6. QME Availability and Reports Medical legal Expense 5 Flashcards
What historical changes were made to sections 32 and 32.5 on 1-13-2009?
On 1-13-2009 a repealer was filed regarding section 32.5 effectively removing it from the Labor Code.
Discuss the significance of the renumbering of sections within the Labor Code. Why is it important?
The renumbering of sections within the Labor Code is important for clarity organization and legal reference. It helps ensure that the sections are consistent and can be easily located by legal professionals lawmakers and the public.
What implications do amendments in the Labor Code have on labor law compliance?
Amendments in the Labor Code can directly affect labor law compliance requirements for businesses and organizations making it crucial for them to stay updated on changes to avoid legal issues.
What is the general purpose of the Labor Code as indicated in the referenced sections?
The Labor Code serves to regulate labor relations workplace safety workers’ compensation and various rights and responsibilities of both employers and employees.
What is the role of the Medical Director regarding Qualified Medical Evaluators (QMEs)?
The Medical Director shall issue a panel of Qualified Medical Evaluators upon receipt of an order of a Workers’ Compensation Administrative Law Judge or the Appeals Board confirming that an additional evaluation is reasonable and necessary to resolve disputes under specific Labor Code sections.
Which Labor Code sections are relevant for issuing an order for a Qualified Medical Evaluation?
The relevant Labor Code sections are 4060 4061 and 4062.
What information must be specified in the order for issuing a panel of QMEs?
The order must specify the residential or employment-based zip code for random selection of evaluators the specialty for the QME panel who will select the specialty of the QME panel and who will select a new specialty if there are too few QMEs in the initially selected specialty.
Under which title of the California Code of Regulations is the selection of the QME panel governed?
The selection of the QME panel is governed by section 31d of Title 8 of the California Code of Regulations.
What authority is cited in relation to the issuance of panels of Qualified Medical Evaluators?
The authority cited includes Sections 133 139.2 4061 4062 4064 5307.3 5703 and 5703.5 of the Labor Code.
Which Labor Code sections serve as references in the context of Qualified Medical Evaluations?
The reference Labor Code sections are 139.2 4060 4061 4062 4062.1 4062.2 and 4064.
What is the significance of the order issued by the Workers’ Compensation Administrative Law Judge or the Appeals Board?
The order indicates that an additional evaluation is deemed reasonable and necessary to resolve disputed issues under the specified Labor Code sections thereby justifying the issuance of a QME panel.
What happens if there are too few QMEs in the initially selected specialty?
In the event there are too few QMEs in the specialty initially selected the order must specify who shall select a new specialty.
When was the new section regarding Qualified Medical Evaluators filed?
The history states that a new section was filed but the specific date is not provided in the input text.
What is the operative date for the Rebuttal QME Examinations as filed on 2-17-2009?
The Rebuttal QME Examinations were made operative on 2-17-2009.
What authority is cited for Section 32.7 regarding Rebuttal QME Examinations?
Authority cited includes Sections 139.2 4061 and 4062 of the Labor Code.
What references are made in Section 32.7?
The references made in Section 32.7 are Sections 4061 and 4064 of the Labor Code.
When was the new section 32.7 filed and when did it become operative?
The new section 32.7 was filed on 8-23-96 and became operative on 9-22-96.
What change occurred to section 32.7 on 4-14-2000?
On 4-14-2000 the former section 32.7 was renumbered to section 32.5 which was effective on 5-14-2000.
What is the protocol for a QME who is unavailable for comprehensive medical evaluations?
A QME who will be unavailable for scheduling or performing comprehensive medical evaluations for 14 to 90 days must notify the Medical Director by submitting the form in Section 109 (Notice of Qualified Medical Evaluator Unavailability) at least 30 days before the unavailability period begins.
What regulations pertain to the notice of unavailability of a QME?
The notice of unavailability is regulated by 8 Cal. Code Regs. 109.
What is the maximum duration of unavailability for a QME within a one-year fee period?
The maximum duration of unavailability for a QME during a one-year fee period is up to 90 days.
What discretion does the Medical Director have regarding a QME’s notice of unavailability?
The Medical Director may at their discretion grant unavailable status even within the 30-day notice period.
How far in advance must a QME notify the Medical Director of upcoming unavailability?
A QME must notify the Medical Director at least 30 days before the period of unavailability is scheduled to begin.
What are acceptable reasons for a QME to request unavailable status?
A QME can request unavailable status for good cause which includes but is not limited to medical or family emergencies.
What must a QME provide to the Medical Director when requesting unavailable status?
The QME must provide a list of any and all comprehensive medical-legal evaluation examinations already scheduled during the time requested for unavailable status.
How should a QME indicate the status of scheduled examinations when requesting unavailable status?
The QME shall indicate whether each scheduled examination is being rescheduled or if the QME plans to complete the exam and report while in unavailable status.
What is prohibited for a QME who is in unavailable status?
A QME who is unavailable shall not perform any new evaluation examinations as a QME until they return to active status.
What evaluations can a QME in unavailable status complete?
A QME in unavailable status may complete medical-legal examinations and reports that are already scheduled and reported to the Medical Director as well as reports for evaluations performed before becoming unavailable.
Can a QME in unavailable status complete supplemental reports?
Yes a QME in unavailable status may complete supplemental reports.
Is it acceptable for a QME to claim unavailability because they do not intend to work?
No it is not an acceptable reason for unavailability that a QME does not intend to work.
What is the maximum number of days a QME can file notifications for unavailability during the QME fee period without facing reappointment issues?
A QME can file notifications for unavailability totaling more than ninety (90) days after which they may be denied reappointment subject to section 52 of Title 8 of the California Code of Regulations.
What constitutes ‘good cause’ for a QME’s unavailability?
Good cause includes but is not limited to sabbaticals or the death or serious illness of an immediate family member.
What happens if a party is unable to obtain an appointment with a QME within sixty (60) days of their appointment request?
The party may waive the right to a replacement in order to accept an appointment no more than ninety (90) days after the date of their initial appointment request.
What action can either party take if the selected QME cannot schedule the evaluation within ninety (90) days of the initial appointment request?
Either party may report the unavailability of the QME to the Medical Director.
What is a QME in the context of medical-legal evaluations?
QME stands for Qualified Medical Examiner a professional who performs medical-legal evaluations for unrepresented workers.
Under which title and section of the California Code of Regulations can the QME reappointment rules be found?
The QME reappointment rules can be found under section 52 of Title 8 of the California Code of Regulations.
Can parties accept a later appointment if the selected QME is unavailable?
Yes if the selected QME is unable to schedule an evaluation within ninety (90) days the party may accept an appointment after waiving the right to a replacement.
What section of the California Code of Regulations addresses the replacement of a Qualified Medical Evaluator (QME)?
Section 31.5 of Title 8 of the California Code of Regulations addresses the replacement of a Qualified Medical Evaluator (QME) upon request.
What is the time limit for scheduling the initial evaluation with a QME and how can it be waived?
The time limit for scheduling the initial evaluation with a QME is ninety (90) days which can be waived if both parties agree in writing.
What must a QME do to notify the Medical Director of their unavailability?
A QME must submit the form specified in section 109 titled ‘Notice of Qualified Medical Evaluator Unavailability’ to notify the Medical Director of their unavailability at a medical office at least thirty (30) days before the evaluator becomes unavailable.
What happens if a QME fails to notify the Medical Director of their unavailability within the required timeframe?
If a QME fails to notify the Medical Director of their unavailability at least thirty (30) days prior the Medical Director may designate the QME as unavailable at that location for thirty (30) days from the date the Medical Director learns of the unavailability.
What action is taken by the Medical Director when notified about a QME’s unavailability?
When notified by a party seeking an appointment with a QME or otherwise becoming aware that the QME is not available and not responding the Medical Director will send a certified letter to the QME.
Under which regulation is the Notice of Qualified Medical Evaluator Unavailability found?
The Notice of Qualified Medical Evaluator Unavailability is found in 8 Cal. Code Regs. 109.
What is the consequence if a party seeking an appointment with a QME does not receive a response?
If a party seeking an appointment with a QME does not receive a response they can notify the Medical Director who will then send a certified letter to the QME regarding their unavailability.
Explain the role of the Medical Director concerning unavailability notifications of QME.
The Medical Director is responsible for handling notifications about QMEs’ unavailability; upon receiving such a notification the Director must send a certified letter to the QME to inform them of the issue.
What is the significance of a certified letter sent by the Medical Director?
The certified letter sent by the Medical Director serves as an official communication to the QME regarding their unavailability status and may affect their eligibility to serve in that capacity.
What is the legal framework governing the scheduling of evaluations with Qualified Medical Evaluators in California?
The legal framework is governed by Title 8 of the California Code of Regulations particularly sections 31.5 and 109.
What happens if the Medical Director does not receive a response from the QME within fifteen (15) days after mailing a certified letter?
The QME will be made unavailable at that location.
How does the unavailable status of a QME affect the ninety (90) day limit specified in subdivision 33a of Title 8 of the California Code of Regulations?
The time a QME is placed on unavailable status will count toward the ninety (90) day limit.
What requirement was established on or after January 1 2013 regarding QMEs notifying the Medical Director?
QMEs must notify the Medical Director of the 10 or fewer office locations where qualified medical evaluations will be conducted as specified in section 31.2a.
Where can the form referred to in the document be obtained?
The form can be obtained at no charge by downloading it from www.dir.ca.gov/dwc/forms.html or by requesting it at 1-800-794-6900.
What sections of the Labor Code are cited as authority for this regulation?
Sections 133 139.2 and 5307.3 of the Labor Code.
Which sections of the Labor Code are referenced in relation to the regulation discussed?
Sections 139.2 4060 4061 4062 4062.1 4062.2 4062.5 and 4067 of the Labor Code.
When was the new section concerning QME unavailability filed?
The new section was filed on August 1 1994.
What is the significance of a QME being made unavailable at a location?
Being made unavailable at a location means that the QME can no longer conduct evaluations at that specific site until they are reinstated.
Why is it important for QMEs to notify the Medical Director of their office locations?
It is important to ensure that the Medical Director has updated information to manage the availability of QMEs for conducting evaluations effectively.
What does QME stand for in the context of this regulation?
QME stands for Qualified Medical Evaluator.
What are the potential consequences for a QME failing to notify the Medical Director of their office locations?
Failure to notify may result in the QME being designated as unavailable impacting their ability to conduct evaluations.
What is the operative date of the section filed on 8-1-94?
The operative date of the section filed on 8-1-94 is 8-31-94.
What amendment was filed on 4-14-2000 and when did it become operative?
The amendment filed on 4-14-2000 became operative on 5-14-2000.
What significant change occurred on 1-13-2009 regarding this section?
On 1-13-2009 an amendment of section and Note was filed which became operative on 2-17-2009.
Outline the emergency filing that occurred on 12-31-2012 concerning subsection h.
A new subsection h was filed as an emergency on 12-31-2012 operative from 1-1-2013 under Government Code section 11346.1d.
What deadline was set for transmitting a Certificate of Compliance to OAL following the emergency language in 2012?
A Certificate of Compliance must be transmitted to OAL by 7-1-2013; if not the emergency language will be repealed by operation of law on the following day.
Which sections of the Labor Code provide the authority for the Notice of QME Unavailability Form?
Authority is cited from Sections 139 and 139.2 of the Labor Code for the Notice of QME Unavailability Form.
When was the new section added that was referenced as Register 94 No. 31?
The new section was added on 8-1-94 and was operative on 8-31-94 as referenced in Register 94 No. 31.
What changes occurred in the 1996 amendment as noted under Register 96 No. 34?
The heading of the section was amended and a repealer along with a new section was filed on 8-23-96 becoming operative on 9-22-96.
What specific actions were taken with the section on 4-14-2000?
A repealer was filed on 4-14-2000 which became operative on 5-14-2000 as noted in Register 2000 No. 15.
Describe the actions taken regarding Appointment Notification and Cancellation that are noted in the history section. What does it imply about notifications?
The history of Appointment Notification and Cancellation indicates a continuing obligation to notify and manage appointments carefully; however further details in the section were not provided in the text excerpt.
