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 51 - Reappointment and Denial of Reappointment

Universal Citation: 8 CA Code of Regs 51

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

(a) The Administrative Director may deny reappointment to a QME on any one or more of the following grounds:

(1) Any grounds that would provide a basis for suspending or terminating a Physician's privilege to serve as a QME, as specified in paragraphs (1) through (6) of subdivision (k) of Labor Code Section 139.2 or in section 65 of Article 6 of this title.

(2) Failure to comply with the evaluation time frames in sections 34 or 38 on at least three occasions during the calendar year.

(3) Filing notification for unavailability under section 33 for more than 120 calendar days during the calendar year.

(4) On any single occasion, refusing without good cause to perform a medical-legal evaluation. Good cause for not performing a medical-legal evaluation includes but is not limited to the factors in subsections 41(h) and 41(i) of the regulations.

(5) Having had more than five evaluations rejected within a two year period, by a Workers' Compensation Judge or the Appeals Board originally submitted at a contested hearing, subject to the following:
(A) The rejection was based on the failure of the QME's evaluation to prove or disprove a contested issue or failure to comply with regulations adopted by the Administrative Director or the Appeals Board under Title 8 of the California Code of Regulations; and

(B) A finding that rejects an evaluation must be final and the time for appeal must have expired before any rejected evaluation shall be counted as one of the five rejections.

(6) Three or more instances during the most recent period of appointment of billing or charging for medical-legal evaluations, reports or testimony in violation of the Medical-Legal Fee Schedule as set forth in sections 9793-9795 of Article 5.6 in this title.

(7) A finding that the QME violated any order or ruling by a Workers' Compensation Judge or the Appeals Board, provided that the finding is final and the time for appeal has expired.

(8) Performing a QME evaluation or examination without valid QME certification at the time of examining the injured worker or the time of signing the initial or follow-up evaluation report.

(9) Providing false information on or with an application or reapplication for appointment as a QME.

(10) Failing to render expert opinions or conclusions without regard to an injured worker's race, sex, national origin, religion or sexual preference.

(11) Participating in any activity that constitutes a violation of Labor Code Sections 4628, 139.3, or 139.31.

(12) Having violated section 41(a)(5) on three or more occasions during the most recent period of appointment.

(13) Participating in any intentional act that is not a necessary part of the physical examination that causes physical harm or injury to the injured worker.

(14) Failure to notify the Administrative Director within 90 days that the physician's license to practice has been encumbered by suspension or probation by the relevant licensing authority. The 90 days to notify the Administrative Director shall run from the effective date of the order imposing the suspension or probation.

(15) Failure to comply with the continuing education requirements in section 55.

(16) Any grounds that would provide a basis for suspending or terminating a Physician's privilege to participate in the workers' compensation system pursuant to Labor Code section 139.21(a)(1).

(b) Denial of reappointment shall be subject to the notice and appeal procedures in sections 61 and 63.

(c) In lieu of denial, the Administrative Director may reappoint the physician to a probationary status, in accordance with the terms, conditions, and requirements set forth in subsections (b) through (e) of section 62.

Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2(d)(1), 139.3, 139.31 and 4628, Labor Code.

Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Section 139.2(d)(1), Labor Code.

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