6. QME Availability and Reports Medical legal Expense 6 Flashcards
What is the process for a QME to notify about a comprehensive medical evaluation appointment?
The QME shall complete an appointment notification form as per Section 110 QME Appointment Notification Form according to 8 Cal. Code Regs. 110. The completed form must be postmarked or sent by facsimile to the employee and claims administrator (or employer if no claims administrator exists) within 5 business days of scheduling the appointment.
What additional step must a QME take in represented cases when notifying about a comprehensive medical evaluation appointment?
In represented cases a copy of the completed notification form must also be sent to the attorney representing each party if known.
What are the consequences of failing to comply with QME notification requirements?
Failing to comply with the notification requirement constitutes grounds for denial of reappointment under Section 51 of Title 8 of the California Code of Regulations.
Where should the comprehensive medical-legal examination be conducted according to the QME regulations?
The comprehensive medical-legal examination must be conducted at the medical office listed on the panel selection form.
Can an injured worker request a different evaluation appointment for convenience?
Yes an injured worker can request a different evaluation appointment for their convenience; however this request must be made in writing.
What is a QME?
A QME or Qualified Medical Evaluator is a physician who has been certified by the California Division of Workers’ Compensation to evaluate injured workers in workers’ compensation cases.
What is the role of the claims administrator in the QME appointment notification process?
The claims administrator is responsible for receiving the completed appointment notification form from the QME ensuring that the injured worker’s claim is managed appropriately.
Define ‘medical-legal examination’ in the context of QME regulations.
A medical-legal examination is an assessment performed by a QME to determine the extent of an injured worker’s injuries the necessity for treatment and the impact on the worker’s ability to work often used in workers’ compensation cases.
What is the significance of Section 110 in the QME appointment process?
Section 110 outlines the requirements and procedures for notifying involved parties about a QME appointment ensuring proper communication and administration of workers’ compensation claims.
What is the time frame for sending the appointment notification form after scheduling?
The completed appointment notification form must be sent within 5 business days of the date the appointment was made.
What is required if a Qualified Medical Evaluator (QME) moves to another medical office?
If a QME moves to another medical office that is listed with the Medical Director as an additional office location the QME must include this notification in their communication.
What must a QME include in their notification regarding the need for an interpreter?
The QME shall specify whether a Certified Interpreter is required as defined by Labor Code Section 5811 and subject to the provisions of section 9795.3 of Title 8 of the California Code of Regulations and must specify the language needed.
Who is responsible for arranging the Certified Interpreter and who pays the cost?
The party who is responsible for paying the cost of the Certified Interpreter is also the one who must arrange for the interpreter’s services as stated in Section 5811 of the Labor Code.
What is the minimum notice period a QME must provide when canceling a scheduled appointment?
An evaluator whether AME Agreed Panel QME or QME shall not cancel a scheduled appointment less than six (6) business days prior to the appointment date except for good cause.
What should an evaluator do when they cancel a scheduled appointment?
Whenever an evaluator cancels a scheduled appointment they must advise the parties in writing of the reason for the cancellation.
Who retains jurisdiction to resolve disputes related to appointment cancellations?
The Appeals Board retains jurisdiction to resolve disputes among the parties regarding whether an appointment cancellation was for good cause.
Define ‘good cause’ in the context of canceling a scheduled appointment for a QME.
‘Good cause’ refers to a valid justifiable reason that permits an evaluator to cancel a scheduled appointment less than six (6) business days prior to the appointment date.
What is the role of the Administrative Director in relation to Agreed Panel QMEs or QME?
The Administrative Director retains jurisdiction to take appropriate disciplinary action against any Agreed Panel QME or QME for violations of the specified regulations.
What is the time frame for rescheduling an appointment if a QME cancels?
If a QME cancels a scheduled appointment they must reschedule the appointment to a date within 30 calendar days of the cancellation date.
What is the maximum time frame for scheduling a rescheduled appointment from the date of the initial request?
The rescheduled appointment date may not be more than 60 calendar days from the date of the initial request for an appointment unless the parties agree in writing to accept a date beyond the 60-day limit.
What is the rescheduling requirement for an Agreed Medical Evaluator who cancels an appointment?
An Agreed Medical Evaluator who cancels a scheduled appointment must reschedule it within 60 calendar days of the cancellation unless the parties agree in writing to accept an appointment date no more than 30 calendar days beyond this 60-day limit.
What happens if relevant medical records are not received according to the regulations mentioned?
Failure to receive relevant medical records is addressed under section 35 of Title 8 of the California Code of Regulations and section 4062.3 implying that there could be obligations or consequences depending on the specifics outlined in these sections.
What is the definition of Agreed Panel QME?
An Agreed Panel Qualified Medical Evaluator (QME) is a medical professional designated to evaluate and provide an opinion regarding worker’s compensation claims typically agreed upon by the involved parties to ensure impartiality.
What must be included in a written agreement regarding rescheduling dates?
Any written agreement regarding rescheduling dates must explicitly state that the parties accept a date that exceeds the established 30-day or 60-day limits for rescheduling.
