3. Ethical Standards 1 Flashcards
What must an evaluator selected from a QME panel inform an injured worker prior to or at the time of the evaluation?
The evaluator must inform the injured worker that the worker is entitled to ask questions about any matter concerning the evaluation process and the evaluator is required to promptly answer those questions.
What does ‘good cause’ mean in the context of an injured worker discontinuing an evaluation?
Good cause includes: A) Discriminatory conduct by the evaluator towards the worker based on race sex national origin religion or sexual preference; B) Abusive hostile or rude behavior that shows bias against injured workers; C) Instances where the evaluator requests unnecessary exams or procedures.
What are the requirements for a QME to disclose their information as a condition of probation?
The requirements for disclosure are determined by the Administrative Director or the licensing authority which must be specifically followed by the QME.
What are the key responsibilities of evaluators in the context of injured workers?
Evaluators have the responsibility to inform injured workers about their rights concerning the evaluation process to provide answers to questions and to maintain professionalism avoiding any discriminatory or abusive behavior.
List examples of what constitutes ‘discriminatory conduct’ by an evaluator towards an injured worker.
Discriminatory conduct may include any actions or comments that demonstrate bias based on the worker’s race sex national origin religion or sexual preference.
How may an injured worker demonstrate ‘good cause’ to discontinue their evaluation?
An injured worker may demonstrate ‘good cause’ through examples such as discriminatory conduct abusive behavior from the evaluator or being subjected to unnecessary exams or procedures.
What must be done before the evaluation if the injured worker has questions about the process?
The evaluator must address any questions the injured worker has prior to or during the actual evaluation ensuring that all queries are answered promptly.
In which sections are the guidelines for the discontinuation of evaluations by injured workers detailed?
The guidelines for discontinuation of evaluations by injured workers are detailed in section 41g.
What actions can be considered abusive behavior by an evaluator during the evaluation process?
Abusive behavior may include hostility rudeness or any actions showing clear bias against injured workers.
What is the significance of probationary status for a QME (Qualified Medical Evaluator)?
Probationary status allows the QME to explain any circumstances surrounding the probation. If the injured worker opts not to proceed with the evaluation during this time it will be viewed by the Administrative Director as a termination for good cause.
What happens if an injured worker declines to ask questions during the evaluation process?
If an injured worker declines to ask any questions related to the evaluation procedure as established in section 40a and does not voice any objections based on good cause under section 41a during the exam they forfeit the right to object to the QME’s comprehensive medical-legal evaluation.
What are the ethical requirements for QMEs?
All QMEs must maintain a clean professional physician’s office that has functioning medical instruments and equipment suitable for conducting evaluations regardless of whether the injured worker is represented by an attorney.
What does ‘good cause’ refer to in the context of the evaluation proceedings?
‘Good cause’ refers to valid reasons for an injured worker to object to the evaluation process or procedure. If not formally expressed the right to object may be relinquished.
What is the content of ‘section 40a’ that relates to the evaluation procedure?
Section 40a outlines the procedures and rights during the evaluation process including the injured worker’s ability to ask questions and raise objections.
What is mentioned in ‘section 41a’ regarding objections during the exam?
Section 41a specifies that an injured worker must raise any objections during the exam itself on the grounds of good cause to maintain their right to contest the evaluation-based process.
What should a QME’s practice space meet according to ethical requirements in section 1y?
The QME’s practice space should be clean and professional and should include functioning medical instruments and equipment that are adequate for conducting the evaluation.
What is the role of the Administrative Director in relation to injured workers who decline evaluations?
The Administrative Director assesses whether the termination of an evaluation by an injured worker who declines to proceed is for good cause.
Can an injured worker challenge the evaluation after it has taken place if they did not raise concerns?
No if the injured worker did not raise objections at the appropriate time as specified in sections 40a and 41a they cannot later challenge the evaluation.
What implications does having a clean and professional environment have for QMEs?
Maintaining a clean and professional environment is essential to adhere to ethical standards ensuring that the evaluation is credible and meets professional expectations.
What is the scope of practice for a Qualified Medical Evaluator (QME)?
The QME’s scope of practice includes conducting comprehensive medical-legal evaluations scheduling appointments for all injured workers regardless of legal representation and performing evaluations without bias against unrepresented workers.
What must a QME do when scheduling appointments for comprehensive medical-legal evaluations?
A QME must schedule all appointments for comprehensive medical-legal evaluations without regard to whether the worker is represented by an attorney or unrepresented and cannot refuse to schedule based on the worker’s representation status.
Can a QME refuse to schedule an examination based on the lack of reimbursement promises from the worker?
No a QME shall not refuse to schedule an appointment with an injured worker solely because the worker is not represented by an attorney or because a promise to reimburse or reimbursement is not made prior to the evaluation.
What restrictions are placed on a QME regarding unnecessary examinations or procedures?
A QME is prohibited from requesting the employee to submit to any unnecessary exam or procedure.
What types of interactions and communications should a QME maintain with an injured worker?
A QME should communicate with the injured worker in a respectful courteous and professional manner.
What is Title 8 Section 41.5 of the California Code and how does it affect a QME’s practice?
Section 41.5 of Title 8 of the California Code outlines practices that a QME must refrain from which includes actions that could undermine the integrity of the evaluation process. A QME must comply with these regulations to maintain professionalism and legality in their assessments.
What are the consequences for a QME if they violate professional conduct guidelines?
Consequences may include disciplinary actions loss of certification or legal repercussions depending on the severity of the violation.
What are the implications of not treating or soliciting medical treatment from injured workers by a QME?
By refraining from treating or soliciting medical treatment the QME maintains objectivity and integrity ensuring the evaluation remains unbiased and focused solely on the medical-legal assessment.
Why is it important for a QME to maintain a functioning business office phone?
A functioning business office phone allows parties to schedule examinations handle matters related to evaluations and ensures efficient communication between the QME and the injured workers or their legal representatives.
What is meant by ‘comprehensive medical-legal evaluation’?
A comprehensive medical-legal evaluation consists of a thorough assessment of an injured worker’s condition which integrates both medical findings and legal considerations often used in the workers’ compensation system.
What limitation is set on rescheduling a panel QME examination according to the regulations?
A panel QME examination can only be rescheduled twice in the same case.
What is the requirement before cancelling a QME examination?
A QME examination cannot be cancelled less than six (6) business days from the scheduled date without good cause and a new examination date must be provided within thirty (30) calendar days of the cancellation.
What is the prohibition against ex parte communication for QMEs?
Evaluators selected from a QME panel must not engage in ex parte communication as outlined in Labor Code section 4062.3.
What compensatory rule applies to QMEs concerning their evaluations?
QMEs shall refuse any compensation from any source that is contingent upon writing an opinion that could be construed as unfavorable to any party to the case.
What must QMEs do before conducting a comprehensive medical-legal evaluation?
QMEs must review all available relevant medical and non-medical records and any facts necessary for an accurate and objective assessment of the contested medical issues.
According to the regulations what constitutes ‘good cause’ for cancelling a QME examination less than six business days before the exam?
The document does not specify what constitutes ‘good cause’ so it is typically determined on a case-by-case basis considering factors that necessitate the cancellation.
What does Labor Code section 4062.3 prohibit regarding communications?
Labor Code section 4062.3 prohibits QMEs from engaging in ex parte communications regarding the case.
In what timeline must a new QME examination date be scheduled if the original is cancelled?
A new examination date must be provided within thirty (30) calendar days of the date of cancellation.
What is the purpose of a comprehensive medical-legal evaluation conducted by a QME?
The purpose is to objectively assess contested medical issues related to an injured worker’s case.
How many times can a panel QME examination be rescheduled in the same case?
A panel QME examination can be rescheduled a maximum of two times in the same case.
What must a written report contain before generating it for a worker’s case?
The report must list and summarize all medical and non-medical records reviewed as part of the evaluation.
What is the first principle regarding rendering expert opinions or conclusions?
Expert opinions or conclusions must be rendered without regard to an injured worker’s race sex national origin religion or sexual preference.
What qualifications must an evaluator have to render expert opinions or conclusions?
The evaluator must have adequate qualifications education and training pertaining to the issues being evaluated.
On what basis should conclusions in the report be made according to the guidelines?
All conclusions shall be based on the facts and on the evaluator’s training and specialty-based knowledge and shall be without bias either for or against the injured worker the claims administrator or the employer.
What should the report address concerning medical issues?
The report should address all relevant and contested medical issues as presented on one or more claim forms.
What requirement is there for a report to be ratable by the DEU?
The report must be ratable by the Disability Evaluation Unit (DEU) if applicable and must comply with all relevant guidelines of the Administrative Director.
What date should the report be dated?
The report should be dated on the date it is completed and ready for signature and service on the parties.
Is there a restriction on the submission of the report?
No report shall be submitted until it is completed ready for signature and service on the parties.
What is required for the report to be dated on the date of the evaluation examination?
The full written text of the report must be completed and ready for signature and service on the same date.
What should be included in the report regarding medical issues?
All portions of the report that contain discussion of medical issues medical research used as the basis for medical determinations and medical conclusions made by the evaluator must be included.
What should be done if more than one evaluator signs a single report?
Each signing physician shall clearly state the parts of the employee evaluation examination they performed and the portions of the report discussion and conclusion they drafted.
How should a consultation report be treated when obtained from a physician in a different specialty?
The consultation report shall be incorporated by reference into the final report and appended to the referring Qualified Medical Evaluator’s (QME) report.
Who should receive the report and when?
The report must be served simultaneously on the employee the claims administrator (or employer if none exists) and each of their attorneys as provided in the regulations.
What are comprehensive medical-legal evaluations concerned with?
Comprehensive medical-legal evaluations are concerned with all aspects of physical and psychological evaluations that are directly related to contested medical issues as presented by any party or addressed in the reports of treating physicians.
What must be avoided by evaluators during an examination of an injured worker?
Evaluators must avoid any unnecessary physical contact with the injured worker during the examination.
What is prohibited for physicians certified as Qualified Medical Evaluators (QMEs) regarding evaluators?
No physician certified by the Administrative Director as a QME or their agent shall contact an evaluator to influence that evaluator’s opinions or conclusions in any medical-legal evaluation or report.
What is the maximum waiting time an injured worker should experience before being seen by an evaluator?
An injured worker should not be required to wait for more than one hour at the evaluator’s office prior to being seen for the previously agreed-upon appointment time for an evaluation.
What can an injured worker do if not seen by the evaluator within one hour of their appointment?
If an injured worker is not seen by the evaluator within one hour they may terminate the exam and request a replacement evaluator.
What should happen if an evaluation is delayed according to the guidelines?
The evaluator may explain the reasons for the delay to the injured worker and if both parties agree the evaluation may either proceed or be rescheduled for a later date.
What is the time frame for notifying parties of a new evaluation date after rescheduling?
The evaluator must provide notice of the new date of the evaluation to the parties within 5 business days after rescheduling the appointment.
What are the potential consequences if an injured worker terminates the examination due to alleged violations of certain sections of the California Code of Regulations?
If the Appeals Board later determines that good cause did not exist for the termination the cost of the evaluation shall be deducted from the injured worker’s award.
