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

Current through Register 2024 Notice Reg. No. 28, July 12, 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.