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 1 - General › Section 1 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in the regulations in Chapter 1:
(a) "Accreditation" means the conferring of
				  recognized status as a provider of physician education by the Administrative
				  Director.
(b) "Administrative
				  Director" means the administrative director of the Division of Workers'
				  Compensation of the State of California Department of Industrial Relations, and
				  includes his, her or their designee.
(c) "Agreed Panel QME" means the Qualified
				  Medical Evaluator described in Labor Code section
				  4062.2(c),
				  that the claims administrator, or if none the employer, and a represented
				  employee agree upon and select from a QME panel list issued by the Medical
				  Director prior to January 1, 2013, without using the striking process. An
				  Agreed Panel QME shall be entitled to be paid at the same rate as an Agreed
				  Medical Evaluator under section
				  of Title
				  89795 of Title 8 of the California Code of
				  Regulations for medical/legal evaluation procedures and medical testimony. The
				  provisions of this subdivision related to "Agreed Panel QME" do not apply to
				  panel lists issued after January 1, 2013.
(d) "AMA Guides" means American Medical
				  Association, Guides to the Evaluation of Permanent Impairment [Fifth
				  Edition].
(e) "AME" means Agreed
				  Medical Evaluator, a physician selected by agreement between the claims
				  administrator, or if none the employer, and a represented employee to resolve
				  disputed medical issues referred by the parties in a workers' compensation
				  proceeding.
(f) "Appeals Board"
				  means the Workers' Compensation Appeals Board within the State of California
				  Department of Industrial Relations.
(g) "Audit" means a formal evaluation of a
				  continuing education program, disability evaluation report writing course, or
				  an accredited education provider which is conducted at the request of the
				  Medical Director.
(h)
				  "Comprehensive Medical-Legal Evaluation" means a medical evaluation performed
				  pursuant to Labor Code Sections
				  4060,
				  4061,
				  4062,
				  4062.1,
				  4062.2 or
				  4067 and
				  meeting the requirements of section
				  of Title
				  89793(c) of Title 8 of the
				  California Code of Regulations.
(i)
				  "Claims Administrator" means the person or entity responsible for the payment
				  of compensation for any of the following: a self-administered insurer providing
				  security for the payment of compensation required by Divisions 4 and 4.5 of the
				  Labor Code, a self-administered self-insured employer, a group self-insurer, an
				  insured employer, the director of the Department of Industrial Relations as
				  administrator for the Uninsured Employers Benefits Trust Fund (UEBTF) and for
				  the Subsequent Injuries Benefit Trust Fund (SIBTF), a third-party claims
				  administrator for a self-insured employer, insurer, legally uninsured employer,
				  group self-insurer, or joint powers authority, and the California Insurance
				  Guarantee Association (CIGA). The UEBTF shall only be subject to these
				  regulations after proper service has been made on the uninsured employer and
				  the Appeals Board has obtained jurisdiction over the UEBTF by joinder as a
				  party.
(j) "Continuing Education
				  Program" means a systematic learning experience (such as a course, seminar, or
				  audiovisual or computer learning program) which serves to develop, maintain, or
				  increase the knowledge, skills and professional performance of physicians who
				  serve as Qualified Medical Evaluators in the California workers' compensation
				  system.
(k) "Course" means the 16
				  hours of instruction in disability evaluation report writing which is required
				  of a Qualified Medical Evaluator prior to appointment. A course must be
				  approved by the Administrative Director.
(l) "Credit Hour" means a sixty minute hour.
				  A credit hour may include time for questions and answers related to the
				  presentation.
(m) "Direct medical
				  treatment" means that special phase of the physician-patient relationship
				  during which the physician:
(1) attempts to
				  clinically diagnose and to alter or modify the expression of a non-industrial
				  illness, injury or pathological condition; or
(2) attempts to cure or relieve the effects
				  of an industrial injury.