QME Actual Exam QME Exam

QME Actual Exam QME Exam Update Latest ons and Correct Answers Rated A+

Time frame in which either party in represented cases may object to a medical determination by the treating physician -ANSWER-20 days, in writing

Time frame in which either party in unrepresented cases may object to a medication determination by the treating physician -ANSWER-30 days, in writing

Time limit for unrepresented injured worker to submit request for a QME panel after receiving form from employer -ANSWER-10 days

Time frame after which unrepresented worker has the right to obtain an evaluation from any QME within a reasonable geographic area - ANSWER-After 20 days, if request for QME panel is not issued

Time frame in which an injured worker is required to select a physician from the QME panel, make an appointment for the exam and inform the claims administrator of the selection and appointment -ANSWER- Within 10 days after the panel is issued

Rights of the claim administrator in selecting the QME and arranging the appointment -ANSWER-If injured worker does not inform the claims administrator of the selection or date of appointment

Time frame in represented cases during which each party may strike one name from the QME panel -ANSWER-10 days after the assignment of the panel

Time frame in which selected QME must schedule an appointment to see the injured worker -ANSWER-Within 60 days of a request for an appointment (up to 90 days)

Time frame to submit the QME Appointment Notification Form - ANSWER-Within 5 business days of making the appointment

Parties receiving service of the QME Appointment Notification Form - ANSWER-Employee (+ representative) Employer/claims administrator (+ representative)

Trigger to send medical records and other information to the QME - ANSWER-Receipt of the QME Appointment Notification Form

Causes for issuance of a replacement panel -ANSWER-(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

Responsibility for arranging for and paying an interpreter for the QME exam -ANSWER-Employer

Information which may be provided to the QME by any party - ANSWER-(1) All records prepared/maintained by treating physician(s) (2) Other medical records, relevant to the determination of the medical issue in dispute (3) Letter outlining medical determination of the primary treating physician or the compensability issue requested to address in the evaluation (4) If concerning a dispute over a UR decision, a copy of the treating physician's report and the claim administrator's decision to approve, delay, deny or modify the disputed treatment (5) Non-medical records relevant to determination of medical issue(s) in dispute

Time frame for service of info on an opposing party that a party proposes to provide to the selected QME -ANSWER-20 days before the info is provided to the evaluator

Time frame to object to sending of non-medical records to the selected QME -ANSWER-Within 10 days

Info which should never be sent to the selected QME -ANSWER-(1) Any medical/legal report rejected by a party as untimely (2) Evaluation/consulting report written by a physician other than the treatment physician that addresses permanent impairment, permanent disability, or apportionment (unless ruled admissible by a WCALJ) (3) Any medical report/record or other info stricken or found inadequate/in admissable by a WCALJ

Ex-parte contact -ANSWER-Any communication--written or oral--by one party (or their representative) with the evaluator *outside of the presence of the opposing party*

Conflict of Interest (COI) -ANSWER-An evaluator may not request or accept any compensation or other thing of value from any source that does or could create a conflict with his or her duties as an evaluator

Persons/entities with whom a QME may have a disqualifying COI - ANSWER-(1) Injured worker (or their attorney) (2) Employer (or their attorney) (3) Claims administrator (or their attorney) (4) Primary/secondary treating physician, if treatment by physician is being disputed (5) UR physician reviewer or expert reviewer or UR organization if decision is being disputed (6) Surgical center if surgery is being disputed