QME testing 3 Flashcards
(15 cards)
What is the difference between a Panel QME and an Agreed Medical Evaluator (AME)?
A Panel QME is selected from a state-issued list when parties don’t agree; an AME is jointly selected by both parties in represented cases.
In a represented case, how long does a party have to request a QME panel after objecting to a report?
10 days from the date of the objection per Labor Code §4062.2(b).
In an unrepresented case, how is a QME selected?
The DWC Medical Unit issues a QME panel based on the injured worker’s specialty request, per Labor Code §4062.1.
What form is used to request a QME panel?
DWC Form 105 (Request for QME Panel).
What is ex parte communication in the QME context?
Any communication with a QME from one party without the other party’s knowledge or participation. It is prohibited under 8 CCR §35.
What should a QME do if they receive improper ex parte communication?
Disclose it in the report and consider whether it tainted the evaluation; may decline to issue a report if fairness is compromised.
Who has the right to strike a QME name from a panel first?
The party who did not request the panel has the right to strike first.
What is the time limit to complete a QME evaluation report after the exam?
30 calendar days from the date of evaluation, per 8 CCR §38.
What happens if a QME fails to submit the report on time?
Parties may request a replacement QME from the Medical Unit if the report is late without good cause.
Can a QME evaluate body parts that were not accepted by the claims administrator?
Yes, the QME must address all disputed body parts identified in the panel request or relevant medical record.
What are grounds for replacing a QME panel?
ICalifornia Code of Regulations, Title 8, Section 31.5. Below are the most common grounds for replacement:
✅ 1. QME Declines or Is Unavailable
A QME refuses to schedule an appointment within 60 days.
The QME is unavailable for 30+ days from the request for an appointment.
The QME is no longer active or qualified to perform evaluations.
✅ 2. Conflicts of Interest or Bias
A QME has a conflict of interest under Labor Code §139.3 (e.g., financial interest, referral relationship).
There is evidence of bias, lack of neutrality, or misconduct.
✅ 3. Incorrect Specialty
The panel was issued in the wrong specialty based on the nature of the injury or condition.
✅ 4. Procedural or Administrative Errors
The panel was generated using incorrect information, such as:
Wrong party designation (injured worker vs. employer)
Wrong geographic region
Duplicate panel requests
✅ 5. Death or Disability of the QME
The selected QME is deceased or physically unable to perform the evaluation.
✅ 6. QME Fails to Comply with
What regulation governs ethical standards for QMEs?
Regulations (CCR), Section 41.5 — Ethical Requirements.
This regulation outlines specific ethical responsibilities, including but not limited to:
Prohibition against discrimination.
Requirement to maintain impartiality and avoid conflicts of interest.
Obligation to base opinions on medical probability.
Prohibition on fee-splitting and kickbacks.
Rules about advertising and representation of credentials.including conflicts of interest and bias.
Can a QME evaluate a family member or someone they previously treated?
No, this creates a conflict of interest under QME ethics rules.
What happens if a QME violates ethical rules or deadlines?
They may be disciplined, removed from the QME list, or referred to the Medical Board.
What is the role of the DWC Medical Unit in the QME process?
Administers panel selection, oversees compliance, and enforces QME regulations.
