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 5 - QME Reappointment
Section 50 - Reappointment: Requirements and Application Form

Universal Citation: 8 CA Code of Regs 50

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) In addition to the eligibility requirements set forth in section 11, a physician may seek reappointment on the basis that he or she was an active QME on June 30, 2000. For all physicians, applications for reappointment shall include a Reappointment Application Form in section 104, and the appropriate fee under section 17. The reappointment application and the appropriate fee shall be filed at the Administrative Director's headquarters office listed on the reappointment form.

(b) Any Reappointment Application Form may be rejected if it is incomplete or does not contain the required supporting documentation listed in section 11 and on the Reappointment Application Form. As part of the approval of the Reappointment Application Form, the Administrative Director shall verify that the QME has complied with all requirements under this Article.

(c) When a QME applies for reappointment, he or she or they shall submit a statement signed under penalty of perjury:

(1) attesting that he or she or they has completed the applicable QME continuing education requirement; and

(2) listing the dates, locations, and titles of the continuing education programs and the names of the providers of those programs which he or she or they has taken to meet the requirement of Labor Code section 139.2(d)(3), as well as the number of hours of attendance at each program. The Administrative Director may randomly audit QMEs for documentation of program attendance, which supports compliance with this requirement; and

(3) attesting that the physician has accurately reported on the QME SFI Form 124 to the best of the QME's knowledge the information required by section 29 regarding the QME's specified financial interests; and

(4) attesting that the physician's license to practice as a physician, as defined under Labor Code section 3209.3, is neither restricted nor encumbered by suspension or probation, nor has the physician been convicted of a misdemeanor or felony related to the physician's practice or a crime of moral turpitude, and that the physician will notify the Administrative Director if the physician's license to practice is subsequently suspended or placed on probation or if the physician is convicted of a misdemeanor or felony related to the physician's practice or of a crime of moral turpitude; and

(5) attesting that the physician shall abide by all regulations of the Administrative Director and shall refrain from making referrals in violation of those regulations; and

(6) attesting that the physician has not performed a QME evaluation during a time when the physician was not appointed as a QME.

(d) The signature of the QME on the statement required by this subdivision may be an original signature, or an electronic signature as defined in Civil Code section 1633.2, subdivision (h), or a digital signature as defined in Government Code section 16.5. A QME shall not affix an original, electronic or digital signature to the statement referenced in this paragraph without having personally reviewed the content thereof and verified its truth and accuracy.

(e) A QME seeking reappointment must be in compliance with all statutes, duties and regulations relevant to the QME program in order to be reappointed as a QME. Where the Administrative Director determines that there is prima facie evidence of any violation of a statute, duty or regulation that is subject to discipline pursuant to section of Title 865 of Title 8, California Code of Regulations, the Administrative Director may, in his or her discretion, reappoint or deny reappointment to the evaluator. The Administrative Director shall exercise the discretion granted herein with an assessment of the presence and effect of any of the factors of mitigation as well as the factors to be considered in determining penalties contained in section 65.

(f) A QME who has failed to cooperate with an investigation into the evaluator's practice as a QME, which was initiated by the Administrative Director or his or her or their appointees, may be denied reappointment as a QME, at the discretion of the Administrative Director. The Administrative Director shall exercise the discretion granted herein with an assessment of the presence and effect of any of the factors of mitigation as well as the factors to be considered in determining penalties contained in section 65.

(g) At the time of reappointment, along with the reappointment application, the physician shall submit their two most recent medical-legal reports in which there was a face-to-face evaluation and the injured worker was determined to have reached the status of maximum medical Improvement. The physician may submit a statement of explanation in lieu of submitting the two reports only if the physician did not generate two reports in the previous two years that meet this criteria.

Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code.

Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, Labor Code.

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