4.Timely services and retention of reports 3

Question 1

What is the purpose of reimbursing the physician for one office visit in a disputed claim?

Answer 1

The reimbursement is for the office visit used to review and discuss the evaluator’s report with the injured worker.

Question 2

Which regulation governs the applicable rate for the reimbursed office visit?

Answer 2

The applicable rate under section 9789.11 Physician Services Rendered on or After July 1 2004 of Title 8 of the California Code of Regulations governs the reimbursement rate for the office visit.

Question 3

What types of services might be included in the reimbursement for the office visit?

Answer 3

The reimbursement may include record review any necessary face-to-face time during the visit in excess of that specified in the applicable CPT office visit code as well as the standard elements of the office visit.

Question 4

What are the QME Forms mentioned in the document?

Answer 4

The QME Forms are: QME Form 121 which pertains to the protection of mental health records and QME Form 120 which relates to the voluntary directive for alternate service of medical-legal evaluation reports on disputed injuries to the psyche.

Question 5

What does CPT stand for in the context of office visit coding?

Answer 5

CPT stands for Current Procedural Terminology. It is a set of medical codes used to report procedures and services provided by healthcare practitioners.

Question 6

What types of reports may require preparation time and charges during an office visit?

Answer 6

Charges may apply for the time required to prepare a treatment report pertaining to the office visit.

Question 7

What is the purpose of the QME Form 120?

Answer 7

The QME Form 120 labeled as the Voluntary Directive for Alternate Service of Medical-Legal Report on Disputed Injury to the Psyche is used when serving a comprehensive medical-legal report by the evaluator on a physician.

Question 8

What two copies of the medical-legal report are served under subdivision 36.5f?

Answer 8

One of the two copies of the medical-legal report must be served on the physician pursuant to subdivision 36.5f along with the QME Form 120.

Question 9

What does ‘Electronic service’ mean in the context of medical-legal reports?

Answer 9

Electronic service refers to the service of the medical-legal report and all required documents by either electronic transmission or electronic notification.

Question 10

Who can perform electronic service of medical-legal reports?

Answer 10

Electronic service may be performed directly by the physician or by an agent of the physician.

Question 11

What section outlines the electronic service of medical-legal reports?

Answer 11

The electronic service of medical-legal reports is outlined in section 36.7.

Question 12

What types of evaluations are included under the electronic service of reports?

Answer 12

A Qualified Medical Evaluation (QME) Agreed Medical Evaluation (AME) reports and other medical-legal reports may be served electronically.

Question 13

What are the key elements required when serving medical-legal reports electronically?

Answer 13

The service must include the medical-legal report and all documents required by section 36.

Question 14

What happens if a comprehensive medical-legal report is served incorrectly?

Answer 14

If served incorrectly it may lead to disputes regarding the accuracy or validity of the medical-legal report potentially complicating associated legal proceedings.

Question 15

What are the implications of having a comprehensive medical-legal report prepared?

Answer 15

The preparation of a comprehensive medical-legal report may involve additional charges and require thorough documentation affecting both the patient and the evaluator’s responsibilities.

Question 16

What does ‘Electronic transmission’ refer to?

Answer 16

‘Electronic transmission’ refers to the transmission of a document by electronic means to the electronic service address at or through which a party or other person has authorized electronic service.

Question 17

Define ‘Electronic notification’.

Answer 17

‘Electronic notification’ is the process of notifying the party or other person that a document has been served by sending an electronic message to the electronic address at or through which the party or other person has authorized electronic service with details included.

Question 18

What conditions must be met for electronic service to be permitted?

Answer 18

Electronic service shall be permitted only when the parties agree to it and a written confirmation of that agreement is made.

Question 19

What must a party provide at the time of consenting to electronic service?

Answer 19

At the time of giving consent to electronic service a party or entity must provide their electronic address for the purpose of receiving electronic service.

Question 20

To whom must medical-legal reports or other papers be transmitted for electronic service?

Answer 20

For electronic service the medical-legal report or other papers must be transmitted to the electronic address that is the most recent electronic address provided by the party to the physician.

Question 21

What is the significance of having a written confirmation for electronic service consent?

Answer 21

A written confirmation of the agreement for electronic service serves as a record and proof that both parties consented to use electronic means for document transmission.

Question 22

What is the impact of providing an outdated electronic address?

Answer 22

If a party provides an outdated electronic address they may not receive important documents or notifications as the transmission would go to a location that is no longer valid.

Question 23

Why is it important for parties to agree on electronic service?

Answer 23

It is important for parties to agree on electronic service to ensure that both understand and consent to the method of communication which helps in maintaining clarity and avoiding disputes over service methods.

Question 24

What role does the term ‘most recent electronic address’ play in electronic service?

Answer 24

The term ‘most recent electronic address’ is crucial as it indicates that the documents must be sent to the latest address provided by the party to ensure successful delivery and receipt.

Question 25

What is the obligation of a party whose electronic address has changed?

Answer 25

The party must file a notice of change of address with the physician and all parties.

Question 26

What is the moment when service is considered complete when using electronic means?

Answer 26

Service is complete at the time of transmission.

Question 27

How does the period of notice change after service of a document through electronic means?

Answer 27

Any period of notice and any right or duty to act or make a response shall be extended by two business days.

Question 28

What terms apply to the electronic service of medical-legal reports in claims of injury to the psyche?

Answer 28

All of the terms of section 36.5 apply except that the service requirements in section 36.5b6 may be accomplished by electronic service as per this regulation.

Question 29

What is the relevance of section 36 regarding electronic service of medical-legal reports?

Answer 29

For purposes of all medical-legal reports all of the terms of section 36 apply to electronic service but the manner of service can be accomplished through electronic transmission when appropriate.

Question 30

What is the implication of electronic service for medical-legal reports?

Answer 30

Electronic service for medical-legal reports allows for quicker and possibly more efficient communication while still adhering to legal requirements outlined in relevant sections.

Question 31

What is the purpose of the mandatory form 122 AME or QME Declaration of Service of Medical-Legal Report?

Answer 31

This form is used to certify the electronic service of all medical-legal reports in compliance with 8 Cal. Code Regs. 122.

Question 32

What can replace the mandatory form 122 AME or QME Declaration of Service of Medical-Legal Report?

Answer 32

An Affidavit of Proof of Electronic Service can replace the mandatory form.

Question 33

What must the Affidavit of Proof of Electronic Service include regarding the document served?

Answer 33

It must set forth the exact title of the document served in the action.

Question 34

What are the five requirements that must be shown in the Affidavit of Proof of Electronic Service?

Answer 34

A) The name and residence or business address of the person making the service. B) That he or she is a resident of or employed in the county where the electronic service occurs. C) That he or she is over the age of 18 years. D) That he or she is readily familiar with the business' practice for serving electronically. E) That the document would be electronically served that same day in the ordinary course of business.

Question 35

What legal consequence does the Affidavit of Proof of Electronic Service carry when it is signed?

Answer 35

It is signed under penalty of perjury under the laws of the State of California.

Question 36

What other details must be included in the Affidavit of Proof of Electronic Service?

Answer 36

The specific details that must be included were not provided in the text but typically it would include the date of service and the method of electronic communication used.

Question 37

What is the age requirement for a person making electronic service as per the affidavit?

Answer 37

The person making the service must be over the age of 18 years.

Question 38

What does it mean to be readily familiar with the business' practice for serving electronically?

Answer 38

It means that the individual is knowledgeable about the procedures and protocols of the business concerning how documents are typically served electronically.

Question 39

What is the significance of the statement that the document would be served the same day?

Answer 39

This statement assures compliance with business practices and the promptness of service which is crucial in legal proceedings.

Question 40

How is electronic service of documents in California regulated?

Answer 40

It is regulated by the California Code of Regulations specifically under 8 Cal. Code Regs. 122.

Question 41

What information must be included in the electronic service of documents?

Answer 41

1. The electronic service address and the residence or business address of the person making the electronic service. 2. The date of electronic service. 3. The name and electronic service address of the person or entity served. 4. A statement that the document was served electronically.

Question 42

What is the time frame for an unrepresented employee or claims administrator to request a factual correction of a comprehensive medical-legal report from a panel QME?

Answer 42

An unrepresented employee or the claims administrator may request a factual correction within 30 days of the receipt of a comprehensive medical-legal report from a panel Qualified Medical Evaluator.

Question 43

What are the requirements for requesting a factual correction of a medical-legal report from a panel Qualified Medical Evaluator (QME)?

Answer 43

A request for factual correction must be served on: 1. The panel Qualified Medical Evaluator who examined the injured worker. 2. The party who did not file the request. 3. The Disability Evaluation Unit office where the comprehensive report was filed.

Question 44

Under which Labor Code section is the filing of comprehensive medical-legal reports with the DEU required?

Answer 44

Labor Code section 4061e.

Question 45

Who can request a factual correction of a comprehensive medical-legal report?

Answer 45

An unrepresented employee or the claims administrator.

Question 46

What is the purpose of a request for factual correction of a comprehensive medical-legal report?

Answer 46

To address errors or inaccuracies in the report prepared by a panel Qualified Medical Evaluator.

Question 47

What is a Qualified Medical Evaluator (QME)?

Answer 47

A Qualified Medical Evaluator is a physician certified by the state to conduct independent medical evaluations and issue medical-legal reports concerning workers' compensation cases.

Question 48

What is the consequence of not serving the request for factual correction appropriately?

Answer 48

Failure to serve the request appropriately may result in rejection of the request or failing to address the error in the medical-legal report.

Question 49

What document format should be used for the request for factual correction?

Answer 49

The request for factual correction should be made using the specific form as outlined in subdivision f.

Question 50

What is the time frame for the injured worker to respond to a request for factual correction served by the claims administrator?

Answer 50

The injured worker has five (5) days after the service of the request for factual correction to respond to the corrections mentioned in the request.

Question 51

Who must the injured worker serve their response to after receiving the request for factual correction?

Answer 51

The injured worker's response must be served on both the panel Qualified Medical Evaluator and the claims administrator.

Question 52

If the request for factual correction is filed by the injured worker how long does the panel Qualified Medical Evaluator have to review the request?

Answer 52

The panel Qualified Medical Evaluator has ten (10) days after service of the request to review the requested corrections.

Question 53

What is the purpose of the panel Qualified Medical Evaluator's review of the request for factual correction?

Answer 53

The purpose is to determine if factual corrections are necessary to ensure the factual accuracy of the comprehensive medical-legal report.

Question 54

How long does the panel Qualified Medical Evaluator have to review a request for correction if the request is filed by the claims administrator or both parties?

Answer 54

If the request for correction is filed by the claims administrator or by both parties the time to review the request for correction is extended to fifteen (15) days after the service of the request.

Question 55

What happens at the end of the period given for responding to a request for factual correction?

Answer 55

The text does not provide specific information about what happens at the end of the period but typically after the review period the Qualified Medical Evaluator may issue an amended report if corrections are deemed necessary.

Question 56

What must the panel QME do in response to a request for factual correction in subdivision c?

Answer 56

The panel QME shall file a supplemental report with the DEU office where the original comprehensive medical-legal report was filed indicating whether the factual correction of the comprehensive medical-legal report is necessary to ensure its factual accuracy. If factual corrections are necessary the report should also specify whether these corrections change the opinions stated by the panel QME.

Question 57

What is the role of the DEU office in the factual correction process?

Answer 57

The DEU office is where the original comprehensive medical-legal report was filed and it receives the supplemental report from the panel QME regarding the necessity and impact of factual corrections.

Question 58

What limitations are placed on parties regarding documents filed with the panel QME?

Answer 58

No party shall file any documents with the panel QME other than the form indicating the facts that should be corrected nor shall the panel QME review any documents not previously filed with them pursuant to Section 35 of the rules.