Late or Missing Notices; Panel QME Issues

Saturday, June 18, 2005 | 0

A recent post in the Professional WorkCompForums, Claims Adjusters topic, reviewed a likely common problem due to the time constraints concerning Qualified Medical Examinations, and medical-legal dispute resolution. The following is an edited version of that discussion:

Q: I am working on several cases where either the injured workers were permanent and stationary for over a year, but the panel QME letter was never sent, or where the carrier sent the QME panel forms to the injured workers but they never responded. Is it too late to request a panel? Can the carrier still object to the primary treating physicians (PTP) opinion?

A:

The DWC Med Unit will issue a panel list from a carriers panel QME request form if a cover letter is enclosed stating the nature of the dispute, and the relevant Labor Code section (4060,4061,4062), and proof that the injured worker was given notice that they have 10 days to request the panel QME or the IC could request it for them.

I have not gotten any panel QME requests back from DWC Med Unit with the objection that the timeframe (20 to 30 days) to object has passed. That might become more of an audit issue later on perhaps.

Other reasons panel QME requests have been returned:
1. panel list previously issued - they have this info on record;
2. no notice to injured worker of 10 day language to request panel;
3. nature of dispute requiring panel QME not listed;
4. no objection to PTP noted.

Reasons panel QME list change requests returned:
1. both parties must agree to the change in writing (specialty, 2nd list);
2. Insurance Companys (IC) objection to specialty chosen by injured worker is not accepted;
3. Date of injury on panel request form doesn't match the claim number submitted (injured worker wrote different claim number on form).

What happens if 2 panel QME lists issue?

1. it's only happened once so far, but in writing, DWC Med Unit confirmed the first list issued is valid. The second is void even though the injured worker requested this list.

What should IC do if the injured worker calls and says no panel list was received even though IC has a copy?
1. DWC Med Unit encourages IC to send the injured worker a copy of their list (I have reservations about this one as it could eliminate our right to schedule the appt after 10 days should the injured worker just mistakenly misplace the list the DWC sent to them).

Reasons a 2nd panel list might be issued:
1. 2 of the panel QME's on the list are in the same office;
2. PTP is one of the panel QME's on the list;
3. wrong geographical area - QME offices are not within reasonable distance from EE's zip code;
4. both parties (injured worker and IC) agree in writing to a 2nd list with a valid reason 1-3 above.

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