4.Timely services and retention of reports 4 Flashcards
What is the time frame for a QME to prepare and submit an initial or follow-up comprehensive medical-legal evaluation report?
The time frame for preparing and submitting the report shall not exceed thirty (30) days after the QME has agreed to the evaluation.
What distinguishes a QME from an AME in the context of medical evaluations?
A QME (Qualified Medical Evaluator) is appointed by the state in compensation cases whereas an AME (Agreed Medical Evaluator) is agreed upon by both parties in a dispute generally with a focus on a more collaborative evaluation process.
What is Section 35 of the rules regarding documents for the panel QME?
Section 35 outlines the protocols and submissions permissible to the panel QME under which parties can file certain documents relevant to the case.
What should the supplemental report from the QME include if there are factual corrections?
The supplemental report must indicate if factual corrections are necessary for accuracy and whether these corrections alter the opinions previously stated by the panel QME in the original report.
What consequences might there be if the 30-day time frame for a QME report is not adhered to?
Failing to adhere to the 30-day time frame may result in delays in the claim process potential sanctions for the QME or issues in the case being resolved due to lack of timely evaluation.
What happens if no factual corrections are necessary according to the panel QME?
If no factual corrections are necessary the panel QME will indicate this in the supplemental report and submit it to the DEU office.
What does QME stand for in the context of workers’ compensation evaluations in California?
QME stands for Qualified Medical Evaluator.
What is the consequence for a QME or AME if they fail to prepare and serve the evaluation report within thirty days?
If a QME or AME fails to prepare and serve the initial or follow-up comprehensive medical-legal evaluation report within thirty days without obtaining an extension approval from the Medical Director the employee or employer may request a replacement evaluator.
What section of the California Code of Regulations allows for the request of a QME replacement if the report is not timely?
Section 31.5 of Title 8 of the California Code of Regulations allows for the request of a QME replacement.
What is the liability of the employee or employer for payment if the medical evaluation is not completed within the required timeframe?
Neither the employee nor the employer shall have any liability for payment for the medical evaluation if it was not completed within the required timeframes unless they both waive the right to a new evaluation.
What forms must the employee and employer sign to accept the original evaluation despite the delay?
The employee and employer must sign and return either QME Form 113 Notice of Denial of Request For Time Extension or QME Form 116 Notice of Late QME/AME Report.
What does AME stand for in the context of medical evaluations?
AME stands for Agreed Medical Evaluator.
What is required for an evaluator to receive an extension beyond the initial thirty-day report preparation period?
The evaluator must obtain approval from the Medical Director for an extension of time.
What happens if both the employee and employer choose to waive the right to a new evaluation?
If they choose to waive the right to a new evaluation they may accept the original evaluation in writing.
What form is required for an evaluator to request an extension of time according to 8 Cal. Code Regs. 113 and 116?
The evaluator must use form 112 QMEAME Time Frame Extension Request.
What is the maximum extension period an evaluator can request from the Medical Director to complete an evaluation report?
The maximum extension period that can be requested is an additional 30 days.
Under what circumstances can an evaluator be granted an extension of up to 30 days for completing a report?
An extension of up to 30 days shall be granted if the evaluator has not received test results or the report of a consulting physician necessary to address all disputed medical issues in time to meet the initial 30-day deadline.
What is the good cause definition for granting an extension of 15 days according to Labor Code section 139.2j1B?
Good cause refers to circumstances that justify the need for additional time to complete the report though specific examples are not provided in the text.
What is the deadline for an evaluator to notify the Medical Director the employee and the claims department about the need for an extension?
The evaluator must notify them not later than 5 days before the initial 30-day period to complete and serve the report expires.
What happens if an evaluator does not follow the proper procedures for requesting the extension?
While the document does not specify the consequences failing to follow procedures could potentially lead to delays or rejection of the extension request which could impact the evaluator’s ability to complete their report on time.
What regulatory codes govern the request for extensions by evaluators?
The request for extensions is governed by 8 Cal. Code Regs. 113 and 116.
How long is the initial period given to an evaluator to complete and serve the report?
The initial period given to an evaluator to complete and serve the report is 30 days.
What is the purpose of QME Form 112?
QME Form 112 is used to request an extension of time for the completion of a report by a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator.
Who can request an extension using QME Form 112?
The request for an extension can be made by the administrator or if none by the employer.
What regulation governs the use of QME Form 112?
The use of QME Form 112 is governed by 8 Cal. Code Regs. 112.
What must the Medical Director do upon receipt of an extension request?
The Medical Director must notify the requesting evaluator and the parties of the decision regarding the extension request by completing the box at the bottom of QME Form 112.
What happens if a request for an extension is denied?
If a request for an extension is denied the Medical Director must send the parties QME Form 113 which is the Notice of Denial of Request for Time Extension as per 8 Cal. Code Regs. 113.
What options are provided to each party upon receiving QME Form 113?
Each party must state whether they wish to request a new evaluator or to accept the late report of the original evaluator.
Under what condition does the Medical Director become concerned about the timely completion of a report?
The Medical Director becomes concerned if they become aware that the report of a Qualified Medical Evaluator or an Agreed Medical Evaluator has not been completed within the required time under section 38 and no extension of time was requested by the evaluator.
What is the notification process for a time extension request?
Upon completion of the extension request the Medical Director must complete the box at the bottom of QME Form 112 indicating the decision and notify the involved parties.
What two forms are associated with the extension process for Qualified Medical Evaluators?
The two forms associated with this process are QME Form 112 (QMEAME Time Extension Request) and QME Form 113 (Notice of Denial of Request for Time Extension).
What regulatory code outlines the procedures for the timeline and extension requests for medical evaluations?
The procedures are outlined in 8 Cal. Code Regs. 112 and 113.
What is the purpose of the Notice of Late QMEAME Report?
The Notice of Late QMEAME Report is used to inform parties that a Qualified Medical Evaluators’ (QME) report is late and to indicate whether the parties accept the late report or not. Parties must complete QME Form 116 to respond.
What form must each party complete when responding to a late QME report?
Each party must complete QME Form 116 when responding to a late Qualified Medical Evaluator (QME) report.
What constitutes ‘good cause’ for requesting an extension according to California Labor Code and regulations?
According to Labor Code section 139.2j 1 B and section 38b2 of Title 8 of the California Code of Regulations ‘good cause’ includes: 1) medical emergencies of the evaluator or the evaluator’s family 2) death in the evaluator’s family 3) natural disasters or other community catastrophes that interrupt the evaluator’s office operations.
Can extensions be granted if relevant medical information has not been received?
No extensions shall not be granted because relevant medical information or records including the Disability Evaluation Form 101 Request for Summary Determination of Qualified Medical Evaluator’s Report have not been received.
What should be included in the evaluator’s report if it is completed based on available information?
If the evaluator completes the report based on the information available the report should state that the opinions and/or conclusions may or may not be limited due to missing information.
What is the reference for QME Form 116 regarding late report notices?
QME Form 116 regarding late report notices is referenced in 8 Cal. Code Regs. 116.
What is the Disability Evaluation Form 101 used for?
The Disability Evaluation Form 101 is used to Request Summary Determination of Qualified Medical Evaluator’s Report.
What regulation outlines the requirements for responding to late QME reports?
The requirements for responding to late QME reports are outlined in 8 Cal. Code Regs. 10161.
What can the parties do with the completed QME Form 116?
The parties shall return the completed QME Form 116 to the Medical Director to indicate whether or not they accept the late QME report.
What regulatory code defines ‘good cause’ in this context?
‘Good cause’ is defined in Labor Code section 139.2j 1 B and section 38b2 of Title 8 of the California Code of Regulations.
What is the time frame for supplemental reports after a request is made to a physician?
The time frame for supplemental reports shall be no more than sixty (60) days from the date of a written or electronically transmitted request to the physician by a party.
What must accompany a request for a supplemental report?
The request for a supplemental report shall be accompanied by any new medical records that were unavailable to the evaluator at the time of the original evaluation and which were properly served on the opposing party as required by Labor Code section 4062.3.
Can the sixty (60) day time frame for supplemental reports be extended?
Yes an extension of the sixty (60) day time frame for completing the supplemental report of no more than thirty (30) days may be agreed to by the parties without the need to request an extension from the Medical Director.
Who monitors evaluators requesting time extensions?
Evaluators requesting time extensions will be monitored and advised by the Medical Director when such a request appears unreasonable or excessive.
What exceptions are there for requesting factual corrections in supplemental reports?
Section 37 provides exceptions with respect to a request for factual correction; otherwise the standard time frames and requirements apply.
According to Labor Code section 4062.3 what is the significance of the new medical records in supplemental report requests?
The new medical records must be properly served on the opposing party and are important as they provide information that was unavailable to the evaluator at the time of the original evaluation.
What happens if the request for a supplemental report is deemed unreasonable or excessive?
The Medical Director will monitor and advise on requests that appear unreasonable or excessive.
What is the maximum extension time for completing a supplemental report?
The maximum extension time for completing a supplemental report is thirty (30) days.
What type of requests does not need the new medical records to be provided?
Requests for factual correction do not require the new medical records to be provided.
What is the role of the Medical Director in overseeing the time extension requests?
The Medical Director monitors evaluators requesting time extensions and advises them if the requests appear unreasonable or excessive.
What may constitute grounds for denial of a QME’s request for reappointment according to California regulations?
Non-compliance with the requirements outlined in the California Code of Regulations Section 51.
How long must QMEs retain copies of comprehensive medical-legal reports?
QMEs must retain copies of all comprehensive medical-legal reports for a period of five years from the date of each evaluation report.
Can QMEs retain electronic copies of medical-legal reports instead of paper copies?
Yes QMEs may satisfy the retention requirement by keeping electronic copies provided they are true and correct copies of the original reports and show the QME’s signature.
What must a QME do upon written request regarding original radiological films and medical records?
The QME is required to return original radiological films imaging studies and original medical records to the person who supplied them or to the injured worker.
Who should QMEs submit comprehensive medical-legal reports to upon request?
QMEs must submit all comprehensive medical-legal reports to the Medical Director when requested for review.
What is the legislative reference for the retention of records by QMEs in California?
California Code of Regulations Title 8 Section 39.5.
What is required from QMEs regarding the electronic copies of reports?
The electronic copies must be a true and correct copy of the original report displaying the QME’s signature.
What happens if QMEs do not comply with the retention of records requirement?
Failure to comply may result in denial of the QME’s request for reappointment.
What types of records must QMEs retain for five years?
All comprehensive medical-legal reports completed by the QME.
What should QMEs do with original records supplied to them?
They must return original records including radiological films and medical studies upon written request.
What role does the Medical Director play regarding QME reports?
The Medical Director can request all comprehensive medical-legal reports from QMEs for review.
Is there a specific format required for the electronic copies of QME reports?
Yes they must be true and correct copies of the original documents and must show the QME’s signature.
What may constitute grounds for disciplinary action according to Section 60?
Failure to submit evaluations upon request by the Medical Director may constitute grounds for disciplinary action according to Section 60.
