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Thread Title: Can PTP be QME
Created On Wednesday February 18, 2009 5:05 PM


medicalmax
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Wednesday February 18, 2009 5:05 PM

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PTP becomes State Panel QME on CT Claim (post 2004 injury). Then AA designates him to serve as QME on the prior specific (pre 2003 injury). Is there any case law or statutory law stating that a PTP can't serve as either Panel QME or QME regarding bias?


Medicamax

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STEVEPSCA@YAHOO.COM
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Wednesday February 18, 2009 5:23 PM

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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
administrator.
(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...

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medicalmax
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Wednesday February 18, 2009 5:38 PM

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It was a fluke that the panel had him on there and that he didn't get struck. He's a QME in ortho for a specific injury.

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Loislane
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Wednesday February 18, 2009 8:05 PM

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I think common sense would dictate the answer to this, w/o going to the codes.

As a PQME is used when a dispute, in some form, exists, and that dispute is regarding treatment/level of impairment, etc that were ostensibly determined by PTP, how can that PTP be used to settle the dispute as a QME??? Have I missed something? Where was the DA on the case? Asleep?

Lois

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appliedpsych
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Wednesday February 18, 2009 9:14 PM

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According to the New Regs Review at the recent CSIMS workshop:

Previously, it was assumed that a panel QME could not solicit to treat an injured worker, but he/she could treat if the injured worker unilaterally asked. Section 41(a)(4) now positively states that a QME must refrain from treating or soliciting to provide medical treatment, medical supplies or medical devices to the injured worker.

It seems that the corollary would be that a treating doctor also cannot be a QME for the same patient, as then the regulation above would then be violated.

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