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 29 - Specified Financial Interests that May Affect Assignment to QME Panels

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every physician
				  seeking appointment or reappointment as a Qualified Medical Evaluator shall
				  disclose specified financial interests, as defined in section
				  1 (dd) and
				  29(b) of Title 8
				  of the California Code of Regulations.
(b) "Specified Financial Interests" means
				  being a general partner or limited partner in, or having an interest of five
				  (5) percent or more in, or receiving or being legally entitled to receive a
				  share of five (5) percent or more of the profits from, any medical practice,
				  group practice, medical group, professional corporation, limited liability
				  corporation, clinic or other entity that provides treatment or medical
				  evaluation, goods or services for use in the California workers' compensation
				  system.
(c) "SFI Form 124", as used
				  in sections
				  1 though 159 of Title 8 of the
				  California Code of Regulations, means the QME SFI Form 124 that is completed
				  and filed as an attachment to QME Form 100, 103 or 104 by the physician or QME
				  with the Medical Director of the Division of Workers' Compensation.
(d) Specified financial interests shall be
				  disclosed on QME SFI Form 124, respectively, when applying for appointment on
				  QME Form 100, at the time of paying the annual fee on QME Form 103 or when
				  applying for reappointment on QME Form 104.
(e) The completed QME SFI Form 124 shall be
				  filed along with the QME Form 100, 103 or 104, respectively, when the form is
				  filed with the Medical Director of the Division of Workers'
				  Compensation.
(f) Failure of a
				  Qualified Medical Evaluator to complete and file a QME SFI Form 124 with the
				  Medical Director when required by this section shall be grounds for
				  disciplinary action pursuant to section
				  60 of Title 8 of the California
				  Code of Regulations.
(g) The
				  Administrative Director shall use the information provided by physicians
				  pursuant to this section to avoid assigning QMEs who share specified financial
				  interests to the same QME panel. If two or more QMEs assigned to a panel share
				  specified financial interests as defined in this section, any party may request
				  a replacement QME. If three QMEs share specified financial interests as defined
				  in this section, two of the QMEs shall be replaced. If two QMEs share specified
				  financial interests as defined in this section, one of the QMEs shall be
				  replaced. The QMEs that must be replaced shall be randomly selected by the
				  Medical Director.
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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2 and
						4067, Labor
						Code.