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.
What is QME’s Findings Summary Form?
QME’s Findings Summary Form is referred to as QME Form 111 which is a summarization of the findings concerning the evaluation results for the injured worker.
What is the role of the Disability Evaluation Unit (DEU) in the California workers’ compensation process?
The Disability Evaluation Unit (DEU) is responsible for evaluating permanent disabilities and providing related documentation and support in workers’ compensation cases.
What happens if the injured worker in a California workers’ compensation claim is not represented by an attorney?
If the injured worker is not represented by an attorney a copy of the report concerning permanent impairment permanent disability or apportionment must also be served to the appropriate office of the DEU.
What is the purpose of the Request for Summary Rating Determination?
The purpose of the Request for Summary Rating Determination is to evaluate the report from a Qualified Medical Evaluator (QME) in relation to permanent impairment permanent disability or apportionment under California law.
Which regulations govern the Request for Summary Rating Determination of Qualified Medical Evaluator’s Report in California?
The Request for Summary Rating Determination is governed by 8 Cal. Code Regs. 10160 and 10161.
What documents need to be included with the Request for Summary Rating Determination?
Documents to include are the report from the QME the completed QME Form 121 the QME Form 122 (AME or Declaration of Service of Medical-Legal Report) and if applicable the DWC-CA form 10232.1 and separator sheet DWC-CA form 10232.2.
What does DWC-CA form 10232.1 pertain to?
DWC-CA form 10232.1 is associated with the Request for Summary Rating Determination and contains specific required information regarding the evaluation.
What is covered by DWC-CA form 10232.2?
DWC-CA form 10232.2 serves as a separator sheet providing additional organizational structure for the documents submitted.
What is required when the QME report addresses permanent impairment permanent disability or apportionment?
When these topics are addressed the report must be served with the completed QME Form 121 to the physician designated by the injured worker the injured worker’s attorney and the claims administrator’s attorney or if none to the claims administrator.
Who is considered a ‘Mental health record’ under this regulation?
A ‘Mental health record’ is defined as any medical treatment or evaluation record that has been created by or received and reviewed by a licensed physician.
What should happen if the injured worker is represented by an attorney concerning the QME report?
If the injured worker is represented by an attorney a copy of the QME report along with the completed QME Form 121 must be served to the attorney and the designated physician.
What is the role of QME Form 121?
QME Form 121 is used to acknowledge the report from the Qualified Medical Evaluator and must be completed and served along with the QME report when relevant.
What requirements must be met for the service of the medical-legal report according to California regulations?
The report must be served in accordance with 8 Cal. Code Regs. 10160d4 ensuring that all involved parties are notified appropriately.
What is the purpose of Labor Code section 3209.3?
Labor Code section 3209.3 outlines the requirements for the treatment and evaluation of injured workers within the context of workers’ compensation claims. It emphasizes the necessity for maintaining comprehensive medical-legal reports and treatment records.
What types of records are included under Labor Code section 3209.3 for treating or evaluating an injured worker?
The records include treatment records and comprehensive medical-legal reports among others necessary for documenting the injured worker’s condition and care.
What obligations does a physician have when serving a medical-legal report according to Labor Code section 3209.3?
Upon serving the employee’s copy of the medical-legal report as per subdivisions 36.5b6 36.5b7 or 36.5b8 of Title 8 of the California Code of Regulations the evaluator fulfills their obligation to serve the report to the injured worker under applicable Labor Code sections.
Which sections of the California Code of Regulations pertain to the serving of medical-legal reports?
The relevant sections include subdivisions 36.5b6 36.5b7 and 36.5b8 of Title 8 of the California Code of Regulations.
What is the significance of the QME Form 121 Declaration Regarding Protection of Mental Health Record?
The QME Form 121 is significant as it designates the physician who will receive the employee’s copy of the medical-legal report ensuring that the process of serving the report complies with the legal requirements.
Under what condition are mental health records kept confidential according to Labor Code section 3209.3?
Mental health records are confidential under the provisions set by Health and Safety Code section 123115b and Labor Code section 3209.3 limiting access to these records unless ordered otherwise by a Workers’ Compensation appeal.
Who is responsible for maintaining the confidentiality of mental health records as stated in Labor Code section 3209.3?
The claims administrator and all parties’ attorneys involved in the case are responsible for keeping the mental health records confidential unless a different order is issued.
What happens if a Workers’ Compensation appeal orders otherwise regarding mental health records?
If a Workers’ Compensation appeal issues an order it may override the confidentiality provisions allowing access to the mental health records as specified by the order.
What is the overall impact of Labor Code section 3209.3 on workers’ compensation claims?
Labor Code section 3209.3 ensures that treatment and evaluation processes for injured workers are standardized protects the confidentiality of sensitive mental health information and delineates the responsibilities of medical evaluators and claims administrators in handling these records.
What must a party do before filing a mental health record at the Workers’ Compensation Appeals Board?
The party must request and obtain a protective order from a Workers’ Compensation Administrative Law Judge that specifies how the mental health record may be inspected copied and entered into evidence.
What form does the evaluator provide to the injured worker if they prefer to have the evaluation report served on a designated physician?
The evaluator provides QME Form 120 Voluntary Directive for Alternate Service of Medical-Legal Report.
What should the injured worker do with QME Form 120 after it is given by the evaluator?
The injured worker should complete the form before leaving the evaluator’s office.
What is the significance of Health and Safety Code section 123115b in the evaluation process?
If the evaluator does not make a determination pursuant to Health and Safety Code section 123115b this could indicate that the procedure for directing the report to a designated physician has not been followed.
What is the role of the Workers’ Compensation Administrative Law Judge concerning mental health records?
The Workers’ Compensation Administrative Law Judge is responsible for issuing protective orders that govern how mental health records can be inspected copied and entered into evidence.
What are the implications of filing a mental health record without a protective order?
Filing a mental health record without a protective order may lead to violations of privacy and confidentiality laws and the record may not be admissible as evidence.
What does QME Form 120 facilitate for injured workers?
QME Form 120 facilitates the alternate service of the medical-legal report to a physician designated by the injured worker allowing for preferences in communication and privacy.
What regulations govern the service of medical-legal reports in California Workers’ Compensation?
The regulations governing the service of medical-legal reports in California Workers’ Compensation are outlined in Cal. Code Regs. 120.
What is required to be attached to the original executed QME Form 120?
The original executed QME Form 120 must have the original medical-legal report attached.
Who should receive copies of the medical-legal report when an evaluator serves it with QME Form 120?
Two copies of the medical-legal report with QME Form 120 attached should be served on the designated physician by the injured worker the claims administrator (or the employer if no claims administrator is available) and the injured worker’s attorney if applicable.
What regulation specifies the service requirement for medical-legal reports in California?
The service requirement for medical-legal reports is specified in 8 Cal. Code Regs. 120.
What is the purpose of serving a medical-legal report in compliance with the described subdivision?
Serving the medical-legal report as described satisfies the evaluator’s obligation to provide a copy of the report to the employee under Labor Code sections 139.21 and 4061(c) as well as section 36 of Title 8 of the California Code of Regulations.
What does QME stand for in the context of California regulations?
QME stands for Qualified Medical Evaluator.
What are the Labor Code sections that relate to the evaluator’s obligation to serve reports to employees?
The Labor Code sections relating to the evaluator’s obligation include sections 139.21 and 4061(c).
Can the physician designated by the injured worker be limited in any way according to QME Form 120 or QME Form 121?
No the physician designated by the injured worker in writing and listed on QME Form 120 or QME Form 121 shall not be limited.
What should an evaluator do when an evaluation report is being served on a designated physician using QME Form 120?
The evaluator shall attach two copies of the medical-legal report with QME Form 120 to the report being served on the designated physician.
Who must be served copies of the medical-legal report if there is no claims administrator?
If there is no claims administrator copies of the medical-legal report must be served on the employer.
What happens if the injured worker has an attorney?
If the injured worker has an attorney the medical-legal report must also be served on the attorney.
What is the role of the primary treating physician in a disputed workers’ compensation claim?
The primary treating physician is responsible for providing medical treatment and managing the care of an injured worker. In the context of a disputed workers’ compensation claim their role may also include reviewing evaluator reports and participating in discussions related to the injured worker’s medical care.
What section of the Labor Code outlines the medical treatment expenses incurred in workers’ compensation claims?
Section 4600 of the Labor Code outlines the reimbursement policy for additional medical treatment expenses incurred in workers’ compensation claims.
What is required for a physician to be reimbursed under section 4600?
The physician must be designated by the injured worker and listed on the QME Form 121 Declaration Regarding Protection of Mental Health Record or the QME Form 120 Voluntary Directive for Alternate Service of Medical-Legal Evaluation Report on Disputed Injury to the Psyche.
