Replacement QME-Private Treating Physician (California)

[wcscout]

You can get a replacement QME when the QME acted as the PTP/Secondary treating physician, is there anything regarding replacement panel if the doctor acted as a private/personal physician?

[50Cal20]

The Code of Regulations does address this issue.

CCR 31(c) states: Any physician who has served as a primary treating physician or secondary physician and who has provided treatment to the employee in accordance with section 9785 of Title 8 of the California Code of Regulations for the disputed injury shall not perform a QME evaluation on that employee. Whenever that physician's name appears on a QME panel, he or she shall disqualify him or herself if contacted by a party to perform the evaluation. Either party may request a replacement QME for this reason pursuant to section 31.5 of Title 8 of the California Code of Regulations.

[jpod]

It is not entirely clear (since the poster did not cite the LC section) but I believe the original post was about a LC 4605 physician acting as the QME on a claim not a PTP as defined in CCR 9785.

I think the answer is no b/c a LC 4605 physician could not provide an unbiased opinion/rebuttal regarding his, or her, own opinions on a claim. Furthermore 4605 states any opinions of a LC 4605 physician can not form the sole basis of an award of compensation - allowing a LC 4605 physician to become the QME would run contrary to that provision.

There is a hilarious scene in Woody Allen's Bananas where his character simultaneously acted as the witness and the cross examiner which is pretty much on point with the scenario described above.

[jpod]

It is not entirely clear (since the poster did not cite the LC section) but I believe the original post was about a LC 4605 physician acting as the QME on a claim not a PTP as defined in CCR 9785.

I think the answer is no b/c a LC 4605 physician could not provide an unbiased opinion/rebuttal regarding his, or her, own opinions on a claim. Furthermore 4605 states any opinions of a LC 4605 physician can not form the sole basis of an award of compensation - allowing a LC 4605 physician to become the QME would run contrary to that provision.

There is a hilarious scene in Woody Allen's Bananas where his character simultaneously acted as the witness and the cross examiner which is pretty much on point with the scenario described above.

[jpod]

To add to my post if the question referred to a physician the employee saw under their health insurance plan that "physician-turned-QME" would also not be able to provide an unbiased rebuttal to whatever findings that physician made after treating the patient. That bias would adversely affect one of the parties.

[wcscout]

Thank you, yes, this situation is a physician that Applicant treated with prior to filing her claim, that coincidentally ended up being the QME. This was only discovered after subpoenaing her private medical records.

[jpod]

So why didn't the doctor file a Dr.'s First Report of Injury when he/she treated the patient?

If he/she didn't b/c it was not reported or found to be work related then allowing that doctor to be a QME deprives the injured worker of an unbiased QME to rebut that prior finding.

If the doctor found it to be work related and the defendant objected to the PTP and sought a QME it would appear the defendant is not getting an unbiased rebuttal. So as stated above one party is not getting what the QME process is supposed to provide.