QME Timelines & More Flashcards
A QME may seek reappointment by meeting the original requirements of appointment and by meeting additional requirements (after how long)
2 years
What are the requirements for QME renewal?
- compliance with all applicable regulations and evaluation guidelines adopted by the Administrative Director
- completion of at least 12 hours of continuing education in impairment evaluation or workers’ compensation-related medical dispute evaluation approved by the Administrative Director in the previous 24 months before reappointment
- no more than five evaluations rejected by a workers’ compensation judge (WCJ) while serving as a QME
- no termination, suspension, or probation by any licensing board. (Lab. Code, § 139.2(d).)
A claims administrator may not submit the QME form 10516 (i.e., request a QME panel) “unless the employee has not submitted the form within _________ after the employer has furnished the form to the employee and requested the employee to submit the form.”
10 days
If the request for a panel is not issued within __________ in an unrepresented case the employee shall have the right to obtain an evaluation from any QME within a reasonable geographic area. (Lab. Code, § 139.2(h)(4).)
20 working days
Within __________ after the panel is issued the injured worker is required to select a physician from the panel, make an appointment for the examination and inform the claims administrator of the selection and the appointment. (Lab. Code, § 4062.1(c).)
10 days
The party filing the QME request must wait to file the form 106 “[n]o earlier than (a) __________ that is at least (b) __________ after the date of mailing of a request for a medical evaluation pursuant to Section 4060 or the first working day that is at least (c) __________ after the date of mailing of an objection pursuant to Sections 4061 or 4062, …” (Lab. Code, § 4062.2(b).)
a. the first working day
b. 10 days
c. 10 days
After the assignment of the QME panel by the Medical Director, each party may strike one name from the panel for __________. (Lab. Code, § 4062.2(c).)
a ten (10) day period
After the issuance of a panel and selection of a QME as described in the preceding chapter, the selected QME must schedule an appointment to see the employee within __________ of a request for an appointment.
60 days
An appointment may be scheduled beyond (a)______ of a request for an appointment if the party who has the right to schedule the appointment is willing to accept an appointment up to (b) __________ from the date of the request. (Cal. Code Regs., tit. 8, § 33(e).)
a. 60 days
b. 90 days
When an appointment has been made the QME must submit the QME Appointment Notification form (Form 110) within __________ of making the appointment.
5 business days
Once scheduled, an appointment may not be cancelled by the QME evaluator, or by any party, less than __________ prior to the appointment date, except for good cause.
six (6) business days
Whenever an evaluator cancels a scheduled appointment, the evaluator must advise the parties in writing of the reason for the cancellation, and must reschedule the appointment to a date within __________ of the date of cancellation.
thirty (30) calendar days
The re-scheduled appointment date may not be more than __________ from the date of the initial request for an appointment, unless the parties agree in writing to accept the date beyond the aforementioned limit.
sixty (60) calendar days
An oral cancellation must be followed with a written confirming letter that is faxed or mailed by first class U.S. mail within __________ of the verbal cancellation.
twenty four hours
The Appeals Board has jurisdiction to resolve disputes among the parties regarding whether an appointment cancellation less than __________ prior to the appointment date was for good cause, and the Administrative Director has jurisdiction to take appropriate disciplinary action against any Agreed Panel QME or QME for violations of the regulations on this issue. (Cal. Code Regs., tit. 8, § 34, subds. (d), (e), (h).)
six (6) days
Any party may provide to the QME selected from a panel any of the following information:
A letter outlining the medical determination of the primary treating physician or the compensability issue that the evaluator is requested to address in the evaluation, which shall be served on the opposing party no less than __________ in advance of the evaluation;
20 days
Information that a party proposes to provide to the QME selected from a panel should be served on the opposing party __________ before the information is provided to the evaluator.
20 days
If the opposing party objects to sending non-medical records (such as a video tape) within __________ of receipt of the objection, the records shall not be provided to the evaluator.
10 days
If the party fails to provide relevant medical records within (a) __________ after the date of the evaluation, and the evaluator is unable to obtain the records, the evaluator shall complete and serve the report within (b)__________ of the evaluation to comply with the statutory time frames under section 38 of title 8 of the California Code of Regulations.19
a. 10 days
b. 30 days
The evaluator shall note in the report that the records were not received within __________ after the date of the evaluation.
10 days
The time frame for submission of a comprehensive medical-legal report is __________.
(Cal. Code Regs., tit. 8, § 38 (a).)
30 days
The time frame for submission of the supplemental medical-legal report is __________.
(Cal. Code Reg., tit. 8, § 38 (h).)
60 days
An evaluator who discovers a conflict of interest should disclose the nature of the conflict in writing to the parties __________ of becoming aware of the conflict. (Cal. Code Regs., tit. 8, § 41.5(f).)
within 5 business days
A QME shall advise an injured worker of their rights (when?) ________.
Before the examination or at the time of the actual evaluation
True or False?
An injured worker is entitled to ask the evaluator and the evaluator shall promptly answer questions about any matter concerning the evaluation process in which the QME and the injured worker are involved.
True
True or False?
The injured worker may NOT discontinue the evaluation based on good cause.
False. The injured worker may discontinue the evaluation based on good cause.
__________ includes:
(A) discriminatory conduct by the evaluator towards the worker based on race, sex, national origin, religion, or sexual preference,
(B) abusive, hostile or rude behavior including behavior that clearly demonstrates a bias against injured workers, and
(C) instances where the evaluator requests the worker to submit to an unnecessary exam or procedure.
Good cause (for an injured worker to discontinue the evaluation)
True or False?
When required as a condition of probation by the Administrative Director or his/her licensing authority, the QME shall disclose his/her probationary status. The QME shall be entitled to explain any circumstances surrounding the probation. If at that time, the injured worker declines to proceed with the evaluation, such termination shall be considered by the Administrative Director to have occurred for good cause.
True
True or False?
If the injured worker declines to ask any questions relating to the evaluation procedure, as set forth in section 40, and does not otherwise object on the grounds of good cause to the exam proceedings during the exam itself, the injured worker shall have the right to object to the QME comprehensive medical-legal evaluation based on a violation of this section. (Cal. Code Regs., tit. 8, § 40(c).)
False.
If the injured worker declines to ask any questions relating to the evaluation procedure, as set forth in section 40, and does not otherwise object on the grounds of good cause to the exam proceedings during the exam itself, the injured worker shall have NO right to object to the QME comprehensive medical-legal evaluation based on a violation of this section. (Cal. Code Regs., tit. 8, § 40(c).)
True or False?
If the injured worker terminates the examination process based on an alleged violation of section 40 of title 8 of the California Code of Regulations and the Appeals Board later determines that good cause did not exist for the termination, the cost of the evaluation shall be deducted from the injured worker’s award.
(Cal. Code Regs., tit. 8, § 41(g).)
True
True or False?
A violation of section 40 (of title 8 of the California Code of Regulations) by the evaluator shall NOT constitute good cause for purposes of an Appeals Board determination.
False.
A violation of section 40 by the evaluator shall constitute good cause for purposes of an Appeals Board determination.
(Cal. Code Regs., tit. 8, § 41(g)).
True or False?
No party shall be liable for any cost for medical reports or medical services delivered as a result of an exam terminated for good cause. (Cal. Code Regs., tit. 8, § 41(g)).
True.
The minimal face to face time for neuromusculoskeletal evaluations (whether a specific or cumulative injury is involved) by a QME is:
Twenty (20) minutes. This is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9).)
Cardiovascular evaluations (whether a specific or cumulative injury) minimal face to face evaluation time by a QME is:
Thirty (30) minutes. This is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9).)
The minimal face to face time for Pulmonary evaluations (whether a specific or cumulative injury) by a QME is:
Thirty (30) minutes. This is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9).)
The minimal face to face time Psychiatric evaluations (whether a specific or cumulative injury) by a QME is:
Sixty (60) minutes. This is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9).)
The minimal face to face time for an evaluation for any type of unjustly except for Neuromusculoskeletal, Cardiovascular, Pulmonary, and Psychiatric evaluations (whether a specific or cumulative injury) by a QME is:
Thirty (30) minutes is the minimum allowable face to face time for an uncomplicated evaluation. (Cal. Code Regs., tit. 8, § 49.9).)
A QME who will be unavailable to schedule or perform comprehensive medical evaluations as a Panel QME for a period of (a) __________ or up to a maximum of (b) __________ during a calendar period, for any reason shall notify the Medical Director at least (c) __________ before the period of unavailability is to begin. (Notice of Qualified Medical Evaluator Unavailability, QME Form 109.)
a. 14 days
b. 90 days
c. 30 days
If a QME fails to notify the Medical Director, by submitting the Notice of Qualified Medical Evaluator Unavailability of his or her unavailability at a medical office at least (a) __________ prior to the period the evaluator becomes unavailable, the Medical Director may designate the QME to be unavailable at that location for (b) __________ from the date the Medical Director learns of the unavailability.
a. 30 days
b. 30 days
