Qme Division Of Workers'
Compensation, Title 8 Regulations
Questions And Answers With Verified
Solutions 100% Correct!!!
Accreditation - ANSWER✔✔ recognized status as a provider of physician
education by the Administrative Director
Administrative Director - ANSWER✔✔ AD of DWC and his/her designee.
Agreed Panel QME / AME - ANSWER✔✔ claims administrator, or if none the
employer, and a represented employee agree upon and select from a QME panel
list issued by the Medical Director without using the striking process.
Claims Administrator - ANSWER✔✔ person or entity responsible for the payment
of compensation for any of the following: a self-administered insurer providing
security for the payment of compensation required by Divisions 4 and 4.5 of the
Labor Code, a self-administered self-insured employer, a group self-insurer, an
insured employer, the director of the Department of Industrial Relations as
administrator for the Uninsured Employers Benefits Trust Fund (UEBTF) and for
the Subsequent Injuries Benefit Trust Fund (SIBTF), a third-party claims
administrator for a self-insured employer, insurer, legally uninsured employer,
group self-insurer, or joint powers authority, and the California Insurance
Guarantee Association (CIGA). The UEBTF shall only be subject to these
regulations after proper service has been made on the uninsured employer and
the Appeals Board has obtained jurisdiction over the UEBTF by joinder as a party.
,Course - ANSWER✔✔ the 12 hours of instruction in disability evaluation report
writing which is required of a Qualified Medical Evaluator prior to appointment. A
course must be approved by the Administrative Director.
Direct medical treatment - ANSWER✔✔ special phase of the physician-patient
relationship during which the physician: (1) attempts to clinically diagnose and to
alter or modify the expression of a non-industrial illness, injury or pathological
condition; or (2) attempts to cure or relieve the effects of an industrial injury.
DEU - ANSWER✔✔ Disability Evaluation Unit under the Administrative Director
responsible for issuing summary disability ratings
Medical Treatment Utilization Schedule - ANSWER✔✔ the treatment utilization
scheduled adopted by the Administrative Director of the Division of Workers'
Compensation
Panel QME - ANSWER✔✔ the physician whose name remains after completion of
the striking process or who is otherwise selected as provided in Labor Code
section 4062.2(c) when the parties are unable to agree on an Agreed Panel QME.
Qualified Medical Evaluator - ANSWER✔✔ Physicians who determines disability
but acupuncturist QMEs shall not perform comprehensive medical-legal
evaluations to determine disability
QME competency examination for acupuncturists - ANSWER✔✔ examination
administered by the Administrative Director for the purpose of demonstrating
competence in evaluating medical-legal issues in the workers' compensation
system which are not pertinent to the determination of disability, but should be
, understood by acupuncturist QMEs. This examination shall be given at least as
often as twice annually.
Unrepresented employee - ANSWER✔✔ an employee not represented by an
attorney
QME Appointment - ANSWER✔✔ An applicant who passes the QME competency
examination shall file the QME Fee Assessment Form in Section 103 (see, 8 Cal.
Code Regs. section 103) including the appropriate fee within thirty (30) days of
the date of the notice. The physician shall not be appointed to the official QME
list until the appropriate fee is paid and has completed a disability evaluation
report writing course pursuant to section 11.5. Appointments shall be for two-
year terms beginning with the date of appointment by the Administrative
Director.
QME Re-test - ANSWER✔✔ the applicant may apply to take any subsequent
examinations, upon submission of a new test application form and a fee of $125.
An applicant who fails the exam three times shall show proof of having completed
six (6) hours continuing education from a course approved by the Administrative
Director prior to taking the examination again.
QME Test Appeal - ANSWER✔✔ Grounds for appeal are:
(A) Significant procedural error in the examination process;
(B) Unfair Discrimination;
(C) Bias or fraud.
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