QME testing 8 Flashcards
(15 cards)
Can a QME evaluate a family member or someone with whom they have a financial relationship?
No. This is a conflict of interest and a violation of QME ethics rules under 8 CCR §60.
What must a QME do if they realize a conflict of interest exists?
Disclose it and decline to conduct the evaluation or withdraw from the case.
What is the consequence for engaging in prohibited ex parte communication with a QME?
The QME must disclose it, and the communication may invalidate the report; disciplinary action may follow.
Can a QME provide treatment to an injured worker they evaluated?
No. Treating a QME patient violates impartiality and creates a conflict of interest.
How long must a QME retain a copy of their medical-legal reports and related records?
At least 5 years, per DWC regulations.
What is the appropriate QME response if the patient refuses to participate in the exam?
Document the refusal and submit a report describing the lack of cooperation.
If a QME finds a discrepancy in the patient’s history versus medical records, how should they respond?
Note the inconsistency, provide a clinical judgment, and explain which source was more credible.
Can a QME bill for missed appointments?
Yes, but only under conditions specified by the DWC and not if the cancellation was timely or justified.
Is it appropriate for a QME to reference MTUS guidelines when making treatment recommendations?
Yes. Treatment recommendations should align with MTUS/ACOEM standards where applicable.
What is the ethical obligation of a QME if they receive late records after submitting a report?
They should review the records and consider issuing a supplemental report if it materially impacts their conclusions.
Can a QME report include opinions on issues not raised by the panel request?
Yes, if clinically relevant, but the QME should state that these are provided for completeness and not specifically requested.
Is it ethical for a QME to submit templated or “boilerplate” findings without individual analysis?
No. Each case must be evaluated individually, and reports must reflect patient-specific findings and opinions.
What action may be taken if a QME fails to submit a timely or complete report multiple times?
They may be suspended or removed from the QME list and referred to the Medical Board or DWC for discipline.
How should a QME handle language or communication barriers during the exam?
Use a certified interpreter and document their presence and identity in the report.
What is a QME’s responsibility in assessing malingering or symptom magnification?
Document objective inconsistencies, perform validity testing if appropriate, and discuss findings professionally without bias.
