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  1. #1
    Join Date
    Sep 2011
    Posts
    33

    Question QME Final Report

    I have been trying to get an answer out of my AA, but have not been able to. I was just wondering if anyone knows what we can do to get a QME to turn in his final report? We have been waiting for 5 months and still no report. My AA's office says they have been in contact with his of and all they said is he's getting to it. Can my AA subpoena the QME for the final report? Or do we have to start over? I think he has 30 days to turn in the report or ask for an extension, neither of which he's done. Without this report we can not go to MSC and this is the final report that we need to try to close this out. thank you
    Last edited by upsetIW; 07-03-2013 at 09:21 AM.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: QME Final Report

    request another QME.
    the carrier will not pay for two and he won't get paid for his exam.
    make sure to report him to the DWC medical bureau and request that he be removed from the QME list.
    do it in writing with a copy to the doctor.

    if you want his opinion in writing you can depose him.

  3. #3
    Join Date
    Jul 2008
    Location
    California
    Posts
    1,899

    Default Re: QME Final Report

    Quote Quoting upsetIW View Post
    I have been trying to get an answer out of my AA, but have not been able to. I was just wondering if anyone knows what we can do to get a QME to turn in his final report? We have been waiting for 5 months and still no report. My AA's office says they have been in contact with his of and all they said is he's getting to it. Can my AA subpoena the QME for the final report? Or do we have to start over? I think he has 30 days to turn in the report or ask for an extension, neither of which he's done. Without this report we can not go to MSC and this is the final report that we need to try to close this out. thank you


    Your attorney can request another QME panel if the QME did not request an extension. You would have to start all over with another QME, and on average it is taking 5 months to get a panel. Since you are represented by an attorney, he is the one that would do something.

    The QME would have requested an extension with the medical unit. Are you sure this was not done? This is something the injured worker is not usually copied on.

    This topic was just posted on another site, and I will copy below.


    http://www.dir.ca.gov/t8/38.html
    "(a) The time frame for an initial or a follow-up comprehensive medical-legal evaluation report to be prepared and submitted shall not exceed thirty (30) days after the QME, Agreed Panel QME or AME has seen the employee or otherwise commenced the comprehensive medical-legal evaluation procedure. If an evaluator fails to prepare and serve the initial or follow-up comprehensive medical-legal evaluation report within thirty (30) days and the evaluator has failed to obtain approval from the Medical Director for an extension of time pursuant to this section, the employee or the employer may request a QME replacement pursuant to section 31.5 of Title 8 of the California Code of Regulations. Neither the employee nor the employer shall have any liability for payment for the medical evaluation which was not completed within the timeframes required under this section unless the employee and the employer each waive the right to a new evaluation and elect to accept the original evaluation, in writing or by signing and returning to the Medical Director either QME Form 113 (Notice of Denial of Request For Time Extension) or QME Form 116 (Notice of Late QME/AME Report - No Extension Requested) (See, 8 Cal. Code Regs. 113 and 116)."

    I would also check to see if the QME requested an extension.

    "A. The QME has 30 calendar days from the date of the commencement of the exam to issue the report. There are three reasons a physician may request an extension:
    1.The physician requested you have medical tests and is awaiting results
    2.The physician requested a consultation and is awaiting the consultant's report
    3.The physician has a "good cause" for an extension. A good cause is a medical emergency of the evaluator or the evaluator's family, death in evaluator's family, natural disaster or other community catastrophes that interrupt the operation of the evaluator's office. The computer breaking down or a staff member quitting is not considered good cause. Extensions for good cause may not exceed 15 days from the date the report is required to be served.

    The physician may not request an extension because the claims administrator failed to provide your medical records or past medical tests. If the report is going to be late, the physician must file a time frame extension request with the DWC Medical Unit and send a copy to the claims administrator and to you. This must be filed five days before the report is due. (Title 8, California Code of Regulations, section 38)"
    Last edited by kelly38; 07-03-2013 at 10:12 AM.

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