a scheduled appointment shall:

Answer 27

Reschedule the appointment within 60 calendar days

Question 28

QME has to schedule a deposition within .. days.

Answer 28

120 days. It takes place w/in 20 miles where IW’s eval took place.

Question 29

Temporary disability may last up to… week within … years from the DOI for injuries from 1/1/2008

Answer 29

2 years (104 weeks) , 5 years

Question 30

Employers who contract with HCO can direct tx of IW up to … days.

Answer 30

90 or 180 days following an injury.

Question 31

The boss (insurer) has … days to accept or deny IW’s claim. In the meantime, IW may receive $….. worth of treatment.

Answer 31

90 days $10,000

Question 32

QME may be denied reappointment if she was made unavailable for more than… days during a calendar year, WITHOUT good cause.

Answer 32

120 days

Question 33

QME can apply for an extension on a 30 day after appointment report deadline in cases of good cause (medical emergency, natural disaster etc) - how long is the extension?

Answer 33

15 days

Question 34

Employee has … years to use Supplemental Job Displacement Benefit (SJDB) or within … years of DOI.

Answer 34

2 years or 5 years.

Question 35

Employer has … days to give return to work date after the Return To Work (RTW) and voucher report.

Answer 35

60 days.

Question 36

Supplemental reports must be completed and served no later than…. days since the request.

Answer 36

60 days from the request.

Question 37

Supplemental report deadline may have extended for no more than… days.

Answer 37

You have 60 days to issed a supplemental report. Request for an extention of 30 days if agreed by both parties.

Question 38

The re-scheduled appointment date may not be more than … calendar days from the date of the CANCELLATION request (unless parties agree in writing).

Answer 38

60 days

Question 39

In how many days after the PTP’s report, shall 2nd opinion spine report be served to all partied?

Answer 39

45 days

Question 40

IMR decision must be provided to all parties in layterms within how many days of the receipt of the request for review?

Answer 40

30 days and 72 hrs for expedited request

Question 41

To get the money, IW has to tell the boss about the injury within … days of injury.

Answer 41

30 days

Question 42

When UR is RETROSPECTIVE, decisions must be communicated to PTP who requested med. services and IW/his lawyer within… days.

Answer 42

30 days

Question 43

If employer doesn’t provide a new PTP within … days, then IW can choose one himself.

Answer 43

30 days * normally within 5 days boss should provide a new PTP if IW requests.

Question 44

Unrep IW. If request for QME panel is not issued within … working days, then IW can have eval from any QME within reasonable geographic area.

Answer 44

20 days

Question 45

Either party may object PTP’s med. determination by notifying the other party in writing in how many days? rep vs unrep IW

Answer 45

represented IW- 20 days unrepresented- 30 days

Question 46

PTP says IW is P&S. PTP must report within how many days from the date of exam all info about perm. impairment & any need for med. Tx?

Answer 46

20 days unless good cause

Question 47

Before 1 party can give any info to the QME/AME they must send it (give the heads up) to the other party within… days before info is sent to QME.

Answer 47

20 days

Question 48

PTP must report results of consults, results of other Drs reports or changes in IW condition in … days after receiving them.

Answer 48

20 days

Question 49

Within …. days of the Request for Authorization, the UR decision must be made.

Answer 49

14 days. If no additional info submitted within 14 days from the date of submission, then request will be denied.

Question 50

IW files Request for Factual Correction of QME report, the QME panel has: … days after request to review corrections and determine if factual corrections are necessary for unrep IW and ….days for both parties or claims admin.

Answer 50

10 days for unrep and 15 days for rep IW or if the request was filed by the both parties or the claims admin.

Question 51

Represented IW. If IW & boss disagree w/PTP’s findings, they must wait…. waiting period and… for mailing an objection before DWC can assign a QME.

Answer 51

10 days waiting period 5 days for mailing an objection

Question 52

Represented IW. If no AME agreed upon, then IW has …days to choose a QME.

Answer 52

10 days

Question 53

A represented IW has…. days to select an AME. This can be extended if agreed upon for… days.

Answer 53

10 days 20 days

Question 54

If unrepresented IW doesn’t make a choice of his QME in … days then the insured can make this choice for him in ….days.

Answer 54

10 days and 10 days

Question 55

If the opposing party objects to sending non-medical records (video tape etc), they need to object how fast so that QME will not be provided the tape?

Answer 55

Within 10 days

Question 56

Dispute about spinal surgery is NOT handled by QME/AME but a special procedure. If boss disagrees with needing a sx, insurer (IW) has …. days from the report to disagree. (with the boss) Both lawyers can agree on a surgeon for a 2nd opinion. If they can’t agree in … days, then AD will provide randomly selected surgeon for a 2nd opinion in … days. If boss/insurer disagrees w/ 2nd opinion–> go to court.

Answer 56

10 days 10 days 5 days

Question 57

How much in advance should QME notify medical director of being unavailable to perform or schedule an eval?

Answer 57

30 days before the period of unavailability

Question 58

QME has to let MD (medical director) know of being unavailable to schedule or perform medical eval if QME is unavailable for how long?

Answer 58

14-120 days max

Question 59

Employer has …. days from the notification of the injury to contest the claim. If he doesn’t, the injury is compensable.

Answer 59

90 days

Question 60

Temporary Disability Benefits payments must begin within…. days of the employer’s knowledge of the claim

Answer 60

14 days (unless the employer contests (objects) the claim.

Question 61

Once scheduled, an appointment can not be canceled by QME or any party in ….day, except for good cause.

Answer 61

6 biz. days

Question 62

A concurrent or prospective Utilization Review REQUEST must get a yes or no decision in… how many days after being received by an adjuster?

Answer 62

5 working days PTP must be informed by phone/fax in 24 hrs

Question 63

After employer learns of an injury, how soon should they complete “Employer’s First Report” Employer’s Report of Occupational Injury or Illness?

Answer 63

5 days

Question 64

Decisions for expedited Utilization Review are made in…

Answer 64

72 hrs (after the receipt of written information reasonably necessary to make a decision)

Question 65

After employer learns about an injury (from any source), he must provide IW Employee’s Claim for WCB claim (DWC1) within…

Answer 65

1 working day. It must be dated. IW fills it out & returns to boss

Question 66

PTP must be notified that his request for authorization prior or concurrent with provision of med care is approve is..

Answer 66

24 hrs

Question 67

Employer must immediately report to OSHA a serious injury in more than ….hrs of hospitalization except obs, loss of body part or disfigurement

Answer 67

24 hrs

Question 68

How many hrs/days does the employer have to get a PTP from their MPN once they learn of an employee injury?

Answer 68

24 hrs

Question 69

Labor Code 5402(b)(1) states, "If liability is not rejected within __ days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division."

Answer 69

90 DAYS