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My QME it's a medical provider for the defense client
#1
Exclamation 
I just discover that the QME designated to evaluate the injury
is listed in the insurance network as a medical provider.
Is this common practice ?  can it be construed as a conflict of interest?
Thanks
 
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#2
Yes, it's common. many doctors trained in work comp rules accept work comp patients for employers, carriers, Third Party Administrators and are on approved QME and AME lists. Since either party can request a QME there are many situations where a worker would want a QME from the same MPN as their treating physician.
Being in the MPN may be a reason one worker selects the doctor while another worker would not. The fact that you wouldn't doesn't prevent them from being on the list. The list is not custom tailored to either party,s bias.

A physician has no control or influence on which lists they appear or if they are selected; without that they have done nothing that is in conflict.
conflicts of interest regulations only apply to evaluators not those eligible for placement on a panel prior to selection. Being put on the panel list is not a conflict of interest as the physician is not performing any service that could conflict with anything and is not even aware of the contents of hundreds of QME lists generated by the DWC.

http://www.dir.ca.gov/t8/41_5.html

(g) Any injured worker or claims administrator or if none the employer, including his or her attorney respectively, who knows of, or becomes aware of, a potential disqualifying conflict of interest, as defined under this section, with a specific evaluator selected to perform a comprehensive medical/legal examination and report or a follow up examination and report, shall notify the selected evaluator in writing at the earliest opportunity and no later than within five (5) business days of becoming aware of the potential conflict, to enable the evaluator to determine whether the disqualifying conflict exists. The notice shall include the person with whom the alleged conflict exists and the nature of the conflict. A copy of this notice shall be served on the opposing party at the same time as it is sent to the evaluator. The evaluator shall review the information provided and advise the parties in writing within five (5) business days of receipt of the notice whether the evaluator has a conflict of interest as specified in this section.

general QME regulations are here (including qualifying reasons for obtaining a replacement panel.)
http://www.dir.ca.gov/samples/search/querydwc.htm
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(11-10-2016, 04:15 PM)joe9117 Wrote: I just discover that the QME designated to evaluate the injury
is listed in the insurance network as a medical provider.
Is this common practice ?  can it be construed as a conflict of interest?
Thanks
I agree with 1171 but you can always call the medical unit and ask. They control the PQME process.

Did you pick this doctor from a panel or are you represented by an attorney?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#4
(11-11-2016, 01:36 PM)California_Help Wrote:
(11-10-2016, 04:15 PM)joe9117 Wrote: I just discover that the QME designated to evaluate the injury
is listed in the insurance network as a medical provider.
Is this common practice ?  can it be construed as a conflict of interest?
Thanks
I agree with 1171 but you can always call the medical unit and ask. They control the PQME process.

Did you pick this doctor from a panel or are you represented by an attorney?
no, I didn't Pick this doctor and no, I'm not represented by an attorney
 
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#5
(11-11-2016, 04:42 PM)joe9117 Wrote:
(11-11-2016, 01:36 PM)California_Help Wrote:
(11-10-2016, 04:15 PM)joe9117 Wrote: I just discover that the QME designated to evaluate the injury
is listed in the insurance network as a medical provider.
Is this common practice ?  can it be construed as a conflict of interest?
Thanks
I agree with 1171 but you can always call the medical unit and ask. They control the PQME process.

Did you pick this doctor from a panel or are you represented by an attorney?
no, I didn't Pick this doctor and no, I'm not represented by an attorney

OK something does not sound right. You should have been given something from your claims adjuster stating you can contact the medical unit and request a panel of 3 doctors. After you request the panel you had 10 days to pick the doctor from the list. If you failed to do this then your adjuster can pick the doctor.

I recommend taking your paperwork down the work comp board where your case is located and ask for an information and assistance officer to sit down with you and help you find out what happened. This QME is going t determine your rating, what injuries where caused by work if any, how much apportionment to the injuries and if and when you are permanent and stationary. This doctor is very important in your case and it sounds like something happened with you missing a deadline or they may be trying to take advantage of your lack of knowledge.

You can also try to hire a workers compensation attorney for help.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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