5. QME Availability and Reports 3 Flashcards
What must a party requesting a replacement do if they object to a report on the basis of lateness?
The party requesting a replacement must attach a copy of their objection to the untimely report along with their request for a replacement.
What is the disqualifying conflict of interest defined in?
The disqualifying conflict of interest for a Qualified Medical Evaluator (QME) is defined in section 41.5 of Title 8 of the California Code of Regulations.
What order can the Administrative Director issue regarding a QME evaluation?
The Administrative Director can issue an order for additional QME evaluation pursuant to section 10164c of Title 8 of the California Code of Regulations.
What happens if a selected medical evaluator refuses to provide a complete medical evaluation when requested?
If the selected medical evaluator refuses to provide a complete medical evaluation as provided in Labor Code sections 4062.3i and 4062.3k they must provide a written statement that explains why they believe they are not medically qualified.
What is the purpose of the Labor Code sections 4062.3i and 4062.3k?
Labor Code sections 4062.3i and 4062.3k outline the requirements and procedures for medical evaluations in the context of workers’ compensation claims.
What is the impact of a QME having a disqualifying conflict of interest?
A QME with a disqualifying conflict of interest may be deemed unqualified to conduct the evaluation potentially resulting in the invalidation of their report or requiring a replacement evaluator.
What documentation is required to support a replacement request based on an evaluator’s untimely report?
The request for replacement must include a copy of the objection to the untimely report.
What can a party do if they believe the QME is not qualified to evaluate their case?
They can either request a complete medical evaluation or ask the QME to provide a written statement explaining their lack of qualification.
Where can the guidelines regarding QMEs be found?
Guidelines regarding QMEs can be found in Title 8 of the California Code of Regulations.
In what scenario might a party request a replacement QME?
A party might request a replacement QME if they believe the current evaluator has a conflict of interest the report is untimely or the evaluator refuses to provide necessary documentation or evaluations.
What is the validity criterion for the QME panel list in relation to the request for a replacement?
The QME panel list must have been issued more than twenty-four (24) months prior to the date the request for a replacement is received by the Medical Unit and none of the QMEs on the panel list can have examined the injured worker.
What happens when the Medical Director determines a request for a QME or QME panel replacement is valid?
When the Medical Director determines that a request for a QME replacement or QME panel replacement is valid the time limit for an unrepresented employee to select a QME and schedule an appointment under Labor Code section 4062.1c and the time limit for a represented employee to strike a QME name from the QME panel under Labor Code section 4062.2c shall be tolled until the replacement QME name or QME panel is issued.
What occurs if parties in a represented case have struck two QME names from a panel and a valid ground arises for replacement?
If the parties in a represented case have struck two QME names from a panel and thereafter a valid ground under subdivision 31.5 arises to replace the remaining QME none of the QMEs whose names appeared on the panel can be considered for replacement.
Define QME in the context of this document.
QME stands for Qualified Medical Evaluator a medical professional authorized to perform evaluations and provide expert opinions in medical disputes especially within workers’ compensation cases.
What are the implications of a QME replacement request in the context of time limits for injured workers?
The implications are that once a replacement request is determined to be valid the time limits for both unrepresented and represented injured workers concerning the selection and striking of QMEs are paused until the new QME is appointed.
What is Labor Code section 4062.1c about?
Labor Code section 4062.1c pertains to the selection of a QME and the scheduling of an appointment by an unrepresented employee.
What does Labor Code section 4062.2c address?
Labor Code section 4062.2c addresses the process by which a represented employee can strike a QME name from the QME panel.
What is the significance of the time limit concerning the panel list in a QME replacement request?
The significance is that the panel list must be current (not issued more than 24 months prior) and that no previous evaluations have taken place by the QMEs on that list for the request for a replacement to be considered valid.
How many QME names can be struck from a panel in a represented case before a valid ground for replacement must be found from other sources?
In a represented case two QME names can be struck from a panel; thereafter any valid ground for replacement must find only QMEs not previously on that panel.
What are potential grounds that could validate a QME replacement request under subdivision 31.5?
While specific grounds are not detailed in the text provided generally these could include conflicts of interest biases unavailability of the QME or the QME’s inability to conduct an evaluation effectively.
What is the protocol after a Qualified Medical Evaluator (QME) issues a medical-legal report in a case when a new medical dispute arises?
Once an Agreed Medical Evaluator an Agreed Panel QME or a panel Qualified Medical Evaluator has issued a comprehensive medical-legal report in a case and a new medical dispute arises the parties shall obtain a follow-up evaluation or a supplemental evaluation from the same evaluator to the extent possible.
What constitutes ‘good cause’ for obtaining an additional QME panel in a different specialty?
Good cause means a written agreement by the parties in a represented case that there is a need for an additional comprehensive medical-legal report by an evaluator in a different specialty.
Under what circumstances can the Medical Director issue an additional panel of QME physicians in a different specialty?
The Medical Director can issue an additional panel of QME physicians in a different specialty upon showing good cause which is defined as having a written agreement by the parties that an additional evaluation is necessary to reach an expeditious and just resolution of disputed medical issues in the case.
What should the parties do before seeking an additional QME panel in a different specialty?
Before seeking an additional QME panel in a different specialty the parties should determine if it is possible to obtain a follow-up or supplemental evaluation from the same evaluator who issued the prior medical-legal report.