4.Timely services and retention of reports 2 Flashcards
What is the role of the designated physician in a workers’ compensation claim?
The designated physician may be but is not required to be the injured worker’s primary treating physician.
Who is responsible for the payment of the designated physician’s office visit in a workers’ compensation claim?
The employer is responsible for payment for one office visit with the designated physician.
Under what circumstances does the evaluator determine a substantial risk of adverse medical consequences in mental health evaluations?
The evaluator determines a substantial risk of significant adverse or detrimental medical consequences when injury to the psyche is claimed.
What is required from the evaluator when there is a substantial risk identified concerning the injured worker’s mental health record?
The evaluator must complete QME Form 121 Declaration Regarding Protection of Mental Health Record.
What must the evaluator advise the injured worker regarding the evaluation report as a mental health record?
The evaluator must advise the injured worker that a determination has been made under Health and Safety Code section 123115b regarding the evaluation report as a mental health record.
What is Section 123115b of the Health and Safety Code related to?
Section 123115b relates to the determination of substantial risk regarding the viewing or receiving of a mental health evaluation report by the injured worker.
What must accompany the report when there is a determination of risk associated with the mental health record?
The report must include the completed QME Form 121 which declares the protection of the mental health record.
What is meant by the term “QME” in the context of the provided text?
QME stands for Qualified Medical Evaluator which is a professional designated to conduct evaluations for injured workers in order to provide an objective assessment of the medical condition.
Who is allowed to inspect and copy the mental health records of the injured worker according to the provided text?
Only a licensed physician as defined in Labor Code section 3209.3 or another health care provider as defined in Health and Safety Code section 123105a may inspect and copy the mental health records.
What must the evaluator do with the evaluation report of the injured worker?
The evaluator may only serve the injured worker’s copy of the evaluation report.
What is required to be completed and attached to the medical-legal evaluation report according to the provided information?
A completed QME Form 121 Declaration Regarding Protection of Mental Health Record must be attached to the evaluation report.
What information must be included on QME Form 121?
QME Form 121 must include the name and address of the physician designated in writing by the injured worker.
What happens to the comprehensive medical-legal evaluation report after it is completed?
It must be served along with the completed QME Form 121 Declaration Regarding Protection of Mental Health Record on the licensed physician as stipulated in the regulations.
Who must the completed QME documentation and reports be served to?
The completed QME documentation and reports must be served to the licensed physician.
What does Health and Safety Code section 123115b pertain to in the context of this evaluation process?
Health and Safety Code section 123115b provides the regulations regarding the determination of who may access mental health records.
What is the purpose of QME Form 121 in the evaluation process?
The purpose of QME Form 121 is to document the protection of mental health records and ensure compliance with legal standards for sharing sensitive health information.
Is a copy of the evaluation report also kept in the injured worker’s medical or medical-legal file?
Yes a copy of the evaluation report should be attached to the injured worker’s medical or medical-legal file along with the completed QME Form 121.
What is QME Form 121 used for in California workers’ compensation claims?
QME Form 121 is designated by the injured worker and is used to select a Qualified Medical Evaluator (QME) in relation to their workers’ compensation claim.
Who must receive notice when an injured worker designates a physician on QME Form 121?
Notice must be served on the claims administrator each party’s attorney (if any) and the designated physician.
According to California Code what sections outline the time periods for serving notices related to QME Form 121?
The time periods for serving notices regarding QME Form 121 are provided in section 36 and section 38 of Title 8 of the California Code of Regulations.
What is required if the injured worker designates a physician other than the current primary treating physician on QME Form 121?
If the injured worker designates a physician other than the current primary treating physician a copy of the report along with the QME Form 121 must be served on the primary treating physician.
What should be included in the report when it addresses permanent impairment or permanent disability?
Whenever the report addresses any permanent impairment permanent disability or apportionment and the injured worker is not represented by an attorney the report must include the completed QME Form 121 and be served on the appropriate office of the Disability Evaluation Unit (DEU) along with the QME Form 111 and DWC-AD form 100.
What are the relevant California Code of Regulations sections that govern the procedures of serving reports for disabilities?
The relevant sections are 8 Cal. Code Regs. 10160 and 10161.
What is DWC-AD form 100?
DWC-AD form 100 is the DEU Employee’s Disability Questionnaire which is included in the submission of reports concerning permanent disability.