Panel QME list then exam time period question (California)

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Panel QME list then exam time period question (California)

Postby laesquire on Thu Dec 17, 2009 6:10 pm

SCENARIO:

1. Unrepresented applicant requests a Panel QME.

2. The list comes out.

3. Three months later the applicant becomes represented. The AA picks a Panel QME and sets the exam. No stirking of QME's he just picks one as AA.

QUESTIONS:
1. Once the Panel QME list is issued, what is the latest the exam can occur?
Ie 60 days for the issuance of the list? 90 days? etc.

2. Post panel qme list issuance, if the applicant becomes represented before the exam does the process change to labor code 4062.2?
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Re: Panel QME list then exam time period question (California)

Postby jpod on Fri Dec 18, 2009 7:50 am

I think the A/A has to try to achieve an AME agreement before he can ask for a panel to do the strike off. No one is allowed to pick their own medical legal doctor anymore, they have to follow the rules for obtaining one.
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Re: Panel QME list then exam time period question (California)

Postby jakelast@aol.com on Wed Dec 23, 2009 8:04 am

The holding in Romero v Costco, 72 Cal. Comp. Cases 824, a Significant Panel Decision would suggest one the employee has obtained counsel, they are in the represented track and must initiate that process to obtain a medical legal exam. In theory the AA could have instructed his client to select a specific QME from the list prior to representation but once represented, I think it is arguable the panel is now moot and the represented process needs to be followed.

While the case does not specifically hold that obtaining representation results in jettisoning of the unrepresented panel, it certainly holds applicant is entitled to a new panel in the circumstance. I see no reason why the opposite would not apply. If defendant cannot select a physician from that panel, I do not think the applicant has any greater right to use the unrepresented panel one becoming represented.
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Re: Panel QME list then exam time period question (California)

Postby stevepsca on Wed Dec 23, 2009 9:09 am

No answer here... but a question/s

1. Unrepresented applicant requests a Panel QME.
2. The list comes out.
3. Three months later the applicant becomes represented. The AA picks a Panel QME and sets the exam. No stirking of QME's he just picks one as AA.
Why is there a 90 day gap here?
The IW should have selected the QME from the panel within 10 days of the assignment... not 90 days later, or after becomming repped. That PQME appt should have been set long before the AA came on board...If the IW did not set the exam within the 10 days, defense has that right... Yes/No...?
1. Once the Panel QME list is issued, what is the latest the exam can occur?
Ie 60 days for the issuance of the list? 90 days? etc.
Thats dependant upon the Dr QME schedule. Unless this is for spinal surgery second opinion.
4062(b)...Examinations shall
be scheduled on an expedited basis. The second opinion report shall
be served on the parties within 45 days of receipt of the treating
physician's report.


At any rate, my qustion is... have Dr.AME, no longer AA'd... is the defense entitled to a Panel now... I don't want a PQME, unless the AME deferrs as out of specialty. Shouldn't an AME be set, then referred out ?

jpod... I'm still waiting for the CA to set the AME appt....
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Re: Panel QME list then exam time period question (California)

Postby jpod on Wed Dec 23, 2009 9:45 am

I don't recal all the specifics...but I understand that you once had an attorney and had agreed to a doctor to act as an AME.

I think you need to file for a hearing if the CA won't agree to return you to the doctor if a dispute has arisen.
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Re: Panel QME list then exam time period question (California)

Postby stevepsca on Wed Dec 23, 2009 10:54 am

j...
Disputed treatment issue, I noticed under 4062, and requested AME exam set. Nothing to date. Since Nov 17th. AME won't take appt from me.

I'm reading/understanding you can't file DOR for hearing w/o a medical/legal evaluation on the disputed issue. Which makes sense to me... why get a judge involved in something the system is intended to resolve these issues (?)
And, I'm not sure this doesn't fall under ''unreasonable'' delay in providing benefits by failure to respond to the request for AME. (BTW...this should have been approved due to the UR Dr being concompliant by one day in the UR process. Yes, the CA has been noticed on that too...)
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Re: Panel QME list then exam time period question (California)

Postby compquest on Tue Dec 29, 2009 12:44 pm

My new screen name compquest.

Neither the adjuster or applicant picked a panel qme until much later. So the 90 gap was claim processing claim.
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