Applicant is entitled to a new Qualified Medical Examiner ( QME ) pursuant to Navarro v. City of Montebello (2014) 79 ccc 418 when applicant filed a new injury claim after being examined by the original QME for the prior claims. Defendant claimed that applicant intentionally delayed filing new claim to obtain new QME. No evidence to support allegation.
Calif Code of Regulations, Section 38-(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.
Privately retained doctor’s reports and opinions are admissable in disability hearings but cannot be the sole basis for an award of compensation. In other words, the WCAB can consider these non MPN doctors opinions but cannot award compensation solely on their opinion. These opinions can be considered by MPN physicians or by QME doctors who have evaluated the applicant and who concur.
Labor Code Section 4062.5 requires that a Qualified Medical Examiner’s ( QME ) report be prepared and submitted within 30 days of the evaluation of the applicant.
Failure to serve the report within 30 days of the evaluation allows either party to object in writing and request replacement of the QME.
Ex Parte Communication With AME Or QME.
Labor Code Section 5701 precludes a party from communicating with an Agreed Medical Evaluator(AME) or Qualified Medical Evaluator(QME) on an ex parte basis. Communications must be joint until an applicant is examined by the doctor. There are strict rules about any communication with the doctor after the exam. Applicant’s should never contact the doctor. They should speak with their attorney. A d irect contact by the applicant with the AME or QME will allow the defense attorney to replace the doctor if they wish.
In Regards To Untimely Medical Reports
Labor Code Section 139.2(j)(1)(A) provides that reports from Agreed Medical Evaluator’s(AME) or Qualified Medical Evaluator’s(QME) must be submitted to the parties within 30 days. A party may object to a late report and the doctor will be removed as AME or QME as long as the objection occurs prior to the receipt of the report.
Defendants Denial Of Medical Treatment Based On Opinion Of QME(Qualified Medical Examiner)
A defendant can deny medical treatment to an injured worker based on the opinion of a QME(Qualified Medical Examiner), even if the primary treating doctor recommends such medical treatment.
In Regards To An Unrepresented Applicant Examined By A QME
An applicant who has been examined by a panel QME and who later obtains representation is not entitled to an additional QME evaluation.
Information that a party proposes to provide to the Qualified Medical Evaluator(QME) shall be served on the opposing party 20 days before the information is provided to the Evaluator(QME). If the opposing party objects to the non-medical records within ten days, the records shall not be provided to the QME.
Communication with AME – QME
All communications with an Agreed Medical Evaluator(AME) or a Qualified Medical Evaluator(QME) before a medical evaluation shall be in writing and shall be served on the opposing party 20 days in advance of the evaluation. Any subsequent communication with the medical evaluator shall be in writing and shall be served on the opposing party when sent to the medical evaluator.
Ex parte communication with an Agreed Medical Evaluator(AME) or Qualified Medical Evaluator(QME) is prohibited.
If a party(including the applicant) communicates with the medical evaluator on an ex parte basis the defendants can select a new AME or a QME.