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+--- Thread: 1171 Help (/showthread.php?tid=1245)
1171 Help - chrischris - 08-24-2007 04:09 PM
1171,
Post SB899, is there anytime that a C/A can object to PQME specialty the I/W has selected, and have a new panel issued?
As the law has been interpretted to me, post SB899, an IW is only allowed one PQME, and all open claims are to be considered if there is a dispute on any claim. Is this correct?
Is it not true that the PQME can consult with other specialties if he is not qualified to give an opinion; i.e.: Ortho Claim and Psyche Claim?
If C/A interferes with PQME appt., i.e.: Ex parte communication, does I/W still have option to keep appt? (intentional interferance?)
If C/A objects to non-medical being sent to PQME, or vice-versa, does a reason have to be given?
I have so many questions that don't see in black and white. Can you cite ammunition LC or CCR if applicable?
Thanks in advance 1171.
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RE: 1171 Help - 1171 - 08-24-2007 05:16 PM
so you have all the smileys (i wondered where they went....)
an excellent resource on the QME process is your local I&A offficer.
you can also check the DWC website
http://www.dir.ca.gov/IMC/faqiw.html#QMEPROCESS
no reason is required just a written objection:
"Once you make the QME appointment, the physician has five days to send the QME appointment notification form" to the carrier advising them of the appointment. The insurance carrier is required to send to you a copy of everything that they plan to send to the QME physician 20 days prior to sending the records to the QME. You are also required to send any information (letters from friends, personal records) that you are planning to send to the QME to the carrier 20 days before you send it to the QME. Either party has 10 days to object to any non-medical records being sent to the QME. There is no form; they simply write a letter to the other party. If either you or the insurer do not follow the 20 day rule, the wronged party has the right to cancel the evaluation. (Labor Code §4062.2 (e, f), IMC Reg. §35)
there is almost too much to answer on a message board but here are some more resources for you:
© For injuries occurring on or after January 1, 1994 a QME may obtain a consultation from any physician who has treated the unrepresented employee for the injury listed on the panel request form or by any physician as reasonable and necessary pursuant to Labor Code section 4064 or upon agreement by a party to pay the cost.
http://www.dir.ca.gov/t8/32.html
the issue of ex parte communication is serious and you should consider
professional representation to deal with it:
(f) If an employer or claims administrator communicates with a QME in violation of Labor Code section 4062.2, the Medical Director shall provide the unrepresented employee with a new panel in which to select a new QME or the employee may elect to proceed with the original QME. If an employee communicates with a QME either before or after the evaluation, in violation of Labor Code section 4062.2, the claims administrator or employer may request the Medical Director to issue a new panel to the unrepresented employee. The Appeals Board shall retain jurisdiction to determine whether ex parte contact has occurred in all cases.
NOTE: Authority cited: Sections 139 and 139.2, Labor Code. Reference: Sections 139.2, 4060, 4061, 4062, 4062.2, Labor Code.
http://www.dir.ca.gov/t8/35.html
does that help?
RE: 1171 Help - chrischris - 08-24-2007 05:51 PM
Thank you 1171, You are always a big help
So, am I 100% without a doubt correct in interpreting this literally as it reads? How can C/A threaten me to file an objection to the Administrative Director by 5 p.m. today if I don't voluntarily change my choice of speciality, and order a new panel issued? (that threat was 2 days ago, given to me at 4 p.m. in the afternoon and I ignored it!)
BTW: The 20 day pre appt. days is upon us and I haven't received C/A's packet to PQME. However, I did follow the law and submit to C/A my packet, which was all objected to via email.
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FAQ:
Q. Who completes the panel request form?
A. Only the injured worker can complete the panel request form and choose the QME specialty. (IMC Reg. 30, 139.2(h), 4061(d), 4062(b)
I know he's playing intimitation games.
P.S. I left you a few smileys to play with. Are you having fun with them and have they succeeded in giving you an attitude adjustment?
RE: 1171 Help - 1171 - 08-24-2007 06:02 PM
that's for all the readers to judge...
p.s.
make sure to have everything in writing --no phone calls to or from or, if so, follow it up in writing.
no judge likes a smart ass adjuster trying to bully an unrepresented worker. when/if it's time to see the judge they'll be undone royally.
you can also sometimes get help from the medical unit at the DWC (provided you are unrepresented):
Mailing Address:
DWC - Medical Unit
P.O. Box 71010
Oakland, CA 94612
Street Address:
DWC - Medical Unit
1515 Clay Street, 18th floor
Oakland CA 94612
Telephone Number: 510-286-3700 or 800-794-6900
you may also want to file a complaint with the audit unit if you haven't already done so
http://www.dir.ca.gov/dwc/Audcomp.pdf
RE: 1171 Help - chrischris - 08-24-2007 06:17 PM
Thanks 1171. I have an email trail which I'm assuming is as good as in writing. I'm waiting a couple of days to see if C/A actually does object to AD in writing, and then POW!
This is my 3rd appt. to try and get a PQME evaluation. I know without a doubt C/A played interferrance on appt. #2. All I was told was via email by C/A that Dr. ***** called and canceled.
What are the sanctions for C/A I/C deliberately interferring in the PQME process?
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Still unrepped until I can no longer get a little help from my friends.
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RE: 1171 Help - chrischris - 08-24-2007 06:21 PM
1171, On second thought, since you were so kind to supply the audit unit complaint form, I will do it tonight. It's time I quit being so nice! Ha!
RE: 1171 Help - 1171 - 08-24-2007 07:36 PM
Under LC §4062.2(f), a party making a prohibited ex parte communication with an AME or QME selected by an unrepresented employee is expressly “liable for the costs incurred by the aggrieved party as a result of the prohibited communication, including the cost of the formal medical evaluation, additional discovery costs, and attorney’s fees for related discovery.
QMEs know they are not to engage in outside communications and are reminded about it before each exam.
RE: 1171 Help - chrischris - 09-14-2007 08:25 PM
I'm MAD!
Does LC §5814 apply when I/C takes it upon their own authority to cancel a PQME appt?
I was able to get the appt. reinstated quoting applicable LC's and reminding them I'm unrepped.
However, the appt. date is delayed yet another month due to their unlawful action. Can I still impose a penalty?
Gotta go, in a hurry. Thanks!
RE: 1171 Help - 1171 - 09-14-2007 09:27 PM
The 5814 penalty provisions apply to any "unreasonably" delayed benefit: medical, TD, PD, etc.
rescheduling a medical apt unless it's for treatment is not really a delayed benefit.