STEVEPSCA@YAHOO.COM
Senior Member
Posts: 990
Joined: Jun 2002
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Sunday February 22, 2009 4:29 PM
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Here is the information on how/what you do for a PQME evaluation...
4062.3. (a) Any party may provide to the qualified medical
evaluator selected from a panel any of the following information:
(1) Records prepared or maintained by the employee's treating
physician or physicians.
(2) Medical and nonmedical records relevant to determination of
the medical issue.
(b) Information that a party proposes to provide to the qualified
medical evaluator selected from a panel shall be served on the
opposing party 20 days before the information is provided to the
evaluator. If the opposing party objects to consideration of
nonmedical records within 10 days thereafter, the records shall not
be provided to the evaluator. Either party may use discovery to
establish the accuracy or authenticity of nonmedical records prior to
the evaluation.
(c) If an agreed medical evaluator is selected, as part of their
agreement on an evaluator, the parties shall agree on what
information is to be provided to the agreed medical evaluator.
(d) In any formal medical evaluation, the agreed or qualified
medical evaluator shall identify the following:
(1) All information received from the parties.
(2) All information reviewed in preparation of the report.
(3) All information relied upon in the formulation of his or her
opinion.
(e) All communications with an agreed medical evaluator or a
qualified medical evaluator selected from a panel before a medical
evaluation shall be in writing and shall be served on the opposing
party 20 days in advance of the evaluation. Any subsequent
communication with the medical evaluator shall be in writing and
shall be served on the opposing party when sent to the medical
evaluator.
(f) Ex parte communication with an agreed medical evaluator or a
qualified medical evaluator selected from a panel is prohibited. If
a party communicates with the agreed medical evaluator or the
qualified medical evaluator in violation of subdivision (e), the
aggrieved party may elect to terminate the medical evaluation and
seek a new evaluation from another qualified medical evaluator to be
selected according to Section 4062.1 or 4062.2, as applicable, or
proceed with the initial evaluation.
(g) The party making the communication prohibited by this section
shall be subject to being charged with contempt before the appeals
board and shall be liable for the costs incurred by the aggrieved
party as a result of the prohibited communication, including the cost
of the medical evaluation, additional discovery costs, and attorney'
s fees for related discovery.
(h) Subdivisions (e) and (f) shall not apply to oral or written
communications by the employee or, if the employee is deceased, the
employee's dependent, in the course of the examination or at the
request of the evaluator in connection with the examination.
(i) Upon completing a determination of the disputed medical issue,
the medical evaluator shall summarize the medical findings on a form
prescribed by the administrative director and shall serve the formal
medical evaluation and the summary form on the employee and the
employer. The medical evaluation shall address all contested medical
issues arising from all injuries reported on one or more claim forms
prior to the date of the employee's initial appointment with the
medical evaluator.
(j) If, after a medical evaluation is prepared, the employer or
the employee subsequently objects to any new medical issue, the
parties, to the extent possible, shall utilize the same medical
evaluator who prepared the previous evaluation to resolve the medical
dispute.
(k) No disputed medical issue specified in subdivision (a) may be
the subject of declaration of readiness to proceed unless there has
first been an evaluation by the treating physician or an agreed or
qualified medical evaluator.http://www.leginfo.ca.gov/cgi-bin/displaycode?section=lab&group=04001-05000&file=4060-4068
<< Must I snail mail the med/non-med records within 20 days or is it possible to simply fax them the medical/non-medical records? >>
Don't fax... you need to send this stuff with a proof of service form, and/or certified, return receipt requested... CYA here...you don't want the CA/DA coming back with the arguement you have not provided the information....
You still are free to provide ANY information, oral or written at the exam...see the rule (h) above.
<< I requested the PQME panel because the claim had been delayed, now it is approved. What is going to happen at the PQME appointment now? >>
What are you disputing now, other than the TTD issue...?
You will need to have the PQME comment/opine specifically on the TTD issues... providing dates you ARE/WERE TTD. It's important so you can determine what dates there may be an overlap in SDI/TTD benefits.
If there are no other disputed medical issues...then that is all the PQME will comment on.
There is no patient/treater relationship with you and the PQME...s/he won't diagnose, or develope a treatment plan...or comment on what treatment you might need for your injury... just the disputed issues should be addressed in the report.
I would be a good idea if you can form a 'working relationship' with this doctor... s/he will be the one you see in the future if there are more disputed issues.
And by that, I mean to not be shy, but direct, honest plain formative answers to the evaluators questions.
Treat this like a deposition.. yes, no, I don't think so... never say "I never...." or "I can't do..."
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