9. Apportionment and reapportionment 3 Flashcards
Under what circumstances can the administrative director suspend or terminate a qualified medical evaluator’s privileges?
The administrative director can suspend or terminate privileges based on a hearing that finds substantial evidence of one or more violations.
List the criteria under which a qualified medical evaluator may be suspended or terminated.
- Violating any material statutory or administrative duty. 2. Failing to follow medical procedures or qualifications established. 3. Not complying with timeframe standards. 4. Not meeting requirements of specific subdivisions. 5. Preparing medical-legal evaluations that do not meet minimum standards.
What does ‘substantial evidence’ refer to in the context of evaluating a medical evaluator’s conduct?
Substantial evidence refers to adequate or sufficient evidence that reasonably supports the conclusion reached such as findings from a hearing.
What might constitute a violation of statutory or administrative duty for a medical evaluator?
A violation can include failing to adhere to laws or regulations pertaining to medical evaluations or not fulfilling obligations defined in related administrative codes.
What are the timeframe standards mentioned in subdivision j that medical evaluators must comply with?
The timeframe standards refer to the specific deadlines and time intervals for the performance of tasks or submission of reports that medical evaluators are required to follow.
What happens if a medical evaluator prepares reports that do not meet minimum standards?
If a medical evaluator prepares medical-legal evaluations that fail to meet minimum standards it could lead to suspension or termination of their privileges to evaluate.
Why is it important for medical evaluators to adhere to established medical procedures or qualifications?
Adhering to established medical procedures or qualifications ensures the integrity and reliability of medical evaluations which ultimately impacts patient care and legal proceedings.
What is the significance of a hearing pursuant to subdivision 1 in the process of determining a medical evaluator’s status?
The hearing serves as a formal process to assess evidence against a medical evaluator and provides a basis for the administrative director’s decision regarding their privileges.
What is the role of the administrative director in relation to qualified medical evaluators?
The administrative director is responsible for establishing procedures and regulations regarding the appointment and reappointment of qualified medical evaluators. They have authority over citations for violations and scheduling hearings related to those violations.
What actions can lead to the suspension or termination of a physician’s privilege to work as a qualified medical evaluator?
A physician can have their privilege suspended or terminated for: 1) Making material misrepresentations or false statements in an application for appointment or reappointment 2) Failing to timely pay the required fees or 3) Having their medical license suspended or revoked by the licensing authority.
Is a hearing always required before suspending or terminating a physician’s privilege to serve as a qualified medical evaluator?
No a hearing is not required prior to suspension or termination if the physician has failed to pay the required fee or has had their license suspended or revoked.
What must the administrative director do in case of a violation by a qualified medical evaluator?
The administrative director must cite the qualified medical evaluator for the violation and set a hearing on the alleged violation within 30 days of service of the citation.
What is the time frame within which the administrative director must set a hearing after issuing a citation to a qualified medical evaluator?
The administrative director must set a hearing within 30 days of serving the citation on the qualified medical evaluator.
What is a qualified medical evaluator?
A qualified medical evaluator is a physician who has been designated to evaluate individuals in medical legal contexts often regarding workers’ compensation cases and ensuring compliance with medical standards.
What actions can the administrative director take upon finding a violation listed in subdivision k regarding qualified medical evaluators (QMEs)?
The administrative director may place a qualified medical evaluator on probation subject to appropriate conditions such as ordering continuing education or training.
What is required of the administrative director after disciplining a qualified medical evaluator?
The administrative director is required to report the name of any disciplined qualified medical evaluator to the appropriate licensing board.
Under what circumstances will the administrative director terminate a physician from the list of qualified medical evaluators?
The administrative director shall terminate a physician from the list if their licensure has been terminated by the relevant licensing board if they have been convicted of a misdemeanor or felony related to their medical practice or if they have been convicted of a crime involving moral turpitude.
What happens to a physician who has been suspended or placed on probation by the relevant licensing board?
The administrative director shall suspend or terminate the physician as a medical evaluator.
What is the significance of the term ‘moral turpitude’ in relation to QMEs?
Moral turpitude refers to conduct that is considered contrary to community standards of justice honesty or good morals and can lead to the termination of a physician from the list of medical evaluators if convicted of such a crime.
What are some potential conditions that could be imposed on a qualified medical evaluator placed on probation by the administrative director?
Potential conditions could include completing continuing education or training.
What is the role of the licensing board in relation to the administrative director’s decisions concerning QMEs?
The licensing board is notified by the administrative director about any disciplinary actions taken against a qualified medical evaluator to maintain oversight.
What are two key factors that could lead to automatic termination of a medical evaluator’s position?
Automatic termination could occur if the physician’s licensure has been terminated or if they have been convicted of crimes related to their medical practice.
What responsibilities does the administrative director have regarding the evaluation and monitoring of qualified medical evaluators?
The administrative director is responsible for placing QMEs on probation imposing conditions and reporting disciplinary actions to licensing boards.
If a physician is placed on probation what type of oversight might they be subjected to?
They may be required to fulfill certain training or educational requirements as a condition of their probation.
What is the implication of a report prepared by a physician that is incomplete unsigned or furnished before a conviction or action of the licensing board?
Such a report shall not be admissible in any proceeding before the appeals board and there shall be no liability for payment for the report or expenses incurred by the physician in connection with the report.
Who determines the fee for a qualified medical evaluator’s appointment or reappointment?
The fee is determined by the administrative director.
On what basis are the fees for qualified medical evaluators established?
The fees are established based on a sliding scale.
What happens to the revenues from fees paid by qualified medical evaluators?
All revenues from these fees are deposited into the Workers’ Compensation Administration Revolving Fund and are available for expenditure upon appropriation by the Legislature.
For what purpose can the funds from the Workers’ Compensation Administration Revolving Fund be used?
The funds can only be used for the administration of the programs of the Division of Workers’ Compensation.
Are revenues from the Workers’ Compensation Administration Revolving Fund allowed to be used by other departments or agencies?
No the revenues cannot be used by any other department or agency or for any purpose other than administration of the programs of the Division of Workers’ Compensation.
What should an evaluator not request or accept according to the provided guidelines?
An evaluator shall not request or accept any compensation or other thing of value from any source that could create a conflict with his or her duties as an evaluator under this code.
What role does the administrative director play in the medical treatment of injured employees?
The administrative director after consultation with the Commission on Health and Safety and Workers’ Compensation shall adopt regulations to implement the provisions related to the medical treatment of injured employees.
What is the form required for the application to become a Qualified Medical Evaluator (QME)?
Applications for appointment as a QME shall be submitted on the form in section 100 known as QME Form 100.
What must be included with the QME application form?
The completed application form and any supporting documentation as required by the application must be filed at the Administrative Director’s office listed on QME Form 100.
What is the process after the Administrative Director receives the QME application?
Upon approval of each application form and supporting documentation the Administrative Director shall certify applicants as eligible to sit for the QME competency examination provided they meet all statutory and regulatory eligibility requirements.
What are the QME eligibility requirements referenced in the text?
The specific statutory and regulatory eligibility requirements for QME applicants are not detailed in the input text but must be met for an applicant to sit for the competency examination.
What are the reasons an application for appointment may be rejected?
An application for appointment may be rejected if it is incomplete contains false information or does not include the required supporting documentation listed in Section 11.
What authority does the Administrative Director have regarding physician appointments?
The Administrative Director may deny appointment or reappointment to any physician who has performed a QME evaluation or examination without a valid QME certification at the time of examining the injured worker or when signing the initial or follow-up evaluation report.
Can an applicant on probation still take the QME examination?
Yes an applicant serving a period of probation imposed by their professional licensing board or agency may be allowed to take the QME examination while on probationary license status.
How are applications from physicians on probationary license status reviewed?
Applications for appointment or reappointment from physicians on probationary license status with a California licensing board or agency while the QME application is pending shall be reviewed by the Medical Director on a case-by-case basis consistent with the provisions of Labor Code section 139.2.
What happens to physicians who have been convicted of a felony in relation to QME applications?
No physician who has been convicted of a felony may be considered for appointment or reappointment.
What must an applicant for QME appointment not have been convicted of to be eligible?
An applicant must not have been convicted of a felony or misdemeanor related to their practice to be appointed or reappointed as a Qualified Medical Examiner (QME).
What can happen to an applicant convicted of any other type of felony or misdemeanor?
An applicant who has been convicted of any other type of felony or misdemeanor may be denied appointment or reappointment as a QME.
What occurs if a physician withdraws their application for QME after being under investigation?
If a physician withdraws their application for appointment or reappointment while under investigation or after a statement of issues or accusation the disciplinary process may be reactivated whenever they subsequently file for appointment or reappointment.
What can happen if alleged violations are found to have occurred after a physician withdraws their application or fails to seek reappointment as QME?
If any of the alleged violations are found to have occurred the physician’s application for appointment or reappointment may be denied by the Administrative Director.
What criteria does the Administrative Director use for appointing QMEs?
The Administrative Director shall appoint as QMEs all applicants who meet the requirements set forth in the Labor Code.
What is the significance of Labor Code in the context of QME appointments?
The Labor Code outlines the eligibility requirements and criteria that applicants must meet to be appointed as QMEs by the Administrative Director.
What is the consequence of a physician resigning during the investigation process for QME appointment?
If a physician resigns while under investigation for alleged violations they face reactivation of the disciplinary process upon future applications for QME appointment.
Can a physician reapply for QME appointment after having past disciplinary issues?
Yes a physician can reapply for QME appointment after past issues but if there are found violations during reapplication the application may be denied.
What is a QME?
A QME or Qualified Medical Examiner is a physician appointed to evaluate and give opinions on medical issues in workers’ compensation cases.
What regulations govern the appointment of QMEs?
The appointment of QMEs is governed by specific regulations set forth in the Labor Code.
What is required from all applicants under Section 139.2b?
All applicants must submit the required supporting documentation.
What is one of the documents that medical applicants must submit?
A copy of the current license to practice in California.
What specific documentation is required for Medical Doctors or Doctors of Osteopathy?
- A copy of the applicant’s certificate of completion of postgraduate specialty training at an institution recognized by the Accreditation Council for Graduate Medical Education or the osteopathic equivalent as defined pursuant to Section 12 OR 2. A copy of the applicant’s Board certification by a specialty board recognized by the Administrative Director or as defined pursuant to Section 12 OR 3. A declaration under penalty of perjury accompanied by supporting documentation that the physician has qualifications deemed equivalent to board certification in a specialty.
What is one way a physician can prove their qualifications if they do not have board certification?
They can provide a declaration under penalty of perjury accompanied by supporting documentation that their qualifications are deemed equivalent by the Administrative Director and the Medical Board of California or the Osteopathic Medical Board of California.
What is the documentation requirement for psychologists applying for licensure?
Psychologists must submit a copy of a doctoral degree in psychology or a doctoral degree deemed equivalent.
What organization recognizes postgraduate specialty training for Medical Doctors and Doctors of Osteopathy?
The Accreditation Council for Graduate Medical Education (ACGME) recognizes postgraduate specialty training.
Under what conditions can a doctor declare their qualifications equivalent to board certification?
The doctor must provide a declaration under penalty of perjury along with supporting documentation that their qualifications are deemed equivalent by both the Administrative Director and the appropriate Medical Board.
What legal consequence does a declaration under penalty of perjury carry?
A declaration under penalty of perjury indicates that the person providing the declaration is legally swearing that the information provided is true and accurate; false declarations may lead to legal repercussions.
Which boards are involved in assessing the qualifications of physicians in California?
The Medical Board of California and the Osteopathic Medical Board of California are involved in assessing physician qualifications.
Is it necessary for applicants to submit original documents when applying under Section 139.2b?
The text provided does not specify if original documents are needed; it only states that applicants must submit required supporting documentation.
