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AME/PQME Process
Timing is Everything!
Doc Talk
Forms, Forms, Forms
Med/Legal True or False
100
This is what "PQME" stands for.
What is Panel Qualified Medical Evaluator?
100
DAILY DOUBLE!!! (Wager any or all of your points) Utilization Review of a request for spine surgery must be completed within this many days of receipt of the request.
What is 10 days? The objection and 2nd opinion request form must also be sent out during this period.
100
This is the definition of Ex Parte communication.
What is unilateral communication with the AME/PQME without the opposing side being present or copied?
100
The medical specialty codes required on QME Panel requests contain this many letters.
What is 3 letters? (i.e. MOS for orthopedic surgery and MPA for pain medicine.)
100
In an unrepresented case, the parties have 10 days to agree on a doctor from a QME panel then, absent an agreement, 3 business days to strike a doctor.
What is FALSE? An unrepresented employee has 10 days from issuance of a QME panel to select a doctor. After that, the defense selects the doctor.
200
This is the number of physicians that are listed on each QME Panel assigned by the Medical Unit.
What is 3?
200
An unrepresented employee has this many days from the date a QME panel is issued to select a doctor from the panel.
What is 10 days?
200
A party has this many days to object to records the opposing side proposes to provide to the AME/PQME.
What is 10 days? Any records objected to shall not be sent to the doctor.
200
The Medical Unit will do this to a premature/incomplete QME panel request.
What is reject or deny it.
200
A party has 10 days to object to nonmedical evidence the opposing side proposes to send to the medical evaluator.
What is TRUE?
300
Injuries occurring on or after this date are subject to the PQME process.
What is January 1, 2005?
300
A PQME must issue his/her med/legal report within this many days from the date of the evaluation.
What is 30 days?
300
Surveillance videos and personnel files are considered this type of information (as opposed to doctor's reports and diagnostic results.)
What is nonmedical evidence?
300
When requesting a QME panel in a represented case, be sure to include a copy of this letter with your request form.
What is the AME offer/Objection letter? Your QME panel request will be rejected without it!
300
A PQME may be removed from a panel if he/she has previously treated the applicant.
What is TRUE? Most likely, an entirely new panel will be issued.
400
In a represented case, the parties can agree to utilize one of these rather than go through the Panel QME process.
What is an Agreed Medical Evaluator (AME)?
400
In a represented case, a party must issue an objection to a treating doctor's findings within this many days of receipt.
What is 20 days? 30 days in an unrepresented case.
400
All information provided to a PQME/AME must be served on the opposing party this many days prior to the evaluation.
What is 20 days?
400
When requesting a 2nd opinion for a Spine Surgery request, be sure to include these documents with your request form.
What are the Utilization Review denial and objection letter?
400
A QME may request a reporting extension on the grounds that he/she has did not receive all the medical records.
What is FALSE? Lack of medical records/information is not a proper rationale for extension per Rule 38(h).
500
The PQME process for an unrepresented employee is governed under which Labor Code section?
What is Labor Code Section 4062.1? The PQME process in represented cases is governed by 4062.2.
500
In an unrepresented case, the claims administrator must wait this many days after providing the injured worker with the PQME request form (Form 105) before requesting a panel.
What is 16 days? 10 days starting after the form is provided, plus 5 days for mailing.
500
A party that communicates with a doctor inappropriately may be subject to this.
What is liability for exam costs and attorney's fees?
500
A QME Panel request form for an unrepresented employee is form number this.
What is Form 105? Use Form 106 for represented employees.
500
Submitting a QME Panel request to the Medical Unit via fax or hand-delivery is a good way to make sure your request is received first.
What is FALSE? QME Panel requests may only be submitted via regular mail.