MDpanel Attestations and Panel Terms
MDpanel Attestations and Panel Terms
Please review the attestations, sign and date as acknowledgement.
Attestations
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I certify that I have not been convicted of either a felony or a misdemeanor involving drug abuse, sexual misconduct, or dishonesty, or related to the practice of medicine.
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I certify that I am working within the United States and Canada in accordance with all applicable laws, including, without limitation, all employment and immigration laws.
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I understand that it is my responsibility to ensure continuous compliance with any maintenance of certification (MOC) process required by my board certifying entity (if any), and to take whatever measures necessary to prevent a lapse in my board certification status. Should there be a lapse in my board certification status for failure to comply with MOC requirements or for any other reason, I will notify MDpanel immediately of same and I will reasonably cooperate with MDpanel to remedy or mitigate such lapse.
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I understand and agree that I am prohibited from using Generative AI Tools (including, without limitation, ChatGPT, Gemini, Claude, Jasper, Copy.ai, or other similar tools) to create or complete any part of a report or IME decision and that my documentation must be based entirely on direct observation, interaction, medical/clinical history, review of diagnostic tests, and medical records.
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I understand that, as an Independent Medical Examiner or Peer Reviewer, I am completely and solely responsible for the content of the report I produce.
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As an Independent Medical Examiner, Peer Reviewer, or a provider of similar services, I must uphold the highest standards of confidentiality and ensure that my reports and peer reviews are created in a manner that protects privacy and complies with relevant laws and regulations, including, if applicable, HIPAA.
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With each case performed, I will attest that I have the scope of licensure and certification that permits management of the issue, medical/behavioral health condition, procedure, or treatment issue under review; and that I have current, relevant experience and/or knowledge to render a determination for the case under review, otherwise I will recuse myself from reviewing and providing an opinion on said case.
I will notify MDpanel immediately of:
- The revocation, suspension, restriction or termination or voluntary relinquishment of any of my licenses, certifications or accreditations, or any encumbrance or restriction thereof;
- Any claim or legal action pending against me for professional negligence, recklessness, or intentional misconduct;
- Any indictment, arrest or conviction for a felony, misdemeanor or for any other criminal charge;
- Any judgment against me which might materially impair my ability to carry out responsibilities in accordance with performance of an IME, Peer Review, or other similar service;
- Any restriction, suspension, revocation or voluntary relinquishment of my medical staff membership or clinical privileges, or any encumbrance or restriction thereof, at any health care facility;
- Any change in my practice or income composition other than minor changes in the ordinary course of practice that would not affect my qualification for the IME, Peer Review, or other services that I provide;
- Any change in my clinical hours worked per week, other than minor changes in the ordinary course of practice that would not affect my qualification for the IME, Peer Review, or other services that I provide;
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For any case reviews or independent medical examinations I accept, I will complete the report/case without any third party involvement.
Panel Terms
By submitting your Credentials Packet to MDpanel, you are acknowledging you have reviewed and are agreeing to these Panel Terms (the “Panel Terms” or the “Terms”).
Although presumed to be infrequent, MDpanel reserves the right to update the Panel Terms in its sole discretion. The Panel Terms will be posted in the MDpanel provider portal (the “Portal”), to which you will be given access credentials, as well as on mdpanel.com. You acknowledge that all referrals from MDpanel are bound by the Panel Terms posted at the time of placement as well as any terms highlighted at case placement (“Case Terms”). MDpanel will make reasonable efforts to notify You of any material amendments to the Panel Terms, but it is Your responsibility to review the Portal or website for any updates or changes prior to accepting any specific referral.
You agree as follows:
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You are an independent contractor and not an employee of MDpanel. You will not subcontract all or any portion of your obligations under any engagement to any other party or entity without the written consent of MDpanel. You are not eligible for and will not receive any employee benefits from MDpanel and shall be solely responsible for the payment of all taxes, FICA, unemployment insurance contributions, disability premiums, and all similar fees and taxes relating to the fees earned under these Terms.
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You confirm that there is no current conflict of interest or doctor-patient relationship that would affect your ability to perform the Services. A conflict of interest can exist if (a) you accept compensation that is dependent in any way on the specific outcome of a case, (b) you were involved in the care of the claimant prior to any referral, (c) you have a material relationship (including professional, familial, or business) with certain individuals involved in the underlying case. You are expected to review the updated Panel Terms and to understand and agree to the conflict-of-interest requirements contained therein. If you have any questions about your professional or ethical responsibilities, please contact MDpanel immediately.
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You agree to make reasonable arrangements to be available for depositions and other testimony, as requested by MDpanel or a client, or as necessary under the circumstances of the case.
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You are solely responsible for your medical actions, conclusions, testimony, and reports. You will function as an independent expert, making all determinations and assessments in accordance with your own judgment and expertise and without influence or interference from MDpanel or any third party. MDpanel, which acts in an administrative capacity, shall not be responsible or liable for your actions or determinations.
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If MDpanel is unable to collect full payment from its client due to Your acts or omissions (e.g., poor quality, lack of timeliness, or disruptive behavior), the Parties will reasonably cooperate to determine an appropriate adjustment to payment that apportions fault between the Parties.
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You will retain sole responsibility for calculating and withholding any applicable taxes from the fees paid.
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You represent and warrant that you maintain adequate liability coverage with respect to your performance of the Services. MDpanel does not provide insurance coverage to you.
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You will not provide direct medical care or prescribe specific treatment to the examinee unless permitted or required by applicable law or regulation.
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You will not perform diagnostic tests without obtaining prior authorization from MDpanel. Any tests performed without such authorization will not be eligible for reimbursement.
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You agree to preserve the confidentiality of all information and records provided to you in connection with the Services. All such materials shall be securely destroyed upon your completion of the Services or at such other time as may be mutually agreed upon by you and MDpanel. You further agree to manage and safeguard any health information received in a manner fully compliant with all applicable state and federal laws and regulations governing patient privacy, including, without limitation, the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”). In the event of any unauthorized disclosure of health information pertaining to an examinee, you shall take immediate corrective measures and notify MDpanel immediately. Note that the Panel Terms or Case Terms may include additional privacy and/or security obligations and measures. These may, without limitation, be required by a client, payer, law or regulation, or accrediting organization. The Parties will reasonably cooperate to give effect to the legal and contractual privacy and security obligations applicable to a particular engagement.
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You shall indemnify, defend, and hold harmless MDpanel and its officers, directors, members, managers, shareholders, partners, employees, agents, affiliates, successors, and permitted assignees from and against any and all claims, liabilities, damages, losses, and expenses, including reasonable attorneys’ fees, arising out of or occurring in connection with the negligence, recklessness, willful misconduct, or breach of these Terms by You.
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These Terms shall be construed and governed in accordance with the laws of the state where you are domiciled, without regard to any conflicts of law provisions contained therein.
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To the maximum extent permitted by applicable law, the Parties mutually agree to resolve any and all disputes between or among them exclusively through final and binding arbitration before the American Arbitration Association, rather than in court or before any administrative or regulatory body. This agreement to arbitrate ("Arbitration Provision") is governed by the Federal Arbitration Act, and it will apply to all claims including but not limited to those arising out of or relating to these Terms, as amended (including the termination of these Terms), Your independent contractor classification and status with MDpanel or its affiliates, the provision of services hereunder or any other aspect of the relationship between the You, any subcontractor, MDpanel and/or any affiliate of MDpanel, whether arising under federal, state or local statutory and/or common law. The Parties waive their right to have any dispute or claim brought between them heard or arbitrated as a class action or collective action. Any dispute will be arbitrated on an individual basis only. Any claim that all or part of this provision is unenforceable, unconscionable, void or voidable may be determined only by a court of competent jurisdiction and not by an arbitrator. Except with respect to the enforceability, revocability or validity of the class action waiver, only an arbitrator, and not any federal, state, or local court or agency, shall have the exclusive authority to resolve any dispute relating to the interpretation, applicability, enforceability, or formation of this arbitration provision. The arbitrator shall have no power or authority to adjudicate claims or award any remedy on a class or collective basis. MDpanel will pay for any administrative or hearing fees, and any and all fees and costs of the arbitrator and the arbitration, to the extent required by law; otherwise, the Parties will equally split such fees and costs.
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Any notice required or permitted to be sent under these Terms shall be in writing, delivered by any available means to the other Party at its mailing address or email address, and shall be effective upon actual receipt by the addressee.
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Either Party may terminate these Terms upon 30 days’ notice to the other Party. In the event of the expiration or termination of these Terms, any terms that, by their nature, extend beyond expiration or termination, including, but not limited to, terms and conditions related to confidentiality, shall survive such expiration or termination and remain in effect until fulfilled. In the event of expiration or termination, the Parties will reasonably cooperate to ensure a smooth transition for both Parties, as well as other stakeholders such as examinees, clients, payers, and the like. This shall include, without limitation, an obligation to mitigate damages.
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These Panel Terms may not be assigned by You without the prior written consent of MDpanel, and any such assignment is void.