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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 30.2 - The Request for Qualified Medical Evaluator Instruction Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Change without regulatory effect amending thrid paragraph filed 2-25-97
					 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 97, No. 9).
3. Repealer filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
4. Editorial correction
					 reinstating inadvertently deleted section (Register 2013, No.
					 44).
Note: Authority cited: Sections
						4061 and
						4062, Labor
						Code. Reference: Sections
						4061 and
						4062, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 30.5 - Specialist Designation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Medical Director shall utilize in the QME panel
					 selection process the type of specialist(s) indicated by the requestor online
					 or on the Request for Qualified Medical Evaluator Form 105 or 106 of Title 8 of
					 the California Code of Regulations, unless otherwise provided in these
					 regulations.
1.
					 Renumbering and amendment of former section
					 32 to new section
					 30.5 filed 4-14-2000; operative
					 5-14-2000 (Register 2000, No. 15).
2. Amendment of section and NOTE
					 filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
3.
					 Editorial correction reinstating inadvertently deleted section (Register 2013,
					 No. 44).
4. Amendment of section and NOTE 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
						133,
						139.2,
						4061,
						4062 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 31 - QME Panel Selection

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The panels shall be selected randomly
				  from the appropriate specialty identified by the party who holds the legal
				  right to designate the specialty, with consideration given to the proximity of
				  the QME's medical office to the employee's residence.
(b) The Medical Director shall exclude from
				  the panel selection process any QME who has informed the Medical Director that
				  he or she is unavailable pursuant to section
				  33 of Title 8 of the California
				  Code of Regulations.
(c) Any
				  physician who has served as a primary treating physician or secondary physician
				  and who has provided treatment to the employee in accordance with section
				  9785 of Title 8 of the California
				  Code of Regulations for the disputed injury shall not perform a QME evaluation
				  on that employee. Whenever that physician's name appears on a QME panel, he or
				  she shall disqualify him or herself if contacted by a party to perform the
				  evaluation. Either party may request a replacement QME for this reason pursuant
				  to section 31.5 of Title 8 of the California
				  Code of Regulations.
(d) To issue a
				  panel in a selected specialty there shall be at least five active QMEs in the
				  specialty at the time the panel selection is requested. In the event less than
				  five QMEs are active in a requested specialty, the Medical Director shall
				  contact the party who holds the legal right to designate the specialty for an
				  alternate specialty selection.
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Repealer of subsection (d) and subsection relettering, and amendment of newly
					 designated subsection (d) filed 8-23-96; operative 9-22-96 (Register 96, No.
					 34).
3. Amendment of subsections (b) and (d) filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
4. Amendment of section
					 and NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
5. Editorial correction reinstating inadvertently deleted
					 section (Register 2013, No. 44).
Note: Authority cited: Sections
						133,
						139.2,
						4061,
						4062 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 31.1 - QME Panel Selection Disputes in Represented Cases

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Disputes regarding the validity of panel
				  requests shall be resolved by a Workers' Compensation Administrative Law
				  Judge.
(b) Disputes regarding the
				  appropriateness of the specialty designated shall be resolved pursuant to
				  section 31.5(a)(10) of
				  Title 8 of the California Code of Regulations. Either party may appeal the
				  Medical Director's decision as to the appropriateness of the specialty to a
				  Workers' Compensation Administrative Law Judge.
(c) In the event the Medical Director is
				  unable to issue a QME panel in a represented case within thirty (30) calendar
				  days of receiving the request, either party may seek an order from a Workers'
				  Compensation Administrative Law Judge that a QME panel be issued. Any such
				  order shall specify the specialty of the QME panel or the party to be
				  designated to select the specialty.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3). For prior
					 history, see Register 2000, No. 15.
2. Editorial correction
					 reinstating inadvertently deleted section (Register 2013, No.
					 44).
3. 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
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						4060,
						4061,
						4062,
						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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 31.2 - QME Office Locations. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section 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. For prior history, see Register 2000, No. 15.
2. New
					 section 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.
3. Certificate of Compliance as to 7-1-2013 order, including
					 repealer of section, transmitted to OAL 8-2-2013 and filed 9-16-2013; repealer
					 operative 9-16-2013 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2013, No. 38).
Note: Authority cited: Sections
						133,
						139.2 and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4062.5 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 31.7 - Obtaining Additional QME Panel in a Different Specialty

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Once
				  an Agreed Medical Evaluator, an Agreed Panel QME, or a panel Qualified Medical
				  Evaluator has issued a comprehensive medical-legal report in a case and a new
				  medical dispute arises, the parties, to the extent possible, shall obtain a
				  follow-up evaluation or a supplemental evaluation from the same
				  evaluator.
(b) Upon a showing of
				  good cause that a panel of QME physicians in a different specialty is needed to
				  assist the parties reach an expeditious and just resolution of disputed medical
				  issues in the case, the Medical Director shall issue an additional panel of QME
				  physicians selected at random in the specialty requested. For the purpose of
				  this section, good cause means:
(1) A written
				  agreement by the parties in a represented case that there is a need for an
				  additional comprehensive medical-legal report by an evaluator in a different
				  specialty and the specialty that the parties have agreed upon for the
				  additional evaluation; or
(2) Where
				  an acupuncturist has referred the parties to the Medical Unit to receive an
				  additional panel because disability is in dispute in the matter; or
(3) An order by a Workers' Compensation
				  Administrative Law Judge for a panel of QME physicians that also either
				  designates a party to select the specialty or states the specialty to be
				  selected and the residential or employment-based zip code from which to
				  randomly select evaluators; or
(4)
				  In an unrepresented case, that the parties have conferred with an Information
				  and Assistance Officer, have explained the need for an additional QME evaluator
				  in another specialty to address disputed issues and, as noted by the
				  Information and Assistance Officer on the panel request form, the parties have
				  reached agreement in the presence of and with the assistance of the Officer on
				  the specialty requested for the additional QME panel. The parties may confer
				  with the Information and Assistance Officer in person or by conference
				  call.
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 32 - Acupuncture Referrals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  In any case where an acupuncturist has been selected by the injured worker from
				  a three-member panel and an issue of disability is in dispute, the
				  acupuncturist shall notify the parties to the examination that another
				  specialty is required to determine disability and refer the parties to the
				  Medical Unit to request an additional panel pursuant to section
				  31.7(b) (2). The
				  acupuncturist shall evaluate all other issues as required for a complete
				  evaluation.
(b) Except as provided
				  in subdivision
				  32(a) above, no
				  QME may obtain a consultation for the purpose of obtaining an opinion regarding
				  permanent disability and apportionment consistent with the requirements of
				  Labor Code sections
				  4660 through
				  4664 and the
				  AMA Guides.
NOTE: Form referred to above 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 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Renumbering of former section
					 32 to new section
					 30.5 and renumbering and amendment
					 of former section
					 32.5 to section
					 32 filed 4-14-2000; operative
					 5-14-2000 (Register 2000, No. 15).
3. Amendment of section and NOTE
					 filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
4.
					 Amendment of section heading and section 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
						133,
						139.2,
						4061,
						4062,
						4064,
						5307.3 and
						5703.5, Labor
						Code. Reference: Sections
						3209.3,
						4061,
						4062,
						4062.1,
						4062.2,
						4064,
						4067 and
						5703.5, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 32.5 - Reserved

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
2.
					 Renumbering of former section
					 32.5 to section
					 32 and renumbering and amendment of
					 former section
					 32.7 to section
					 32.5 filed 4-14-2000; operative
					 5-14-2000 (Register 2000, No. 15).
3. Repealer filed 1-13-2009;
					 operative 2-17-2009 (Register 2009, No. 3).
Note: Authority cited: Sections
						139.2,
						4061,
						4062 and
						4064, Labor
						Code. Reference: Sections
						4061 and
						4062, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 32.6 - Additional QME Evaluations Ordered by the Appeals Board

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Medical Director shall issue a panel of Qualified
					 Medical Evaluators upon receipt of an order of a Workers' Compensation
					 Administrative Law Judge or the Appeals Board, that includes a finding that an
					 additional evaluation is reasonable and necessary to resolve disputed issues
					 under Labor Code sections
					 4060,
					 4061 or
					 4062. The order
					 shall specify the residential or employment-based zip code from which to
					 randomly select evaluators, specify the specialty for the QME panel or
					 designate the party who shall select the specialty of the QME panel, and
					 specify who shall select a new specialty in the event there are too few QMEs in
					 the specialty initially selected to issue a panel in accordance with section
					 31(d) of Title 8
					 of the California Code of Regulations.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.2,
						4061,
						4062,
						4064,
						5307.3,
						5703 and
						5703.5, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2 and
						4064, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 32.7 - Rebuttal QME Examinations. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
2.
					 Renumbering of former section
					 32.7 to section
					 32.5 filed 4-14-2000; operative
					 5-14-2000 (Register 2000, No. 15).
Note: Authority cited: Sections
						139.2,
						4061 and
						4062, Labor
						Code. Reference: Sections
						4061 and
						4064, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 33.1 - The Notice of QME Unavailability Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Amendment of section heading, repealer and new section filed 8-23-96; operative
					 9-22-96 (Register 96, No. 34).
3. Repealer filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
Note: Authority cited: Sections
						139 and
						139.2, Labor
						Code. Reference: Sections
						139.2,
						4061 and
						4062, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 34.1 - The Appointment Notification Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Repealer filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
Note: Authority cited: Sections
						139 and
						139.2, Labor
						Code. Reference: Sections
						139.2,
						4061 and
						4062, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 35 - Exchange of Information and Ex Parte Communications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The claims
				  administrator, or if none the employer, shall provide, and the injured worker
				  may provide, the following information to the evaluator, whether an AME or QME:
(1) All records prepared or maintained by the
				  employee's treating physician or physicians;
(2) Other medical records, including any
				  previous treatment records or information, which are relevant to determination
				  of the medical issue(s) in dispute;
(3) A letter outlining the medical
				  determination of the primary treating physician or the compensability issue(s)
				  that the evaluator is requested to address in the evaluation, which shall be
				  served on the opposing party no less than 20 days in advance of the
				  evaluation;
(4) Where the
				  evaluation is for injuries that occurred before January 1, 2013, concerning a
				  dispute over a utilization review decision if the decision is communicated to
				  the requesting physician on or before June 30, 2013, whenever the treating
				  physician's recommended medical treatment is disputed, a copy of the treating
				  physician's report recommending the medical treatment with all supporting
				  documents, a copy of claims administrator's, or if none the employer's,
				  decision to approve, delay, deny or modify the disputed treatment with the
				  documents supporting the decision, and all other relevant communications about
				  the disputed treatment exchanged during the utilization review process required
				  by Labor Code section
				  4610;
(5) Non-medical records, including films and
				  videotapes, which are relevant to determination of medical issue(s) in dispute,
				  after compliance with subdivision of Title 835(c) of Title 8 of the California
				  Code of 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 35.5 - Compliance by AMEs and QMEs with Administrative Director Evaluation and Reporting Guidelines

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each
				  evaluation examination and report completed pursuant to Labor Code sections
				  4060,
				  4061,
				  4062,
				  4062.1,
				  4062.2,
				  4064,
				  4067 or
				  5703.5 shall be
				  performed in compliance with all appropriate evaluation procedures pursuant to
				  this Chapter.
(b) Each reporting
				  evaluator shall state in the body of the comprehensive medical-legal report the
				  date the examination was completed and the street address at which the
				  examination was performed. If the evaluator signs the report on any date other
				  than the date the examination was completed, the evaluator shall enter the date
				  the report is signed next to or near the signature on the report.
(c)
(1) The
				  evaluator shall address all contested medical issues arising from all injuries
				  reported on one or more claim forms prior to the date of the employee's
				  appointment with the medical evaluator that are issues within the evaluator's
				  scope of practice and areas of clinical competence. The reporting evaluator
				  shall attempt to address each question raised by each party in the issue cover
				  letter sent to the evaluator as provided in subdivision
				  35(a)(3).
(2) If the evaluator declares the injured
				  worker permanent and stationary for the body part evaluated and the evaluator
				  finds injury has caused permanent partial disability, the evaluator shall
				  complete the Physician's Report of Permanent and Stationary Status and Work
				  Capacity (DWC-AD Form 10133.36) and serve it on the claims administrator
				  together with the medical report.
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 36 - Service of Comprehensive Medical-Legal Evaluation Reports by Medical Evaluators Including Reports Under Labor Code Section 4061

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1)
				  Whenever an injured worker is represented by an attorney, the evaluator shall
				  serve each comprehensive medical-legal evaluation report, follow-up
				  comprehensive medical-legal evaluation report and supplemental evaluation
				  report on the injured worker, his or her attorney and on the claims
				  administrator, or if none the employer, by completing QME Form 122 (AME or QME
				  Declaration of Service of Medical-Legal Report Form)(See, 8 Cal. Code Regs.
				  §
											122) and attaching QME Form 122 to
				  the report, unless section
				  36.5 of Title 8 of the California
				  Code of Regulations applies.
(2) If
				  applicable in a claim involving disputed injury to the psyche, the evaluator
				  shall comply with the requirements of section
				  36.5 of Title 8 of the California
				  Code of Regulations (Service of Comprehensive Medical-Legal Report in Claims of
				  Injury to the Psyche)(See, 8 Cal. Code Regs. §§
											36.5,
				  120 and
				  121).
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 36.1 - The Qualified or Agreed Medical Evaluator's Findings Summary Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Change without regulatory effect amending section filed 11-9-94 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 94, No. 45).
3. Amendment of section filed
					 8-23-96; operative 9-22-96 (Register 96, No. 34).
4. Repealer filed
					 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
Note: Authority cited: Sections
						139,
						139.2,
						4061 and
						4062, Labor
						Code. Reference: Sections
						139.2,
						4061 and
						4062, 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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 36.7 - Electronic Service of Medical-Legal Reports by Medical Evaluators

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A Qualified
				  Medical Evaluation or Agreed Medical Evaluation report, or other medical-legal
				  report and required documents may be served electronically as follows:
(1) For purposes of this section:
(A) "Electronic service" means service of the
				  medical-legal report and all documents required by section
				  36, on a party or other person, by
				  either electronic transmission or electronic notification. Electronic service
				  may be performed directly by the physician or by an agent of the physician, or
				  through an electronic service provider.
(B) "Electronic transmission" means the
				  transmission of a document by electronic means to the electronic service
				  address at or through which a party or other person has authorized electronic
				  service.
(C) "Electronic
				  notification" means the notification of the party or other person that a
				  document is served by sending an electronic message to the electronic address
				  at or through which the party or other person has authorized electronic
				  service, specifying the exact name of the document served, and providing a
				  hyperlink at which the served document may be viewed and
				  downloaded.
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 38 - Medical Evaluation Time Frames; Extensions for QMEs and Ames

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The time frame for an initial or a
				  follow-up comprehensive medical-legal evaluation report to be prepared and
				  submitted shall not exceed thirty (30) days after the QME, Agreed Panel QME or
				  AME has seen the employee or otherwise commenced the comprehensive
				  medical-legal evaluation procedure.
(b) If an evaluator fails to prepare and
				  serve the initial or follow-up comprehensive medical-legal evaluation report
				  within thirty (30) days and the evaluator has failed to obtain approval from
				  the Medical Director for an extension of time pursuant to this section, the
				  employee or the employer may request a QME replacement pursuant to section
				  31.5 of Title 8 of the California
				  Code of Regulations. Neither the employee nor the employer shall have any
				  liability for payment for the medical evaluation which was not completed within
				  the timeframes required under this section unless the employee and the employer
				  each waive the right to a new evaluation and elect to accept the original
				  evaluation, in writing or by signing and returning to the Medical Director
				  either QME Form 113 (Notice of Denial of Request For Time Extension) or QME
				  Form 116 (Notice of Late QME/AME Report - No Extension Requested) (See, 8 Cal.
				  Code Regs. §§
										113 and
				  116).
(c) All requests by an evaluator for
				  extensions of time shall be made on form 112 (QME/AME Time Frame Extension
				  Request) (See, 8 Cal. Code Regs. §
										112). If the evaluation will not be
				  completed on the original due date, the evaluator may request an extension from
				  the Medical Director, not to exceed an additional 30 days. An extension of the
				  time for completing the report shall be approved, as follows:
(1) When the evaluator has not received test
				  results or the report of a consulting physician, necessary to address all
				  disputed medical issues in time to meet the initial 30-day deadline, an
				  extension of up to thirty (30) days shall be granted;
(2) When the evaluator has good cause, as
				  defined in Labor Code section
				  139.2(j)(1)(B),
				  an extension of fifteen (15) days shall be granted.
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 38.1 - The QME and AME Time Frame Extension Request Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Change without regulatory effect amending form filed 4-2-96 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 96, No. 14).
3. Repealer filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 38.2 - "The Time Extension Approval" Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Change without regulatory effect amending section filed 3-28-96 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 96, No. 13).
3. Repealer filed 4-14-2000;
					 operative 5-14-2000 (Register 2000, No. 15).
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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 38.3 - The "Denial of Time Extension" Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Amendment of section heading and repealer and new section filed 8-23-96;
					 operative 9-22-96 (Register 96, No. 34).
3. Repealer filed
					 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 38.4 - The "Notice of Late QME Report" Form. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Repealer filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 39 - Destruction of Records by the Medical Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Medical Director may destroy any forms filed pursuant
					 to these regulations five years after the date of receipt, provided that the
					 completed "Application for Appointment as Qualified Medical Evaluator" form
					 shall be preserved for each QME during the period(s) of his or her appointment
					 as a QME. The "Request for Qualified Medical Evaluator" forms may be destroyed
					 by the Medical Director two years after the date of receipt.
1. New
					 section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
					 Amendment of section heading, section and NOTE 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 and
						4062, Labor
						Code; and Section
						14755,
						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 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 39.5 - Retention of Records by QMEs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All QMEs shall retain a copy of all
				  comprehensive medical-legal reports completed by the QME for a period of five
				  years from the date of each evaluation report. A QME may satisfy this
				  requirement by retaining only an electronic copy of the report, as long as the
				  electronic copy retained is a true and correct copy of the original, showing
				  the QME signature, that was served on the parties. Upon written request, a QME
				  is required to return original radiological films, imaging studies and original
				  medical records to the person who supplied the original records to the QME or
				  to the injured worker.
(b) An
				  evaluator shall submit all comprehensive medical/legal reports performed as a
				  QME under this article to the Medical Director upon request for a review by the
				  Medical Director. Failure to submit evaluations upon request by the Medical
				  Director may constitute grounds for disciplinary action pursuant to Section
				  60.
1. New
					 section filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
2.
					 Amendment filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
3. Amendment of section heading, section and NOTE filed
					 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.2(j)(1)
						and
						5307.3, Labor
						Code. Reference: Sections
						139.2,
						4060,
						4061,
						4062,
						4062.1,
						4062.2,
						4064 and
						4062.5, Labor
						Code; and Section
						14755,
						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 4 - Evaluation Procedures › Section 40 - Disclosure Requirements: Injured Workers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An evaluator selected from a QME panel
				  shall advise an injured worker prior to or at the time of the actual evaluation
				  of the following:
(1) That he or she is
				  entitled to ask the evaluator and the evaluator shall promptly answer questions
				  about any matter concerning the evaluation process in which the QME and the
				  injured worker are involved;
(2)
				  That subject to section
				  41(g), the injured
				  worker may discontinue the evaluation based on good cause. Good cause includes:
(A) discriminatory conduct by the evaluator
				  towards the worker based on race, sex, national origin, religion, or sexual
				  preference,
(B) abusive, hostile or
				  rude behavior including behavior that clearly demonstrates a bias against
				  injured workers, and
(C) instances
				  where the evaluator requests the worker to submit to an unnecessary exam or
				  procedure.
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 4 - Evaluation Procedures › Section 41 - Ethical Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  All QMEs, regardless of whether the injured worker is represented by an
				  attorney, shall:
(1) Maintain a clean,
				  professional physician's office (as defined in section
				  1(y) at all times
				  which shall contain functioning medical instruments and equipment appropriate
				  to conducting the evaluation within the physician's scope of practice and a
				  functioning business office phone with the phone number listed with the Medical
				  Director for that location which a party may use to schedule an examination or
				  to handle other matters related to a comprehensive medical/legal
				  evaluation.
(2) Schedule all
				  appointments for comprehensive medical-legal evaluations without regard to
				  whether a worker is unrepresented or represented by an attorney. A QME shall
				  not refuse to schedule an appointment with an injured worker solely because the
				  worker is not represented by an attorney or because a promise to reimburse or
				  reimbursement is not made prior to the evaluation.
(3) Not request the employee to submit to an
				  unnecessary exam or procedure.
(4)
				  Refrain from treating or soliciting to provide medical treatment, medical
				  supplies or medical devices to the injured worker.
(5) Communicate with the injured worker in a
				  respectful, courteous and professional manner.
(6) Refrain from violating section
				  41.5 of Title 8 of the California
				  Code of Regulations.
(7) Refrain
				  from unilaterally rescheduling a panel QME examination more than two times in
				  the same case.
(8) Refrain from
				  cancelling a QME examination less than six (6) business days from the date the
				  exam is scheduled without good cause and without providing a new examination
				  date within thirty (30) calendar days of the date of
				  cancellation.
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 4 - Evaluation Procedures › Section 41.5 - Conflicts of Interest by Medical Evaluators

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An evaluator shall not request or accept
				  any compensation or other thing of value from any source that does or could
				  create a conflict with his or her duties as an evaluator under the Labor Code
				  or the regulations of the Administrative Director (Title 8 of the California
				  Code of Regulations, Chapters 1 through 1.8, section
				  1 et seq) or of the Workers'
				  Compensation Appeals Board (Title 8 of the California Code of Regulations,
				  Chapters 1.9, sections
				  10600 through
				  10727).
(b) A conflict with the duties of an
				  evaluator as used in Labor Code section
				  139.2(o)
				  means having a disqualifying conflict of interest with one or more of the
				  persons or entities described in subdivision (c) and failing to disclose the
				  fact of the conflict.
(c) The
				  persons or entities with whom a disqualifying conflict of interest can exist
				  are:
(1) The injured worker, or his or her
				  attorney;
(2) The employer, or the
				  employer's attorney;
(3) The claims
				  adjuster or insurer or third party administrator, or their attorney,
				  respectively;
(4) Any primary
				  treating physician or secondary physician for the employee, if the treatment
				  provided by that physician is disputed in the case;
(5) The utilization review physician reviewer
				  or expert reviewer, or utilization review organization, only if the opinion of
				  that reviewer or that utilization review organization is disputed in the
				  case;
(6) The surgical center in
				  which the injured worker had, or is proposed to be used to have, surgery, only
				  if the need for surgery is disputed in the case.
(7) Other purveyor of medical goods or
				  medical services, only if the medical necessity for using such goods or
				  services is in dispute in the case.
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 4 - Evaluation Procedures › Section 41.6 - Procedures After Notice of Conflict of Interest and Waivers of Conflicts of Interest of an Evaluator

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Whenever an Agreed or Qualified Medical Evaluator notifies the parties that a
				  disqualifying conflict of interest exists, and even if it arises after the
				  evaluator has performed an initial or follow up comprehensive medical-legal
				  evaluation, the parties shall use the following procedures.
(b) An evaluator shall proceed with any
				  scheduled evaluation involving a physical examination or supplemental report in
				  the case, unless either the evaluator declines to proceed due to disqualifying
				  himself or herself pursuant to section
				  41.5(e) of Title 8
				  of the California Code of Regulations or unless, pursuant to this section, the
				  injured worker or the claims administrator is entitled to a replacement
				  QME.
(c) Within five (5) business
				  days of receipt of the evaluator's notice of conflict:
(1) If the injured worker is not represented
				  by an attorney, the parties shall obtain a new evaluator by following the
				  procedure provided under section
				  31.5 of Title 8 of the California
				  Code of Regulations and a replacement QME, or when necessary replacement QME
				  panel, shall be issued.
(2) If the
				  injured worker is represented by an attorney, each party shall notify the
				  evaluator and the opposing party in writing of the party's decision either to
				  waive the conflict or to object to the evaluator on the basis of the
				  evaluator's conflict. Whenever either party objects to the evaluator due to a
				  conflict, the parties shall obtain a new evaluator by following the procedures
				  provided in Labor Code section
				  4062.2 and
				  section 31.5 of Title 8 of the California
				  Code of Regulations.
(3) In the
				  event the parties in a represented case wish to waive a conflict of interest,
				  any such waiver shall be valid only if the general nature of the conflict of
				  interest is disclosed in writing and on the same document, or duplicate copies
				  of the same document, each party has signed a statement indicating that the
				  signing party understands that the evaluator has a conflict of interest, the
				  party understands the nature of the conflict, and the party wishes to waive the
				  opportunity to obtain another evaluator. The signature of an attorney shall
				  have the same effect as the signature of the party represented by the attorney,
				  if a copy of the document signed by the attorney is served on the represented
				  party by the attorney or by any other party or attorney. It shall be the duty
				  of the attorney to serve a copy of the signed document on the
				  party-client.
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 4 - Evaluation Procedures › Section 41.7 - Gifts to Medical Evaluators

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  No physician reporting as an Agreed Medical Evaluator or a Qualified Medical
				  Evaluator shall accept gifts that have a total fair market value in the
				  aggregate of three hundred sixty dollars ($ 360) or more, from any single
				  source that handles California workers' compensation matters, in the course of
				  any consecutive twelve months. The sources include, but are not limited to, one
				  or more attorneys, physicians, employers, claims administrators, medical or
				  health care or insurance or utilization review business entities. This
				  prohibition shall not include reasonable and appropriate income earned from a
				  Medical Provider Network as defined in Labor Code sections
				  4616 et seq,
				  from a Health Care Organization as defined in Labor Code sections
				  4600.3 et seq,
				  from a Preferred Provider Organization or managed care organization as defined
				  in Health and Safety Code sections
				  1340
				  et seq for services performed as a treating physician nor for reasonable and
				  appropriate income paid for services performed as reviewing physician or
				  medical director pursuant to Labor Code section
				  4610, or for
				  services performed as an Agreed Medical Evaluator or Qualified Medical
				  Evaluator.
(b) For the purposes of
				  this section, "Gift" means any payment to the extent that consideration of
				  equal or greater value is not received. It includes any rebate or discount in
				  the price of anything of value, unless the rebate or discount is also made in
				  the regular course of business to members of the public, and any loan,
				  forgiveness or other thing of value having a fair market value in excess of $
				  360 in the aggregate.
(c) Any
				  person who claims that a payment, rebate, discount, loan, forgiveness, or other
				  thing of value is not a gift by reason of receipt of consideration has the
				  burden of proving that the consideration received is of equal or greater
				  value.
(d) A Qualified Medical
				  Evaluator who violates any portion of this section shall be subject to
				  disciplinary action pursuant to section
				  60 et seq of these
				  regulations.
1. New
					 section filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
					 3).
Note: Authority cited: Sections
						133,
						139.2(o)
						and
						5307.3, Labor
						Code. Reference: Sections
						139.2 and
						139.3, 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 4 - Evaluation Procedures › Section 42 - Disciplinary Proceedings. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 4-11-95; operative 5-11-95 (Register 95, No. 15).
2.
					 Repealer filed 4-14-2000; operative 5-14-2000 (Register 2000, No.
					 15).
Note: Authority cited: Sections
						139.2 and
						5307.3, Labor
						Code; Section
						11370 et seq., Government Code; and
						Section 11500 et seq., Government Code.
						Reference: Sections
						139,
						139.2,
						4060,
						4061 and
						4062, Labor
						Code