Joined: Jul 2007
Wednesday February 18, 2009 5:23 PM
You don't say what the "QME" is required for, but if it's in relation to a second opinion to a surgery ...
the labor code is pretty clear in providing guidance on this...
<< (c) The second opinion physician shall not have any material
professional, familial, or financial affiliation, as determined by
the administrative director, with any of the following:
(1) The employer, his or her workers' compensation insurer,
third-party claims administrator, or other entity contracted to
provide utilization review services pursuant to Section 4610.
(2) Any officer, director, or employee of the employer's health
care provider, workers' compensation insurer, or third-party claims
(3) A physician, the physician's medical group, or the independent
practice association involved in the health care service in dispute >>
I don't know, but you could probably make the same/similar arguement for most scenaios.
A PTP can be requested to perform a M/L evaluation....and a QME can become a PTP....
<< 4061 (i) No issue relating to the existence or extent of permanent
impairment and limitations resulting from the injury may be the
subject of a declaration of readiness to proceed unless there has
first been a medical evaluation by a treating physician or an agreed
or qualified medical evaluator. With the exception of an evaluation
or evaluations prepared by the treating physician or physicians, no
evaluation of permanent impairment and limitations resulting from the
injury shall be obtained, except in accordance with Section 4062.1
or 4062.2. Evaluations obtained in violation of this prohibition
shall not be admissible in any proceeding before the appeals board. >>
To be a PQME in a claim, doesn't the evaluators name have to be provided on a panel provided by the medical unit...?
AA could not 'name' a PTP as a PQME on his/her own...