QME Psychiatrist with 2 Different IC Issues (California)

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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby steelmanlaw on Wed Mar 16, 2011 10:31 am

York - Good analysis!

It seems that the more byzantine rules are propagated in attempt to deal with each minute circumstance, the farther away we get from consistency; and consistency does justice both for employees and employers.

Would it not then be a better approach to repeals these rules; and for the Board to allow all otherwise relevant opinions into evidence, subject to a party proving prejudice due to delay in issuing a report? Of course, judges utilizing presumptive powers and inherent discretion could provide for substantial justice on these procedural issues of consequence.

That scenario would be more productive of resolution than we practitioners having to fret over whether five days mailing applies to the filing of a medical report by a QME.
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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby jobmdpsych on Wed Mar 16, 2011 3:09 pm

My call would be not to bill on the late report, from a judgment viewpoint more than a legal viewpoint.

There's a difference between what's permissible and what might provoke someone to make exercising your right a poor financial decision in the long run.
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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby psychqme on Wed Mar 16, 2011 5:28 pm

Thanks to all who responded. I appreciate all of your thoughtful comments. Here are the updates regarding the 2 situations:

1) Office staff has sent a letter objecting to the objection for lateness. The adjuster told staff that she objected to paying for the report on the advice of defense counsel, who claimed to not have received the report although the adjuster had it at the time they communicated about this! We of course have proof of receipt evidence that the IC received the report several weeks ahead of the date of their objection. The 60 day deadline to pay on this report passed earlier this week.

I appreciate the recommendation to file a lien and a DOR however I am confused as another poster (viewtopic.php?f=70&t=1131) indicated that filing a DOR is prohibited until the case has settled, if the case is at the LA board. I am based out of LA but travel far afield to perform these evals so I don't know if the case venue is based on the applicant's address or where I am based out of. Either way, if this is correct, does this mean I have to wait until whenever the case settles to actually collect on this QME even though the objection appears to be illegal? If the answer is yes, does that mean that all medical legal evaluators are generally at the mercy of the carrier to act in good faith? If the board venue is based on the applicant's address and is therefore NOT the LA Board then does filing a DOR mean I or my staff have to show up in person in court to argue our case? If it comes to that are we allowed to get compensated for lost wages, overhead expenses, etc. associated with this misadventure?

2) I followed the suggestion of the other posters here and served and mailed this report within the 30 days. Others have posted that I acted wrongly by not sending in time, but that is not correct as I made my original post well ahead of the deadline in order to solicit input before the 30 days was up. It is still early but we have not heard from any of the parties regarding this report despite the adjuster's change of heart weeks ago, indicating that they are not going to pay or authorize for a report. I had a similar circumstance some months ago when an adjuster called a couple of weeks after an evaluation saying "Don't bother sending the report, we settled." Problem was the report was already done and on its way. That one got paid, thankfully, but in this situation if the adjuster maintains her stance that she "never authorized the evaluation" do I have any recourse apart from the murky lien/DOR/petition route? Is a DEU audit unit referral, or threat thereof, usually sufficient to get one paid?

I'm glad my original post garnered so much interest and I look forward to more thoughtful replies!
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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby Ichanen on Wed Feb 15, 2017 11:46 pm

thanks a lot for this information about Psychiatrists n California! I think a lot of people need some help!
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Re: QME Psychiatrist with 2 Different IC Issues (California) (Ca

Postby spreare on Thu Feb 16, 2017 10:13 pm

I really would like to revisit this issues as I do not see the resolution re the internal conflict of two competing requirements in submission of a timely PQME report for reimbursement and the requirement that an untimely report be objected to prior to its service. As Yorks stated in this thread way back in 2011 (time flies).

The last sentence in Rule 38(a) states, "Neither the employee nor the employer shall have any liability for payment for the medical evaluation which was not completed within the timeframes required under this section unless the employee and the employer each waive the right to a new evaluation and elect to accept the original evaluation, in writing or by signing and returning to the Medical Director either QME Form 113 (Notice of Denial of Request For Time Extension) or QME Form 116 (Notice of Late QME/AME Report – No Extension Requested) (See, 8 Cal. Code Regs. §§ 113 and 116)." (emphasis added)

[i](Interestingly enough, I perused the DWC Forms website --- http://www.dir.ca.gov/dwc/forms.html --- and could not find any copies of QME Form 113 or 116.)
The unanswered question I see is whether it is required that either of the parties timely object to the untimely report, prior to receipt of the report, as required by Rule 31.5, or whether there is any financial liability for the untimely report due to the last sentence in Rule 38(a), absent agreement in writing by both employee and employer.
The answer to this internally inconsistent conflict between Rule 31.5(a)(12), and Rule 38(a), may be a judicially resolved in the future.york McGavin
ymcgavin@socal.rr.com osts: 175Joined: Fri Apr 30, 2010 6:48 am

I am dealing with a situation as in a more recent thread where the 30th day landed on a Sunday, the ER is not paying for a PQME report bc the postmark is on a Tue. The report should have been postmarked by Monday, but was evidently dropped in the mail on Monday some time subsequent to when the mail carrier collected mail. Actually what we think may have happened is speculation it should have been postmarked on Monday but was postmarked on Tue. So now employer is not paying as the PQME is "one day late."

I am arguing: 1), We did drop it in by the 30th day, the postmark of day 31 does not controvert that a mail deposit on day 30. 2) there is no standing objection and request for replacement. 3) clearly the ER had the opportunity to read the report and then decide if they wanted to pay or not -- which is unethical. 4) The proof of service document supersedes the postmark document (per DIR/DWC). 5) there is no PQME regulation that requires a postmark by day 30 for reimbursement .

And yea yea other posters can patronize regarding the need to deposit and get a postmark by day 30, but in the real work things happen.
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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby jpod on Fri Feb 17, 2017 2:53 pm


I'll let the attorneys answer your legal questions but I do have some comments about how to find QME Forms 113 and 116 if you are trying to obtain them.

First you have an old labor code refernce. The language you cite for Title 8 California Code of Regualtions Rule 38(a) is now found in Title 8 CCR 38(b).

QME Form 113 refers to Title 8 California Code of Regualtions Rule 113. That rule has the same link you posted (I checked and don't see the form on the website either). CCRs 113 and 116 also list a telephone number (1-800-794-6900) where the forms can be requested. I am not sure how easy it is to get through on that number or whether it is automated.

I will provide a guess on your mailbox issue though. I think if you provide someone to testify about your "business practice" for putting items into the US Mail system there is a good chance a WCJ would rule in your favor. But perhaps the attorneys have a different view.
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Re: QME Psychiatrist with 2 Different IC Issues (California)

Postby ella7382 on Tue Jan 16, 2018 5:47 am

I have heard about this forum from my friends so thanks for the opportunity to know more about it! Take care now!
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