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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure
Section 33 - Unavailability of QME

(a) A QME who will be unavailable to schedule or perform comprehensive medical evaluations as a Panel QME for a period of 14 days, or up to a maximum of 120 days during a calendar year, for any reason shall notify the Medical Director by submitting the form in section 109 (Notice of Qualified Medical Evaluator Unavailability) at least 30 days before the period of unavailability is to begin. The Medical Director may, in his or her or their discretion, grant unavailable status within the 30-day notice period for good cause, including but not limited to medical or family emergency or the QME's inability to schedule any new medical-legal evaluation appointments within 90 days of the initial appointment request because of time commitments related to existing medical-legal evaluation appointments. For purposes of this subsection, a "new medical-legal evaluation appointment" is one that is not currently scheduled at the time that the physician requests unavailability status. Both Comprehensive Medical-Legal Evaluations and Follow-Up Medical-Legal Evaluations are considered new medical-legal evaluation appointments for purposes of this section.

(b) At the time of requesting unavailable status, the QME shall provide the Medical Director with a list of any and all comprehensive medical/legal evaluation examinations already scheduled during the time requested for unavailable status. The QME shall indicate whether each such examination is being rescheduled or the QME plans to complete the exam and report while in unavailable status.

(c) A QME who is unavailable as provided in subdivision (a) shall not perform any new evaluation examinations as a QME until the physician returns to active QME status. Such a QME may complete medical-legal examinations and reports already scheduled and reported to the Medical Director, as well as reports for evaluation examinations performed prior to becoming unavailable under subdivision (a). Such a QME also may complete supplemental reports.

(d) It shall not be an acceptable reason for unavailability that a QME does not intend to perform comprehensive medical-legal evaluations for unrepresented workers. A QME who has filed notifications for unavailability totaling more than one hundred and twenty (120) days during the QME calendar year without good cause may be denied reappointment subject to section 51(a)(3). Good cause includes, but is not limited to, sabbaticals, or death or serious illness of an immediate family member.

(e) If a QME fails to notify the Medical Director, by submitting the form in section 109 (Notice of Qualified Medical Evaluator Unavailability), of his or her or their unavailability at a medical office at least thirty (30) days prior to the period the evaluator becomes unavailable, the Medical Director may designate the QME to be unavailable at that location for thirty (30) days from the date the Medical Director learns of the unavailability.

(f) Whenever the Medical Director is notified by a party seeking an appointment with a Qualified Medical Evaluator, or otherwise becomes aware, that the QME is not available and not responding to calls or mail at a location listed for the QME, a certified letter will be sent to the QME by the Medical Director regarding his/her or their unavailability. If the Medical Director does not receive a response within fifteen (15) days of the date the certified letter is mailed, then the QME will be made unavailable at that location. The time a QME is placed on unavailable status pursuant to this subdivision shall count toward the one hundred and twenty (120) day limit in section 33(a).

NOTE: Form referred to above is 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.