FAQ

/FAQ
FAQ2019-03-31T23:35:53-07:00
Document Separator Sheet2019-03-31T23:35:53-07:00
Document Cover Sheet2019-03-31T23:35:53-07:00
Notice of and Request for allowance of lien2019-03-31T23:35:54-07:00
Declaration of Readiness2019-03-31T23:35:54-07:00
Application for Adjudication2019-03-31T23:35:54-07:00
Return to Work2019-03-31T23:35:54-07:00
Request for Authorization2019-03-31T23:35:54-07:00
Primary Treating Physician’s Progress Report2019-03-31T23:35:54-07:00
1997 – Primary Treating Physician’s Permanent and Stationary Report2019-03-31T23:35:54-07:00
2005- Primary Treating Physician’s Permanent and Stationary Report2019-03-31T23:35:54-07:00
Doctor’s First Report2019-03-31T23:35:54-07:00
ACOEM Guidelines2019-03-31T23:35:54-07:00
Designation of Treating Physician2019-03-31T23:35:54-07:00
What is the Code for Supplemental Reports?2016-06-14T09:24:12-07:00

ML106 -For Record Review Only

What are the Medical Legal Complexity Factors2016-06-14T09:24:17-07:00

ML104 Complexity Factors
4 complexity factors required to constitute ML104


2 or more hours of face to face interview
2 or more hours of record review
2 or more hours of medical research by physician

OR

4 or more hours spent on any combination of the above = 2 complexity factors.
6 or more hours spent on any combination of the above = 3 complexity factors.

Psychological Evaluation -The nature of the evaluation is psychiatric = 1 complexity factor

Addressing issue of causation if requested or if found to be an issue in the evaluation

Addressing issue of apportionment can be a complexity factor if there are:
3 or more employers
3 or more injuries to the same body system or region
2 or more injuries involving 2 or more body systems or regions

Addressing issue of denial or modification of treatment by the claims administrator
following Utilization Review