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.