California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 1 - Division of Workers' Compensation - Qualified Medical Evaluator Regulations
Article 2 - QME Eligibility
Section 11 - Eligibility Requirements for Initial Appointment as a QME
Universal Citation: 8 CA Code of Regs 11
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
The Administrative Director shall appoint as QMEs all applicants who meet the requirements set forth in Labor Code Section 139.2(b) and all applicants:
(a) Shall submit the required supporting documentation:
(1) Copy of current license to practice in California;
(2) For Medical Doctors, or Doctors of Osteopathy:
(A) A copy of the applicant's certificate of completion of postgraduate specialty training at an institution recognized by the Accreditation Council for Graduate Medical Education or the osteopathic equivalent as defined pursuant to Section 12, or;
(B) A copy of the applicant's Board certification by a specialty board recognized by the Administrative Director or as defined pursuant to Section 12, or;
(C) A declaration under penalty of perjury accompanied by supporting documentation that the physician has qualifications that the Administrative Director and the Medical Board of California or the Osteopathic Medical Board of California both deem to be equivalent to board certification in a specialty.
(3) If a psychologist, (i) a copy of a doctoral degree in psychology or a doctoral degree deemed equivalent for licensure by the Board of Psychology pursuant to Section 2914 of the Business and Professions Code, and has not had less than five years postdoctoral experience in the treatment of emotional and mental disorders or (ii) served as an AME on eight or more occasions prior to January 1, 1990 and has not less than five years postdoctoral experience in the diagnosis and treatment of emotional and mental disorders.
(4) For Doctors of Chiropractic, the physician shall provide a copy of a current or otherwise valid certificate in California Workers Compensation Evaluation by either a California professional chiropractic association or an accredited California college recognized by the Administrative Director (i.e. Workers' Compensation Evaluation Certificate with a minimum 25 hours completed). For purposes of this subsection, a current or otherwise valid certificate in California Workers Compensation Evaluation is one that has been obtained within the three years prior to the current application to become certified as a QME.
(5) Or, for other physicians, a copy of the physician's professional diploma.
(b)
(1) Shall, prior to appointment as a QME, complete a course of at least sixteen (16) hours in disability evaluation report writing pursuant to section 11.5 of this Article. Doctors of Chiropractic who submit documentation showing compliance with section 11(a)(4) are exempt from this requirement; and
(2) Shall accurately and fully report on the SFI Form 124 attached to the application (QME Form 100) to the best of the applicant's knowledge the information required by section of Title 829 of Title 8 of the California Code of Regulations, regarding applicant's specified financial interests.
(c) Shall provide supplemental information and/or documentation to the Administrative Director after an application, QME Form 100 (see, 8 Cal. Code Regs. § 100), is submitted if requested to verify an applicant's eligibility for appointment.
(d) Shall agree that during a QME evaluation exam he, she or they will not treat or offer or solicit to provide medical treatment for that injury for which he, she or they have done a QME evaluation for an injured worker unless a medical emergency arises as defined under subdivision (a) or (b) of section 1317.1 of the Health and Safety Code. A QME may also provide treatment if requested by the employee pursuant to section 4600 of the Labor Code, but he, she or they shall not offer or solicit to provide it. A QME who solicits an injured worker to receive direct medical treatment or to become the primary treating physician of that employee shall be subject to disciplinary action pursuant to section 60.
(e) Shall declare under penalty of perjury on the QME application that he, she or they:
(1) Has an unrestricted California license and is not currently on probation from the state licensing board, or, if the applicant has a California restricted license or is currently on probation, state all the restrictions on the license and all terms of probation; and
(2) Devotes at least one-third of his, her or their total practice time to providing direct medical treatment during each year of the applicant's term of appointment. This requirement shall not apply if the applicant qualifies for appointment because the applicant served as an AME on 8 or more occasions in the year prior to application and in each year of the applicant's term; or if the applicant meets the requirements of section 15; and
(3) Has not performed a QME evaluation without QME certification;
(4) Has accurately and fully reported on QME Form 124 to the best of the applicant's knowledge the specified financial interest information required by section of Title 829 of Title 8 of the California Code of Regulations.
(f) Shall pass the QME Competency Examination, or if an acupuncturist, shall pass the QME Competency Examination for acupuncturists.
(1) In order to take this examination, a physician who is not currently appointed as a QME and not exempt pursuant to Labor Code section 139(b)(1), shall be considered to have applied to take the QME competency examination upon submitting the properly-completed Application for Appointment Form in Section 100 (see, 8 Cal. Code Regs. section 100), and the Registration Form for the QME Competency Examination in section 102 (see, 8 Cal. Code Regs. §
102) and the appropriate fee as specified in section 11(f)(2).
(2) The fee for applying to take or retake the QME competency examination is $ 125.00 and may be waived by the Administrative Director at his, her or their discretion for first time applicants.
(3) The Administrative Director shall give appropriate public notice of the date, time and location of the examination no fewer than sixty (60) calendar days before a competency examination is to be given.
(4) An applicant must submit the properly completed forms as required in section 11(f)(1) to the Administrative Director at least forty-five (45) calendar days prior to the date of the next scheduled competency examination unless the Administrative Director finds good cause to grant an extension to the physician(s).
(5) The Administrative Director shall inform the applicant in writing whether he, she or they shall be allowed to take the examination within fifteen (15) calendar days from the date the Administrative Director receives the properly-completed forms and appropriate fee.
(6) The Administrative Director shall inform the applicant in writing whether or not he, she or they passed the examination within sixty (60) calendar days from the date the applicant takes the competency examination.
(7) An applicant who passes the QME competency examination shall file the QME Fee Assessment Form in Section 103 (see, 8 Cal. Code Regs. section 103) including the appropriate fee within thirty (30) days of the date of the notice. The physician shall not be appointed to the official QME list until the appropriate fee is paid and has completed a disability evaluation report writing course pursuant to section 11.5. Appointments shall be for two-year terms beginning with the date of appointment by the Administrative Director.
(8) Any applicant, who upon good cause shown by the test administrator, is suspected of cheating may be disqualified from the examination and, upon a finding that the applicant did cheat in that exam, the applicant will be denied further admittance to any QME examination for a period of at least five years thereafter. Any applicant who fails to follow test instructions and/or proctor instructions either before or during or at the conclusion of an examination shall be disqualified from the examination procedure and the applicant's exam shall be nullified.
(9) If an applicant fails the competency examination or fails to appear for a noticed QME examination for which the applicant has submitted a QME Exam Registration Form 102 (see, 8 Cal. Code Regs. §
102), the applicant may apply to take any subsequent examinations, upon submission of a new test application form and a fee of $125. An applicant who fails the exam three times shall show proof of having completed six (6) hours continuing education from a course approved by the Administrative Director prior to taking the examination again.
(10) Any applicant who receives a failing grade on a competency exam may appeal the failing grade to the Administrative Director. Appeals shall be considered on a case by case basis. Appeals will be accepted immediately after a candidate has completed the examination and until ten (10) days after the date of the examination results letter. The appeal shall state specific facts as to why the failing grade should be overturned. Pursuant to Section 6254(g) of the Government Code, the Administrative Director will consider appeals of test questions and will base his, her or their decision solely on the written appeal including any supporting documentation submitted by the physician. Appeals will only be accepted for the current examination period. Grounds for appeal are:
(A) Significant procedural error in the examination process;
(B) Unfair Discrimination;
(C) Bias or fraud.
(g) Each applicant shall pay the annual fee required by section 17 of this Article prior to appointment.
(h) Shall, prior to appointment as a QME, complete a course of at least two (2) hours in anti-bias training. The course shall include the following:
(1) Instruction designed to increase awareness and understanding of differences in human experience, as well as awareness of implicit or unconscious bias, stereotyping, and discrimination, and the ways in which unconscious bias can unintentionally impact perceptions and decision-making, including in medical evaluations and reporting, and lead to disparities in health care strategies, to help eliminate or reduce implicit bias in medical evaluations and reporting.
(2) At least one example of potential gender bias in a fictitious QME evaluation in which an apportionment rating is made based on an assumption about a risk factor related solely to the injured worker's gender.
(3) At least one example relating to an evaluation and rating of permanent disability resulting from industrial breast cancer, taking into account the ways in which gender bias could potentially impact an assessment of the impairment that results from breast cancer and its treatment.
(4) The course shall include a post-course examination based on the program material. Credit for the course may be given only for a passing rate of no lower than 70 percent correct responses. The administrative director may audit physicians' examinations and scores.
NOTE: Forms referred to above are available at no charge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.
Note: Authority cited: Sections 133, 139.2, 4060, 4062 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code; and Section 6254, Government Code.
Note: Authority cited: Sections 133, 139.2, 4060, 4062 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code; and Section 6254, Government Code.
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