EAMS and the QME Process

EAMS and the QME Process

Most people are surprised to learn that the DWC Medical Unit is not yet integrated with EAMS. Because of that, here are some special considerations practitioners need to know in order to effectively communicate with the Medical Unit. In addition, the DWC issued new QME regulations on February 17, 2009. Therefore, the following 10 practice tips may be helpful on the subject of Panel QMEs.
Requesting a Panel QME:
1.            To request a Panel QME for a represented injured worker, parties must provide all of the following on Form 106:
  • Identify the disputed issue (requests that use an AME offer that does not identify the disputed issue will be returned);
  • Attach proposal for Agreed Medical Evaluator;
  • Designate specialty (using specialty codes)
  • State specialty of the treating physician; and
  • State specialty preferred by the opposing party.
(Similar information should be provided on Form 105, which is the appropriate form for an injured worker who is not represented.)
2.            Use the medical specialty codes on all requests for QME panels, including the initial request, as well as any subsequent request for a new QME panel. In order to avoid confusion, and to ensure the correct QME Panel is designated, parties must use the medical specialty codes, such as MPA for pain medicine, or PSY for psychology, or MPD for psychiatry. These Codes can be found at page 3 of the forms to Request a QME Panel (Form 105 & Form 106.)
3.            Per new QME Reg 8 CCR §151, a document is not deemed received until it has been received by the Medical Unit. If you have not received a QME Panel within 30 days, you should wait at least an additional 5 days (for a total of 35 days) before you approach a WCJ for an Order requesting an initial Panel QME. (See 8 CCR §31.1(c).)
Requesting a NEW Panel QME:
4.            Use one of the following four options to request a new QME panel, (after an initial QME Panel has been assigned):
5.            Include the number of the FIRST Panel QME that was initially assigned in the case. This number should be placed in the caption as well as in the body of the Request and Proposed Order for a new QME Panel. A sample caption should include:
WCAB Case No(s):
Existing QME Panel No:
Date(s) of Injury:
(Designate: Represented IW OR Unrepresented IW)
Since the Medical Unit is not linked with EAMS, the ADJ number means nothing to them. You might as well be giving them your high school locker combination. But if you provide the QME Panel number from the initial assignment, that will substantially increase your odds of not being assigned the same panel for a second time. Plus, this is helpful data which will enable the Medical Unit to easily identify the injured worker and timely assign a new and appropriate QME panel.
6.            Include ALL of the following information in the body of your request and proposed Order:
  • What was the first specialty that was requested
  • What is the current specialty that is being requested
  • The reason a new QME panel is necessary
  • ZIP code (home or work) of the injured worker
7.            If you are objecting to a doctor’s report based on a technicality such as a late report or canceling an appointment and then rescheduling beyond the deadlines, you should object to the QME’s report BEFORE it has been issued.
Request for Replacement QME Panel:
8.           You do not need a judge’s order to request a replacement QME panel, but you do need one of the 16 fact patterns as set forth in 8 CCR §31.5.
Request for 2nd QME Panel in a Different Specialty:
9.            If good cause exists, as defined in 8 CCR §31.7, you may need to request a 2nd QME panel. For instance, a WCJ may find good cause and issue an Order for a second QME panel. The parties may agree a second QME in a different specialty is warranted, or the first QME may make that recommendation.
10.          All Requests and Orders for Panel QMEs should be sent to the DWC Medical Unit.
Mail by first class to:         DWC Medical Unit, Attn: Sue Honor, P.O. Box 71010, Oakland, CA 94612
These blogs have been approved by the California Division of Workers' Compensation.
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