TIME AND TIMELINES Flashcards
How many hrs/days does the employer have to get a PTP from their MPN once they learn of an employee injury?
24 hrs
Pesticide poisoning, PTP must inform local health center & send a copy of DFR within…
24 hrs
CME for QME is ….. hrs in …years
12 hrs in 2 years. Passing QME is 6 hrs
Employer must immediately report to OSHA a serious injury in more than ….hrs of hospitalization except obs, loss of body part or disfigurement
24 hrs
PTP must be notified that his request for authorization prior or concurrent with provision of med care is approve is..
24 hrs
For represented worker, the party filing QME request must wait to file 106 form no earlier than…
the first working day that is at least 10 days after the mailing of a request (4060)/objection (4061-62) for med eval
After employer learns about an injury (from any source), he must provide IW Employee’s Claim for WCB claim (DWC1) within…
1 working day. It must be dated. IW fills it out & returns to boss
Decisions for expedited Utilization Review are made in…
72 hrs (after the receipt of written information reasonably necessary to make a decision)
Temporary disability is not paid for IW for …. (hrs/days) unless they are hospitalized/miss work for more than 14 days
3 days
If employee requests a change in PTP, in how many days should employer do that?
5 days
An app is made, QME must submit Appointment Notification form (110) within..
5 days
If QME doesn’t do it, a replacement QME panel may be issued
In how many days of spinal surgery rejection (receipt of objection) should AD find a 2nd opinion?
5 days
How soon should PTP get DFR to employer?
5 days
After employer learns of an injury, how soon should he complete “Employer’s First Report” (form 5020)/ Employer’s Report of Occupational Injury or Illness?
5 days
PTP has to file DFR in…
5 days for ANY suspected work-related injury. Within 5 days of IW’s 1st visit
A concurrent or prospective Utilization Review REQUEST must get a yes or no decision in… how many days after being received by an adjuster?
5 working days
PTP must be informed by phone/fax in 24 hrs
Once scheduled, an appointment can not be canceled by QME or any party in ….day, except for good cause.
6 biz. days
Temporary Disability Benefits payments must begin within…. days of the employer’s knowledge of the claim
14 days (unless the employer contests (objects) the claim.
Employer has …. days from the notification of the injury to contest the claim. If he doesn’t, the injury is compensable.
90 days
QME has to let MD (medical director) know of being unavailable to schedule or perform medical eval if QME is unavailable for how long?
14-90 days max
How much in advance should QME notify medical director of being unavailable to perform or schedule an eval?
30 days before the period of unavailability
If the party fails to provide necessary medical records within 10 days of QME eval, QME should still complete her report within..
30 days of eval and note in the report that records were not received within 10 days of eval.
Dispute about spinal surgery is NOT handled by QME/AME but a special procedure.
If boss disagrees with needing a sx, insurer (IW) has …. days from the report to disagree. (with the boss)
Both lawyers can agree on a surgeon for a 2nd opinion. If they can’t agree in … days, then AD will provide randomly selected surgeon for a 2nd opinion in … days. If boss/insurer disagrees w/ 2nd opinion–> go to court.
10 days
10 days
5 days
If the opposing party objects to sending non-medical records (video tape etc), they need to object how fast so that QME will not be provided the tape?
Within 10 days
Unrepresented IW has …. days to choose his QME after panel has been randomly generated.
10 days
If unrepresented IW doesn’t make a choice of his QME in … days then the insured can make this choice for him in ….days.
10 days and 10 days
A represented IW has…. days to select an AME.
This can be extended if agreed upon for… days.
10 days
20 days
Represented IW. If no AME agreed upon, then IW has …days to choose a QME.
10 days
How many days for each party to strike out 1 QME name from the panel?
If they don’t, then another party choses a QME.
3 days
The party that submitted the request for QME shall determine his/her…?
Specialty of the QME
Represented IW. After QME is selected, IW has … days to make an appointment with QME. If they don’t, the boss will arrange it.
10 days
Represented IW. If IW & boss disagree w/PTP’s findings, they must wait…. waiting period and… for mailing an objection before DWC can assign a QME.
10 days waiting period
5 days for mailing an objection
…. days after a QME panel is issued, an IW must:
- select a physician (QME)
- make an app w/ QME for an exam
- let claims admin know about QME name & exam date
10 days
IW files Request for Factual Correction of QME report, the QME panel has:
… days after request to review corrections and determine if factual corrections are necessary for unrep IW and
….days for both parties or claims admin.
10 days for unrep and 15 days for rep IW or if the request was filed by the both parties or the claims admin.
Within …. days of the Request for Authorization, the UR decision must be made.
14 days. If no additional info submitted within 14 days from the date of submission, then request will be denied.
PTP must report results of consults, results of other Drs reports or changes in IW condition in … days after receiving them.
20 days
AD shall calculate PD (perm disability) rating and serve it on the boss & IW within…. days of the receipt of a med. eval.
20 days
Before 1 party can give any info to the QME/AME they must send it ( give the heads up) to the other party within… days before info is sent to QME.
20 days
PTP says IW is P&S. PTP must report within how many days from the date of exam all info about perm. impairment & any need for med. Tx?
20 days unless good cause
Either party may object PTP’s med. determination by notifying the other party in writing in how many days?
rep vs unrep IW
represented IW- 20 days
unrepresented- 30 days
Unrep IW.
If request for QME panel is not issued within … working days, then IW can have eval from any QME within reasonable geographic area.
20 days
If employer doesn’t provide a new PTP within … days, then IW can choose one himself.
30 days
* normally within 5 days boss should provide a new PTP if IW requests.
If the employer doesn’t have an MPN & didn’t provide a new PTP within 30 days, then IW can chose their…
personal chiro or acupuncturist if they are pre-designated. . Otherwise boss has control over 1st 30 days of who the PTP is.
IF QME has to cancel scheduled app, she must tell the parties in writing the reason and reschedule within ….days of cancelation.
30 days
When UR is RETROSPECTIVE, decisions must be communicated to PTP who requested med. services and IW/his lawyer within… days.
30 days
To get the money, IW has to tell the boss about the injury within … days of injury.
30 days
3 reasons for ineligibility for IMR:
- didn’t submit IMR application within 30 days of adverse UR determination
- didn’t sign IMR application
- dispute reg. liability
IMR decision must be provided to all parties in layterms within how many days of the receipt of the request for review?
30 days and 72 hrs for expedited request
How to appeal IMR and in what time frame?
Filing a petition before a WCAB judge within 30 days of the mailing of the final determination.
If you file a petition to appeal IMR, what can WCAB judge do?
He can not make a finding of medical necessity contrary to the final determination of IMR but judge can order a repeat IMR decision to be performed by different Drs.
PTP must report on IW’s condition every… days.
45 days
In how many days after the PTP’s report, shall 2nd opinion spine report be served to all partied?
45 days
PTP progress report are submitted within every … days and … days if any exam occurs.
45 days and 20 days.
QME has to provide an appointment no later than … days from the request.
60 days
* it can be extended up to 90 days from the request if the requesting party is OK with that.
The re-scheduled appointment date may not be more than … calendar days from the date of the INITIAL request (unless parties agree in writing).
60 days
Supplemental reports must be completed and served no later than…. days since the request.
60 days from the request.
Supplemental report deadline may have extended for no more than… days.
30 days if agreed by both parties.
Employer has … days to give return to work dater after the RTW and voucher report.
60 days.
If employer doesn’t provide a return to work DATE 60 days after the RTW and voucher report, then what kicks in?
SJBD.
6K. 1K towards computer. The rest is resume, job search, exam fees etc.
Employee has … years to use SJDB or within … years of DOI.
2 years or 5 years.
In how many days must QME hand in her report after an exam/appointment ?
30 days
QME can apply for an extension on a 30 day after appointment report deadline in cases of good cause (medical emergency, natural disaster etc) - how long is the extension?
15 days
QME may be denied reappointment if she was made unavailable for more than… days during a calendar year.
90 days
The boss (insurer) has … days to accept or deny IW’s claim. In the meantime, IW may receive $….. worth of treatment.
90 days
$10,000
Employers who contract with HCO can direct tx of IW up to … days.
90 or 180 days following an injury.
QME has to schedule a deposition within .. days.
120 days. It takes place w/in 20 miles where IW’s eval took place.
Temporary disability may last up to… week within … years from the DOI for injuries from 1/1/2008.
2 years (104 weeks) , 5 years
