EPISODE DESCRIPTION

Here are the notes on the podcast episode:
The episode covers key terms and concepts related to workers’ compensation medical exams:
– Primary Treating Physician (PTP) oversees patient care, Secondary Treating Physician (STP) is a specialist
– Maximum Medical Improvement (MMI) and Permanent and Stationary (PNS) status indicate the patient’s condition is stable
– Applicant Attorney (AA) represents the injured worker, Defense Attorney (DA) represents the employer’s insurance company
– AA aims for higher impairment ratings and future medical care, DA seeks to minimize injury scope
– Qualified Medical Evaluators (QMEs) provide impartial medical opinions, unlike “hired guns”
– Importance of apportionment to determine work-related vs. non-work factors
– Whole Person Impairment (WPI) rating impacts treatment and compensation
– Need to examine Activities of Daily Living (ADLs) and use the correct AMA Guides edition (5th for California)
– Difference between QMEs and Agreed Medical Evaluators (AMEs) who are agreed upon by both parties
– Financial aspects: initial in-person intake costs $3/page over $200, supplemental review $3/page over $50, with time limits

KEY LESSONS

The key learnings that are likely surprising to the reader are:
• The distinction between Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs), with AMEs being agreed upon by both parties and typically paid at a higher rate.
• The financial aspects of medical evaluations, including the costs for the initial in-person intake ($3 per page over $200) and the supplemental review of records ($3 per page over $50).
• The concept of “supplemental requests,” which allow QMEs to request additional information or tests after the initial intake, and the importance of submitting these within 60 days.

CHAPTERS

00:00 Understanding Key Terms for Exam Taking
02:07 Dispute Over Impairment Rating and Apportionment
04:17 Deferring Legal Matters to Judges as a QMA
05:16 Uncovering the Injured Worker’s Story
06:51 Navigating Apportionment and Impairment Ratings as a QME
08:59 Supporting Claims with Evidence
10:33 Understanding the 5th Edition AMA Guides for Medical-Legal Reporting
12:24 Choosing Unbiased Medical Examiners in Workers’ Comp Cases
14:31 Understanding the Role of the California Department of Workers’ Compensation
15:06 Navigating the Workers’ Compensation System: Panels, Injured Workers, and Supplemental Requests
17:13 Navigating Supplemental Intakes in Workers’ Compensation

SUMMARY

The speakers discuss key terms related to workers’ compensation exams, including the primary treating physician (PTP), secondary treating physician (STP), maximum medical improvement
(MMI), and permanent and stationary (PNS) status. They explain that the PTP is the main doctor overseeing the patient’s care, while the STP is a specialist consulted by the PTP. MMI and PNS indicate that the patient has reached the point where their condition is unlikely to improve substantially with further treatment. The speakers also describe the roles of the applicant attorney (AA), who represents the injured worker, and the defense attorney (DA), who represents the employer’s insurance company. The AA aims to expand the scope of the injury and secure higher future medical care and impairment ratings, while the DA seeks to minimize the injury and lower the impairment rating and apportionment to the employer. The speaker discusses key legal concepts that physicians (QMAs) should be aware of when dealing with workers’ compensation cases, such as the role of the “trier of fact” (the judge), the distinction between specific and cumulative trauma injuries, and the importance of understanding the differences between aggravation and exacerbation. The speaker also emphasizes the importance of apportionment, which involves determining the percentage of an injury that is attributable to the work-related incident versus other factors. Finally, the speaker highlights the crucial role of the QMA in assessing the whole person impairment (WPI) or impairment rating, which is a key factor in determining the appropriate course of treatment and compensation for the injured worker. The speakers discuss the importance of supporting claims when providing medical evaluations and ratings. They emphasize the need to thoroughly examine activities of daily living (ADLs) and to use the correct edition of the AMA Guides, which is the 5th edition in California. The speakers also explain the difference between Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs), with AMEs being agreed upon by both parties and typically paid at a higher rate. The key points are the need to provide evidence-based claims, the importance of understanding ADLs, and the distinction between QMEs and AMEs in the medical-legal evaluation process. The speakers discuss the importance of using unbiased medical evaluators, known as Qualified Medical Evaluators (QMEs), in workers’ compensation cases. QMEs provide impartial medical opinions, unlike “hired guns” who may lean towards one side. The Department of Workers’ Compensation (DWC) oversees the QME process, organizing panels of three potential evaluators, one of which is selected after the parties strike out the others. The speakers emphasize the need for QMEs to provide high-quality, defensible reports in a timely manner to increase their chances of being selected for future cases. They also discuss the concept of “supplemental requests,” which allow QMEs to request additional
information or tests after the initial intake. The speakers discuss the financial aspects of medical evaluations for workers’ compensation cases. The initial in-person intake costs $3 per page over
$200, while the supplemental review of records costs $3 per page over $50. Supplementals are often requested when the patient has not reached maximum medical improvement or is not
permanent and stationary, and must be submitted within 60 days. The initial intake must be completed within 30 days.