QME testing 2 Flashcards
(15 cards)
What California Labor Code section outlines the procedures for QME evaluations?
Labor Code §4062.2 details procedures for obtaining QME evaluations, including panel requests and timelines.
Within how many days must a QME submit an initial evaluation report?
California Code of Regulations, Title 8, Section 38(h), which states:
“The QME shall serve the comprehensive medical-legal evaluation report within 30 days of the date the evaluation commenced.”
Exceptions:
If the QME cannot complete the report within 30 days, they must request an extension using Form 112 (Request for Time Extension) within 5 days of the evaluation.
Which regulation specifies the required elements of a complete medical-legal report?
Code of Regulations, Title 8, Section 49.
What is the maximum time allowed for a QME to reschedule an evaluation?
No more than 60 days from the date of the original appointment, per 8 CCR §41.5.
What section of the Labor Code mandates apportionment of permanent disability?
Labor Code §4663.
What must a QME include in their declaration of accuracy?
California Code of Regulations, Title 8, Section 49(l).
The required language is:
“I hereby declare under penalty of perjury under the laws of the State of California that the medical-legal report and all opinions expressed herein are, to the best of my knowledge and belief, true and correct and that I have not violated Labor Code Section 139.3 in the preparation of this report. I further declare that if I have not personally performed all elements of the evaluation, I have clearly identified the findings of each portion I did not perform and have verified those findings and am responsible for them.”
Can a QME communicate with the applicant attorney before the evaluation?
No ex parte communication is allowed; any communication must be shared with all parties per 8 CCR §35.
How many days does a party have to object to a treating physician’s report to preserve QME rights?
Within 20 days for represented cases or 30 days for unrepresented cases per LC §4062(a).
What are the three core components of a QME’s opinion on permanent disability?
Causation, apportionment, and impairment rating.
Who selects the specialty for a panel QME?
In represented cases, the parties agree on a specialty; in unrepresented cases, the Medical Unit assigns one (LC §4062.1 & §4062.2).
What form must be used to request a QME panel?
DWC Form 105 (Request for QME Panel - Represented or Unrepresented cases).
Under what conditions may a QME issue a supplemental report?
When new information is provided, clarification is requested, or errors are identified in the original report (8 CCR §35.5).
What time frame is required for QME panel selection in a represented case?
Panel must be requested within 10 days of an objection, per LC §4062.2(b).
Can a QME address denied body parts?
Yes, the QME must evaluate all body parts in dispute or as requested, even if denied by the claims administrator.
What does CCR stand for in this context?
California Code of Regulations – governing administrative procedures in workers’ compensation.
