reglab/statecodes huggingface dataset:
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 10 - QME Application Forms › Section 103 - The QME Fee Assessment Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Change without regulatory effect
					 amending section filed 6-27-2000 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2000, No. 26).
3. Repealer and new section and
					 new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Section
						139.2, Labor
						Code.
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 10 - QME Application Forms › Section 104 - The Reappointment Application as Qualified Medical Evaluator Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Amendment filed 9-6-2001;
					 operative 10-6-2001 (Register 2001, No. 36).
3. Repealer and new
					 section and new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
4. Repealer and new Form 104 filed 9-16-2013; operative
					 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
5. Amendment filed 8-12-2015; operative
					 9-1-2015 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2015, No. 33).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4061.5,
						4062,
						4062.1 and
						4062.2, Labor
						Code; Sections
						1798 et seq., Civil Code; and
						Sections 6250 et seq., Government
						Code.
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 10.5 - QME Process Forms › Section 105 - The Request for Qualified Medical Evaluator Panel - Unrepresented Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
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					 here to view image
NOTE: Forms are available at no charge by downloading from
					 the web at
http://www.dir.ca.gov/dwc/forms.html
or by requesting at 1-800-794-6900.
1. New
					 article 10.5 (sections
					 105-117) and new section filed
					 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior history see
					 Register 94, No. 31.
2. Amendment of section heading, repealer and
					 new section and new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009,
					 No. 3).
3. Amendment of section heading, new QME Form 105a and
					 amendment of informational note filed 12-31-2012 as an emergency; operative
					 1-1-2013 pursuant to Government Code section
					 11346.1(d)
					 (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
					 by 7-1-2013 or emergency language will be repealed by operation of law on the
					 following day.
4. Amendment of section heading, new QME Form 105a
					 and amendment of informational note refiled 7-1-2013 as an emergency; operative
					 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be
					 transmitted to OAL by 9-30-2013 or emergency language will be repealed by
					 operation of law on the following day.
5. Certificate of Compliance
					 as to 7-1-2013 order, including amendment of section heading and repealer and
					 new Form 105, transmitted to OAL 8-2-2013 and filed 9-16-2013; amendments
					 operative 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
6. Change without regulatory effect
					 amending form and explanatory Note filed 11-6-2013 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2013, No. 45).
7. Amendment filed 8-12-2015;
					 operative 9-1-2015 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2015, No. 33).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4061.5,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 106 - The Request for Qualified Medical Evaluator Panel - Represented Form - for Injuries Occurring Prior to January 1, 2005

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
NOTE: Forms 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 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Change without regulatory effect
					 amending section filed 5-2-2002 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2002, No. 18).
3. Amendment of section
					 heading, repealer and new section and new NOTE filed 1-13-2009; operative
					 2-17-2009 (Register 2009, No. 3).
4. Amendment of section heading,
					 new QME Form 106a and amendment of informational note filed 12-31-2012 as an
					 emergency; operative 1-1-2013 pursuant to Government Code section
					 11346.1(d)
					 (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
					 by 7-1-2013 or emergency language will be repealed by operation of law on the
					 following day.
5. Amendment of section heading, new QME Form 106a
					 and amendment of informational note refiled 7-1-2013 as an emergency; operative
					 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be
					 transmitted to OAL by 9-30-2013 or emergency language will be repealed by
					 operation of law on the following day.
6. Certificate of Compliance
					 as to 7-1-2013 order, including amendment of section heading and repealer and
					 new Form 106, transmitted to OAL 8-2-2013 and filed 9-16-2013; amendments
					 operative 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
7. Amendment of section heading and section
					 filed 8-12-2015; operative 9-1-2015 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2015, No. 33).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 107 - The Qualified Medical Evaluator Panel Selection Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Repealer and new section and new
					 NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 108 - The Qualified Medical Evaluator Panel Selection Instruction Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRAIL RELATIONS
DIVISION OF WORKERS' COMPENSATION-MEDICAL
					 UNIT
P.O. Box 71010
Oakland, CA 94612
(510)286-3700 or (800) 794-6900
TO: THE INJURED WORKER
The list of Qualified Medical Evaluators (QMEs) enclosed
					 with this letter is being sent to you because either you or your claims
					 administrator requested a QME panel (list of QMEs). If you have an attorney,
					 contact your attorney. If you do not have an attorney, please take the
					 following steps:
1 Select a QME
				  physician from the list
within ten (10) days of the date the list was
				  issued
(shown at the top of the panel list).
Your claims administrator should not select the QME or try
					 to influence your decision. You may ask your treating physician for assistance,
					 they cannot act as the QME. You have the right to consult with an Information
					 and Assistance Officer at DWC Information and Assistance Unit
					 https://www.dir.ca.gov/dwc/landA.html#landAoffices or 1-800-736-6401.
2 Call the QME's office, listed on
				  the panel form,
within ten (10) days of the date the QME list was
				  issued
by the Medical Unit and make an appointment for an examination.
Tell the office staff for the QME that you are calling for
					 a "QME exam". If you will need an interpreter, tell the QME's office. The staff
					 will ask you for information that you will find at the top of the QME panel
					 list. The examination can occur by agreement at an office location listed with
					 the medical director or by a remote health evaluation in accordance with
					 regulation section
					 46.3. If the QME you call is unable
					 to schedule an appointment within ninety (90) days of the date of your call,
					 the QME's office may
not
suggest another physician in that office
					 to do the QME evaluation. You may:
a
				  agree to wait as long as the QME you selected is able to schedule your
				  appointment within one-hundred twenty (120) days of the date of your first call
				  for an appointment; or
b select a
				  different QME on the panel list.
If you decide to ask for a replacement QME from the Medical
					 Unit, tell the claims administrator to avoid having duplicate requests for
					 replacement QME's. To obtain a replacement panel you will need to complete
					 Replacement Panel Request Form 31.5 and mail your request to the Medical Unit
					 with a copy to your claims examiner. This Form can be found on the DWC website
					 at:
https://www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm31_5.pdf
.
					 If you need assistance requesting a replacement panel contact an Information
					 and Assistance Officer.
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 10.5 - QME Process Forms › Section 109 - The Qualified Medical Evaluator Notice of Unavailability Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Amendment of section heading,
					 repealer and new section and new NOTE filed 1-13-2009; operative 2-17-2009
					 (Register 2009, No. 3).
3. Repealer and new Form 109 filed
					 9-16-2013; operative 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
4. Amendment filed 8-12-2015; operative
					 9-1-2015 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2015, No. 33).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 110 - The Appointment Notification Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior
					 history see Register 94, No. 31.
2. Repealer and new section and new
					 NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
3.
					 Repealer and new Form 110 filed 9-16-2013; operative 9-16-2013 pursuant to
					 Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 111 - The Qualified Medical Evaluator's Findings Summary Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Amendment of section heading, repealer and new section and
					 new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064,
						4067 and
						4660-
						4664, Labor
						Code.
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 10.5 - QME Process Forms › Section 112 - The QME/AME Time Frame Extension Request Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Amendment of section heading, repealer and new section and
					 new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
3. Repealer and new Form 112 filed 9-16-2013; operative
					 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 113 - Notice of Denial of Request for Time Extension Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Amendment of section heading, repealer and new section and
					 new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 114 - The Denial of Time Extension Form. [Reserved]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Repealer filed 1-13-2009; operative 2-17-2009 (Register
					 2009, No. 3).
Note: Authority cited: Sections
						139 and
						139.2, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062 and
						4062.5, Labor
						Code.
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 10.5 - QME Process Forms › Section 115 - The Notice of Late Qualified Medical Evaluator Report Form. [Reserved]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Repealer filed 1-13-2009; operative 2-17-2009 (Register
					 2009, No. 3).
Note: Authority cited: Sections
						139 and
						139.2, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062 and
						4062.5, Labor
						Code.
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 10.5 - QME Process Forms › Section 116 - Notice of Late QME/AME Report - NO Extension Requested Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Amendment of section heading, repealer and new section and
					 new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 117 - Qualified Medical Evaluator Course Evaluation Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
2. Change without regulatory effect amending section filed
					 5-2-2002 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2002, No. 18).
3. Amendment of section
					 heading, repealer and new section and new NOTE filed 1-13-2009; operative
					 2-17-2009 (Register 2009, No. 3).
4. Repealer and new Form 117 filed
					 9-16-2013; operative 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 118 - Application for Accreditation or RE-Accreditation as Education Provider

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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NOTE: Form 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.
1. New
					 section filed 10-16-2000 as an emergency; operative 1-1-2001 (Register 2000,
					 No. 42). A Certificate of Compliance must be transmitted to OAL by 5-1-2001 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. New section refiled 5-2-2001 as an emergency; operative
					 5-2-2001 (Register 2001, No. 18). A Certificate of Compliance must be
					 transmitted to OAL by 8-30-2001 or emergency language will be repealed by
					 operation of law on the following day.
3. Certificate of Compliance
					 as to 5-2-2001 order, including further amendment of section, transmitted to
					 OAL 7-12-2001 and filed 8-23-2001 (Register 2001, No. 34).
4.
					 Repealer and new section and new NOTE filed 1-13-2009; operative 2-17-2009
					 (Register 2009, No. 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 119 - Faculty Disclosure of Commercial Interest

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 10-16-2000 as an emergency; operative 1-1-2001 (Register 2000,
					 No. 42). A Certificate of Compliance must be transmitted to OAL by 5-1-2001 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. New section refiled 5-2-2001 as an emergency; operative
					 5-2-2001 (Register 2001, No. 18). A Certificate of Compliance must be
					 transmitted to OAL by 8-30-2001 or emergency language will be repealed by
					 operation of law on the following day.
3. Certificate of Compliance
					 as to 5-2-2001 order, including further amendment of section, transmitted to
					 OAL 7-12-2001 and filed 8-23-2001 (Register 2001, No. 34).
4.
					 Repealer and new section and new NOTE filed 1-13-2009; operative 2-17-2009
					 (Register 2009, No. 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 120 - Voluntary Directive for Alternate Service of Medical-Legal Evaluation Report on Disputed Injury to Psyche

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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					 here to view image
NOTE: Form 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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 121 - Declaration Regarding Protection of Mental Health Record

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 122 - AME or QME Declaration of Service of Medical-Legal Report

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 123 - QME/AME Conflict of Interest Disclosure and Objection or Waiver by Represented-Parties Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Click
					 here to view image
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4067, Labor
						Code.
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 10.5 - QME Process Forms › Section 124 - Specified Financial Interest Attachment to QME Forms 100, 103 or 104 ("Sfi Form 124")

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any physician who files a QME Form 100 (Application for
					 Appointment), 103 (QME Fee Assessment Form) or 104 (Reappointment Application)
					 with the Administrative Director also shall complete the QME SFI Form 124, in
					 order to disclose specified financial interests that may affect the fairness of
					 QME panels, and append it to the form 100, 103 or 104 being submitted when the
					 form is filed.
Click
					 here to view image
NOTE: Form 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.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						53,
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Section
						139.2, Labor
						Code.
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 10.5 - QME Process Forms › Section 149 - Definitions. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 article 4.5 and section filed 7-8-94; operative 8-8-94 (Register 94, No.
					 27).
2. Change without regulatory effect relocating article 4.5
					 heading and renumbering former section
					 149 to new section
					 49 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Section
						139, Labor
						Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 10.5 - QME Process Forms › Section 149.2 - Neuromusculoskeletal Evaluation. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 7-8-94; operative 8-8-94 (Register 94, No. 27).
2.
					 Change without regulatory effect renumbering former section
					 149.2 to new section
					 49.2 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Sections
						139 and
						139.2(j),
						Labor Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 10.5 - QME Process Forms › Section 149.4 - Cardiovascular Evaluation. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 7-8-94; operative 8-8-94 (Register 94, No. 27).
2.
					 Change without regulatory effect renumbering former section
					 149.4 to new section
					 49.4 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Sections
						139 and
						139.2(j),
						Labor Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 10.5 - QME Process Forms › Section 149.6 - Pulmonary Evaluation. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 7-8-94; operative 8-8-94 (Register 94, No. 27).
2.
					 Change without regulatory effect renumbering former section
					 149.6 to new section
					 49.6 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Sections
						139 and
						139.2(j),
						Labor Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 10.5 - QME Process Forms › Section 149.8 - Psychiatric Evaluation. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 7-8-94; operative 8-8-94 (Register 94, No. 27).
2.
					 Change without regulatory effect renumbering former section
					 149.8 to new section
					 49.8 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Sections
						139 and
						139.2(j),
						Labor Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 10.5 - QME Process Forms › Section 149.9 - Other Evaluation. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 7-8-94; operative 8-8-94 (Register 94, No. 27).
2.
					 Change without regulatory effect renumbering former section
					 149.9 to new section
					 49.9 filed 8-31-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 35).
Note: Authority cited: Sections
						139 and
						139.2(j),
						Labor Code. Reference: Sections
						139,
						139.2 and
						4628, Labor
						Code.
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 15 - Fraudulent or Misleading Advertising › Section 150 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this Article:
(a) Administrative Director -- means the
				  Administrative Director of the Division of Workers' Compensation of the State
				  of California, Department of Industrial Relations, and includes his or her
				  designee.
(b) Advertising copy --
				  includes any "public communication" as defined in Business and Professions Code
				  Section
				  651,
				  or any other communication of any message in any form or medium regarding the
				  availability for professional employment of any physician, which is made by or
				  on behalf of any physician to the general public or any substantial portion
				  thereof.
Advertising concerning medical services regarding
					 industrial injuries or illnesses which benefits any physician, and which is
					 placed by any medical clinic, medical service organization or other
					 non-physician third party shall be deemed advertising copy subject to these
					 regulations.
(c) Medical
				  Board -- means the Medical Board of California as established in Business and
				  Professions Code Section
				  2001.
(d) Medical Director -- means the physician
				  appointed pursuant to Labor Code Section
				  122 or such
				  person as he or she may designate.
(e) Physician -- has the meaning defined in
				  Labor Code Section
				  3209.3.
(f) QME -- means a Qualified Medical
				  Evaluator as defined in Labor Code Section
				  139.2.
1. New
					 article 10 and section filed 3-31-93; operative 4-30-93 (Register 93, No.
					 14).
2. Renumbering of article 10 to article 15 filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
3. New subsection (a),
					 repealer of subsection (b), subsection relettering and amendment of NOTE filed
					 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.4,
						139.45 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						139.4 and
						139.45, Labor
						Code.
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 15 - Fraudulent or Misleading Advertising › Section 151 - Filing of Documents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any document filed under these regulations shall be deemed
					 filed on the date when it is received by the Administrative
					 Director.
1. New
					 section filed 3-31-93; operative 4-30-93 (Register 93, No. 14).
2.
					 Amendment of section and NOTE filed 1-13-2009; operative 2-17-2009 (Register
					 2009, No. 3).
Note: Authority cited: Sections
						133,
						139.4,
						139.45 and
						5307.3, Labor
						Code. Reference: Sections
						133,
						139.4 and
						139.45, Labor
						Code.
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 15 - Fraudulent or Misleading Advertising › Section 152 - Statement of Intent

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Nothing in these regulations is intended to alter the
					 interpretation or application of Business and Professions Code section
					 651.
					 These regulations are promulgated under the authority of Labor Code sections
					 139.4 and
					 139.45 and are
					 intended to reflect the Administrative Director's understanding of the
					 Legislature's intent that the Administrative Director apply a higher and
					 independent standard, pursuant to those Sections, to physician advertising
					 which relates to industrial injuries or illnesses.
1. New
					 section filed 3-31-93; operative 4-30-93 (Register 93, No. 14).
2.
					 Amendment of section and NOTE filed 1-13-2009; operative 2-17-2009 (Register
					 2009, No. 3).
Note: Authority cited: Sections
						133,
						139.4,
						139.45 and
						5307.3, Labor
						Code. Reference: Sections
						28,
						139.4 and
						139.45, Labor
						Code.
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 15 - Fraudulent or Misleading Advertising › Section 154 - Permissible Advertising Content

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A physician subject to these regulations,
				  or any person acting on his or her behalf, may use, disseminate, or cause to be
				  disseminated to the public, or any portion of the public, advertising copy
				  which relates to any industrial injury or illness which accurately states:
(1) The name of each physician affiliated
				  with or participating in the physician's practice.
(2) The address, telephone number and
				  business hours of the office or offices.
(3) The areas of practice each physician
				  engages in.
(4) An individual
				  physician's appointment as a QME. A physician who is not currently certified by
				  the Administrative Director as a Qualified Medical Evaluator may, in a
				  curriculum vitae or descriptive text, state any periods in the past during
				  which the physician was certified as a Qualified Medical Evaluator.
(5) A statement that the physician is Board
				  Certified or limits his or her practice to specific fields as authorized by
				  Business and Professions Code Section
				  651.
				  Any statement of Board Certification shall include the name of the certifying
				  board.
(6) Any languages spoken
				  fluently by the physician or his or her staff.
(7) A description of any diagnostic or
				  therapeutic facilities available.
(8) The availability of surgery or
				  hospitalization on a lien basis.
(9) The usual time frame for scheduling
				  appointments or producing medical reports.
(10) That all billings are made in compliance
				  with the Official Medical Fee Schedule promulgated by the Administrative
				  Director.
(11) Biographic
				  information concerning the physician's educational background, internships and
				  residencies, hospital affiliations, professional affiliations and professional
				  publications.
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 15 - Fraudulent or Misleading Advertising › Section 155 - Filing of Complaints

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Any person may file a complaint with the Medical Director, alleging that any
				  physician is using advertising copy which violates the provisions of Business
				  and Professions Code Section
				  651,
				  or the provisions of these regulations.
(b) Complaints filed with the Medical
				  Director shall be in writing and contain the following:
(1) The full name and address of the party
				  filing the complaint.
(2) The full
				  name and address of the physician against whom the complaint is made, or if the
				  complainant is unable to identify the physician using the advertising, as much
				  information as the complainant can provide to assist the Administrative
				  Director in identifying the physician who used the advertisement.
(3) A copy, if available to the complaining
				  party, of the advertising copy against which the complaint is made, or a
				  description of the medium in which the advertising copy appeared. Such
				  description should contain sufficient details regarding the manner and form in
				  which the advertising copy was published to allow a copy of the advertising
				  copy to be obtained by the Administrative Director.
(4) A detailed statement of the grounds on
				  which the advertising copy is alleged to violate Business and Professions Code
				  Section
				  651
				  or these regulations.
(5) All
				  complaints filed under this section shall be filed with the Medical Director,
				  at Division of Workers' Compensation, P.O. Box 71010, Attention: Medical Unit,
				  Oakland, CA 94612.
(6) Nothing in
				  these regulations shall prevent the Administrative Director or Medical Director
				  from acting independently, and without receipt of a complaint, to initiate an
				  investigation and issue a complaint on the Administrative Director's own motion
				  whenever the Administrative Director or Medical Director has reason to believe
				  that there has been a violation of Business and Professions Code section
				  651
				  or these regulations.
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 15 - Fraudulent or Misleading Advertising › Section 156 - Requests to Review Advertising Copy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Upon receipt of a complaint under Section
				  155 of these regulations, the
				  Administrative Director shall serve a written notice of complaint on the
				  physician against whom the complaint was filed. Such notice shall direct the
				  physician to file a copy of his or her advertising with the Medical Director
				  within 15 working days of the date on which the notice was served.
(b) The Medical Director may take such steps
				  as he or she deems necessary to determine whether the complaint has merit.
(1) The Medical Director shall respond to the
				  complaint within fifteen (15) working days of the Administrative Director's
				  receipt of the physician's response and notify the complainant that the
				  Administrative Director:
(A) will investigate
				  the complaint; or
(B) will require
				  additional time to ascertain whether the complaint has merit; or
(C) will refer a copy of the complaint to
				  another agency which also has jurisdiction over the subject matter of the
				  complaint; or
(D) will take no
				  further action on the complaint because the Administrative Director lacks
				  jurisdiction over the person or conduct complained of; or
(E) will take no further action on the
				  complaint because the allegations of the complaint do not warrant further
				  action by the Administrative Director for the reasons stated in the
				  response.
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 15 - Fraudulent or Misleading Advertising › Section 157 - Determinations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If, after
				  reviewing the physician's advertising copy and the physician's answer to the
				  complaint, the Medical Director determines that the advertising copy violates
				  Business and Professions Code section
				  651,
				  or these regulations and that the physician is currently a Qualified Medical
				  Evaluator, the disciplinary and hearing procedures set forth in sections
				  60 through
				  65 of Title 8 of the California
				  Code of Regulations shall apply. The Medical Director shall forward a copy of
				  any final decision of such violations to the physician's licensing board for
				  such proceedings as that board may deem proper.
(b) If the Medical Director determines that
				  the physician subject to the investigation currently is not a QME, the Medical
				  Director shall forward a copy of the preliminary determination, the complaint,
				  and all supporting documentation to the appropriate physician's licensing board
				  for such proceedings as that board may deem proper.
1. New
					 section filed 3-31-93; operative 4-30-93 (Register 93, No. 14).
2.
					 Amendment of subsections (a) and (b), repealer of subsections (c)-(d)(6) and
					 amendment of NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.4,
						139.45 and
						5307.3, Labor
						Code. Reference: Sections
						139.4 and
						139.45, Labor
						Code.