9. Apportionment and reapportionment 1 Flashcards
What is the role of the administrative director in the appointment of qualified medical evaluators?
The administrative director shall appoint qualified medical evaluators in each respective specialty required for the evaluation of medical-legal issues with appointments being for two-year terms.
What are the qualifications required for a physician to be appointed as a qualified medical evaluator?
The physician must be licensed to practice in the state and must demonstrate compliance with requirements in paragraphs 1 2 6 and 7. Additionally if the physician is a medical doctor doctor of osteopathy doctor of chiropractic or psychologist they must also meet applicable requirements in paragraphs 3 4 or 5.
What is the examination requirement for a physician before appointment as a qualified medical evaluator?
Prior to appointment the physician must pass an examination written and administered by the administrative director which is designed to demonstrate competence in evaluating medical-legal issues.
For how long are qualified medical evaluators appointed?
Qualified medical evaluators are appointed for two-year terms.
Who can be appointed as a qualified medical evaluator?
A qualified medical evaluator can be a physician which includes medical doctors doctors of osteopathy doctors of chiropractic or psychologists provided they meet specific qualifications.
What sections of the law define what a ‘physician’ is in the context of qualified medical evaluators?
A physician is defined in Section 3209.3 of the law.
What paragraphs must a physician meet to be appointed as a qualified medical evaluator?
The physician must meet the requirements in paragraphs 1 2 6 and 7 and if applicable those in paragraphs 3 4 or 5.
Why is it important for a qualified medical evaluator to demonstrate competence in evaluating medical-legal issues?
Demonstrating competence is crucial to ensure that the evaluations conducted are accurate reliable and meet the necessary legal and medical standards required for medical-legal issues.
What is the requirement for physicians regarding additional examinations for reappointment in the workers’ compensation system?
Physicians shall not be required to pass an additional examination as a condition of reappointment.
What must a physician complete before being appointed as a qualified medical evaluator as of January 1 2001?
A physician must complete a course on disability evaluation report writing approved by the administrative director prior to appointment.
What are the curriculum requirements for the disability evaluation report writing course?
The curriculum shall include but is not limited to 12 or more hours of instruction.
What are the service requirements for a physician applying to be a qualified medical evaluator?
A physician must devote at least one-third of total practice time to providing direct medical treatment or have served as an agreed medical evaluator on eight or more occasions in the 12 months prior to applying.
What qualifications must a physician have to be a qualified medical evaluator?
The physician must be a medical doctor or doctor of osteopathy and meet one of the requirements: A) Be board certified in a specialty by a board recognized by the administrative director.
What is the role of the Medical Board of California and the Osteopathic Medical Board of California in credentialing medical evaluators?
They are responsible for deeming qualifications as equivalent to board certification in a medical specialty and overseeing the credentialing of qualified medical evaluators.
What residency training programs are recognized by the Medical Board of California and the Osteopathic Medical Board of California?
Programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the osteopathic equivalent.
What was the significance of being an active qualified medical evaluator on June 30 2000?
It is one of the criteria that establishes eligibility for certain qualifications under the regulations of the Medical Board of California.
What qualifications can the administrative director and the Medical or Osteopathic Medical Board deem as equivalent to board certification in a specialty?
Qualifications deemed equivalent by the administrative director and either the Medical Board of California or the Osteopathic Medical Board.
What criteria must a doctor of chiropractic meet to be recognized for California workers’ compensation evaluation?
The doctor must be certified in California workers’ compensation evaluation by a provider recognized by the administrative director.
What does the certification program for doctors of chiropractic include regarding California workers’ compensation evaluation?
Instruction on disability evaluation report writing that meets the standards set forth by the regulatory guidelines.
What are the requirements for a psychologist to be recognized under the Medical Board of California regulation?
A psychologist must be board certified in clinical psychology by a board recognized by the administrative director or hold a related qualification.
What is the importance of certification programs for medical evaluators in California?
They ensure that medical evaluators are trained and knowledgeable in disability evaluation report writing essential for accurate assessment in workers’ compensation cases.
What are the implications for a medical evaluator who does not meet the outlined qualifications by the Medical or Osteopathic Medical Board of California?
They may not be eligible to conduct evaluations for California workers’ compensation limiting their professional practice in this area.
How does board certification of psychologists relate to the Medical and Osteopathic Medical Board of California’s regulations?
Board certification is an essential criterion that validates a psychologist’s qualifications to participate in assessments related to workers’ compensation cases.
What is required for licensure as a psychologist according to Section 2914 of the Business and Professions Code?
A doctoral degree in psychology or a doctoral degree deemed equivalent for licensure by the Board of Psychology.
How many years of postdoctoral experience are required for licensure in psychology?
A minimum of five years’ postdoctoral experience in the diagnosis and treatment of emotional and mental disorders.
What additional experience is required for a psychologist to serve as an agreed medical evaluator?
The psychologist must have served as an agreed medical evaluator on eight or more occasions prior to January 1 1990.
What defines a conflict of interest under the regulations adopted by the administrative director?
A conflict of interest is determined under the regulations adopted by the administrative director although specific criteria are not detailed in the provided information.
What are some potential additional standards for appointment of physicians in regards to licensure?
Any additional medical or professional standards adopted pursuant to paragraph 6 of subdivision j must be met.
Who has the authority to adopt standards for the appointment of retired physicians or those holding teaching positions?
The administrative director has the authority to adopt these standards.
What is the significance of Section 2914 in the context of licensing psychologists?
Section 2914 outlines the educational and experiential requirements necessary for a psychologist to obtain licensure ensuring qualifications to diagnose and treat mental health disorders.
Why is postdoctoral experience important for psychologists?
Postdoctoral experience is crucial as it indicates that the psychologist has practical training beyond academic knowledge equipping them with skills necessary for diagnosing and treating complex emotional and mental disorders.
What might constitute an equivalent degree for licensure by the Board of Psychology?
An equivalent degree would typically come from a recognized program that is similar in curriculum and outcomes to a doctoral degree in psychology.
What implications does serving as an agreed medical evaluator have on a psychologist’s qualification?
Serving as an agreed medical evaluator on multiple occasions demonstrates practical experience and authority in assessing medical and psychological conditions enhancing the psychologist’s credibility and qualifications.
What qualifies a physician as a qualified medical evaluator (QME)?
A physician can be appointed as a qualified medical evaluator if they meet the qualifications outlined in subdivision b of the regulations which includes compliance with applicable regulations and evaluation guidelines adopted by the administrative director.
What is the restriction for physicians whose practice is limited to forensic evaluation of disability regarding QME appointment?
A physician whose full-time practice is limited to the forensic evaluation of disability shall not be appointed as a qualified medical evaluator.
What are the criteria for reappointment as a qualified medical evaluator?
To be reappointed as a QME a physician must meet the qualifications of subdivision b and comply with these criteria: 1) compliance with all applicable regulations and evaluation guidelines and 2) not having more than five of their evaluations rejected by a workers’ compensation administrative law judge during the most recent two-year period in which they served as a QME.
What constitutes a rejection of an evaluation by a workers’ compensation administrative law judge?
An evaluation is considered rejected if it is deemed unsatisfactory or inadequate by the workers’ compensation administrative law judge during a contested hearing.
For how long is the rejection count considered to determine eligibility for reappointment as a QME?
The rejection count is considered during the most recent two-year period in which the physician served as a qualified medical evaluator.
What is the role of the administrative director in the context of QMEs?
The administrative director is responsible for adopting regulations and evaluation guidelines that qualified medical evaluators must comply with.
How many evaluations can a physician have rejected within two years to maintain eligibility as a QME?
A physician can have no more than five evaluations rejected by a workers’ compensation administrative law judge within a two-year period to maintain eligibility for reappointment as a QME.
What happens if a qualified medical evaluator does not meet the compliance and rejection criteria?
If a qualified medical evaluator does not meet the compliance with regulations and has more than five rejections in the specified two-year period they may not be eligible for reappointment as a QME.
What is the significance of being a qualified medical evaluator in the context of workers’ compensation?
Being a qualified medical evaluator is significant as it helps ensure that disability evaluations are conducted by qualified professionals which contributes to fair and just outcomes in workers’ compensation cases.
What is the impact of a rejected evaluation on a physician serving as a QME?
A rejected evaluation can negatively impact a physician’s standing and eligibility to continue serving as a qualified medical evaluator especially if the number of rejections exceeds the acceptable limit.
What happens if the administrative law judge (ALJ) or the appeals board rejects a qualified medical evaluator’s report?
If the ALJ or the appeals board rejects the qualified medical evaluator’s report on the basis that it fails to meet the minimum standards established by the administrative director or the appeals board they must make a specific finding to that effect and notify both the medical evaluator and the administrative director.
How is the rejection of a medical evaluator’s report treated in terms of qualifying rejections?
The rejection shall not count as one of the five qualifying rejections until the specific finding has become final and the time for appeal has expired.
What is the continuing education requirement for a qualified medical evaluator?
A qualified medical evaluator must complete at least 12 hours of continuing education in impairment evaluation or workers’ compensation-related medical dispute evaluation approved by the administrative director within the previous 24 months.
What disciplinary actions can affect a qualified medical evaluator’s status?
A qualified medical evaluator must not have been terminated suspended placed on probation or otherwise disciplined by the administrative director during their most recent term as a qualified medical evaluator.
What are the minimum standards for qualified medical evaluator reports?
The minimum standards for reports are established by the administrative director or the appeals board and must be met for the report to be accepted.
Who must be notified when a qualified medical evaluator’s report is rejected?
The medical evaluator and the administrative director must be notified when a qualified medical evaluator’s report is rejected.
What constitutes a ‘specific finding’ in the context of medical evaluator report rejection?
A specific finding is a formal decision made by the administrative law judge or the appeals board stating that the evaluator’s report does not meet the minimum standards required.
What time frame is relevant for the continuing education of qualified medical evaluators?
The relevant time frame for continuing education is the previous 24 months during which at least 12 hours of education must be completed.
What must happen before a rejection can be counted as a qualifying rejection?
The specific finding regarding the rejection must become final and the time for appeal must expire before it can be counted as a qualifying rejection.
What is the role of the administrative director in relation to qualified medical evaluators?
The administrative director establishes the minimum standards for medical evaluator reports and approves continuing education programs.
What are the consequences for an evaluator who does not meet the appointment criteria?
If the evaluator does not meet any of the criteria established the administrative director has the discretion to either reappoint or deny reappointment according to established regulations.
What happens to a physician who does not currently meet the requirements for initial appointment?
A physician who does not meet the requirements for initial appointment or who has been terminated due to license revocation or termination by a licensing authority is not eligible for reappointment.
Under what circumstances can the administrative director suspend or terminate a Qualified Medical Evaluator?
The administrative director may suspend or terminate a Qualified Medical Evaluator without a hearing if either of the following occurs: 1) The evaluator’s license to practice in California has been suspended revoked or terminated by the relevant licensing authority; 2) The evaluator has failed to timely pay fees as required.
What are the rights of an evaluator facing suspension or termination?
Suspension or termination of a Qualified Medical Evaluator during their term of appointment can occur without a hearing meaning they may not have an opportunity for a formal appeal or discussion regarding the decision.
What does it mean if the evaluator’s license is suspended or revoked by the licensing authority?
If an evaluator’s license is suspended or revoked it prevents them from legally practicing in California which will lead to immediate action from the administrative director regarding their appointment.
What conditions must an evaluator meet to maintain their position as a Qualified Medical Evaluator?
An evaluator must maintain a valid practice license in California and fulfill any other specific requirements defined by the administrative director to retain their position.
Is a hearing required before suspension or termination of a Qualified Medical Evaluator?
No a hearing is not required for the suspension or termination of a Qualified Medical Evaluator under the specified conditions.
What action is taken if a Qualified Medical Evaluator fails to timely pay required fees?
Failure to timely pay required fees can result in suspension or termination of the evaluator’s appointment by the administrative director.
What role does the administrative director play in the appointment of Qualified Medical Evaluators?
The administrative director oversees the criteria for appointment and has the discretion to reappoint deny reappointment suspend or terminate the appointment of Qualified Medical Evaluators based on their compliance with established rules.
What factors can lead to a physician not being reappointed?
Key factors include failing to meet initial appointment requirements or having their medical license revoked or terminated.
What is the requirement for the administrative director regarding written statements to physicians?
The administrative director must furnish a physician upon request with a written statement of its reasons for termination of or for denying appointment or reappointment as a qualified medical evaluator.
What must the administrative director do upon receiving a response from the physician after providing a statement of reasons?
Upon receipt of a specific response to the statement of reasons the administrative director shall review their decision not to appoint or reappoint the physician or to terminate the physician and shall notify the physician of the final decision within 60 days after receipt of the physician’s response.
What agreements must the administrative director establish to support qualified medical evaluators?
The administrative director shall establish agreements with qualified medical evaluators to ensure the expeditious evaluation of cases assigned to them for comprehensive medical evaluations.
What is the timeframe for assigning three-member panels of qualified medical evaluators?
The medical director upon request by an employee or employer pursuant to Section 4062.1 shall assign three-member panels of qualified medical evaluators within five days.
What is the role of the administrative director in the context of qualified medical evaluators?
The administrative director is responsible for providing written reasons for the termination or denial of appointment of qualified medical evaluators reviewing decisions based on physician responses establishing agreements for case evaluations and assigning panels of evaluators.
