Ethical obligations of QMEs
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Ch. 15 (p. 99-101)
Cause for termination of temporary disability
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Finding of permanent and stationary (P&S) OR maximum medical
improvement (MMI) by the primary treating physician
Aggravation
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A medical condition may be present already, but work exposure makes it
worse
Holds authority to appoint physicians as QME evaluators
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Administrative Director (AD) (LC 139.2)
Causes for issuance of a replacement panel
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(1) Failure to serve the QME Appointment Notification Form;
(2) Disclosure of COI by an evaluator after an appointment has been made;
(3) Necessity for subsequent examination by a QME in a different specialty
(due to limitations in scope of practice or clinical competency)
(4) QME doesn't practice in the requested specialty
(5) QME cannot schedule an appointment within 60 days of the initial
request of the appointment
(6) Injured worker changes address since initial request for a panel but
before initial appointment
(7) Two or more members of a QME panel are from the same group
practice
(8) QME is unavailabile
(9) QME who previously reported on the case is unavailable
(10) QME is currently, or has been, the treating physician of the worker for
the injury currently under dispute
(11) Claims administrator/employer agrees that a new panel be issued based
upon the geographic area of the worker's employment
(12) Untimely filing of report by QME
(13) QME doesn't cancel an appointment in a timely manner
, (14) QME panel was issued more than 24 months prior to the request for
the replacement panel and none of the QMEs have examined the worker
(15) Qualifed and competent QME refuses to provide an evaluation or
written statement explaining why he/she is not qualified or competent to
address one or more issues in dispute in the case
(16) Administrative Director orders an additional QME evaluation
Items determined by the DOI
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(1) Statute of limitations for particular procedures within the workers'
compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
Minimum face-to-face time requirements for uncomplicated evaluations
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20 minutes for neuromusculoskeletal evaluations
60 minutes for psychiatric evaluations
30 minutes for all other evaluations
Term of appointment as QME evaluator
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, 2 years (LC 139.2)
Perception is not disability
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Disability is not based on how much stress should have been felt by
employee, but rather how much stress is felt by an individual worker
reacting uniquely to the work environment
Stress must have proximately caused the injury
Types of reports
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Comprehensive (first)
Follow-up
Supplemental
Ex-parte contact
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Any communication--written or oral--by one party (or their representative)
with the evaluator outside of the presence of the opposing party
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Ch. 15 (p. 99-101)
Cause for termination of temporary disability
Give this one a try later!
Finding of permanent and stationary (P&S) OR maximum medical
improvement (MMI) by the primary treating physician
Aggravation
,Give this one a try later!
A medical condition may be present already, but work exposure makes it
worse
Holds authority to appoint physicians as QME evaluators
Give this one a try later!
Administrative Director (AD) (LC 139.2)
Causes for issuance of a replacement panel
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(1) Failure to serve the QME Appointment Notification Form;
(2) Disclosure of COI by an evaluator after an appointment has been made;
(3) Necessity for subsequent examination by a QME in a different specialty
(due to limitations in scope of practice or clinical competency)
(4) QME doesn't practice in the requested specialty
(5) QME cannot schedule an appointment within 60 days of the initial
request of the appointment
(6) Injured worker changes address since initial request for a panel but
before initial appointment
(7) Two or more members of a QME panel are from the same group
practice
(8) QME is unavailabile
(9) QME who previously reported on the case is unavailable
(10) QME is currently, or has been, the treating physician of the worker for
the injury currently under dispute
(11) Claims administrator/employer agrees that a new panel be issued based
upon the geographic area of the worker's employment
(12) Untimely filing of report by QME
(13) QME doesn't cancel an appointment in a timely manner
, (14) QME panel was issued more than 24 months prior to the request for
the replacement panel and none of the QMEs have examined the worker
(15) Qualifed and competent QME refuses to provide an evaluation or
written statement explaining why he/she is not qualified or competent to
address one or more issues in dispute in the case
(16) Administrative Director orders an additional QME evaluation
Items determined by the DOI
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(1) Statute of limitations for particular procedures within the workers'
compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
Minimum face-to-face time requirements for uncomplicated evaluations
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20 minutes for neuromusculoskeletal evaluations
60 minutes for psychiatric evaluations
30 minutes for all other evaluations
Term of appointment as QME evaluator
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, 2 years (LC 139.2)
Perception is not disability
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Disability is not based on how much stress should have been felt by
employee, but rather how much stress is felt by an individual worker
reacting uniquely to the work environment
Stress must have proximately caused the injury
Types of reports
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Comprehensive (first)
Follow-up
Supplemental
Ex-parte contact
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Any communication--written or oral--by one party (or their representative)
with the evaluator outside of the presence of the opposing party
