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 51 - Reappointment and Denial of Reappointment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  Administrative Director may deny reappointment to a QME on any one or more of
				  the following grounds:
(1) Any grounds that
				  would provide a basis for suspending or terminating a Physician's privilege to
				  serve as a QME, as specified in paragraphs (1) through (6) of subdivision (k)
				  of Labor Code Section
				  139.2 or in
				  section 65 of Article 6 of this
				  title.
(2) Failure to comply with
				  the evaluation time frames in sections
				  34 or
				  38 on at least three occasions
				  during the calendar year.
(3)
				  Filing notification for unavailability under section
				  33 for more than 120 calendar days
				  during the calendar year.
(4) On
				  any single occasion, refusing without good cause to perform a medical-legal
				  evaluation. Good cause for not performing a medical-legal evaluation includes
				  but is not limited to the factors in subsections
				  41(h) and
				  41(i) of the
				  regulations.
(5) Having had more
				  than five evaluations rejected within a two year period, by a Workers'
				  Compensation Judge or the Appeals Board originally submitted at a contested
				  hearing, subject to the following:
(A) The
				  rejection was based on the failure of the QME's evaluation to prove or disprove
				  a contested issue or failure to comply with regulations adopted by the
				  Administrative Director or the Appeals Board under Title 8 of the California
				  Code of Regulations; and
(B) A
				  finding that rejects an evaluation must be final and the time for appeal must
				  have expired before any rejected evaluation shall be counted as one of the five
				  rejections.
(6) Three or
				  more instances during the most recent period of appointment of billing or
				  charging for medical-legal evaluations, reports or testimony in violation of
				  the Medical-Legal Fee Schedule as set forth in sections
				  9793-9795 of Article 5.6 in this
				  title.
(7) A finding that the QME
				  violated any order or ruling by a Workers' Compensation Judge or the Appeals
				  Board, provided that the finding is final and the time for appeal has
				  expired.
(8) Performing a QME
				  evaluation or examination without valid QME certification at the time of
				  examining the injured worker or the time of signing the initial or follow-up
				  evaluation report.
(9) Providing
				  false information on or with an application or reapplication for appointment as
				  a QME.
(10) Failing to render
				  expert opinions or conclusions without regard to an injured worker's race, sex,
				  national origin, religion or sexual preference.
(11) Participating in any activity that
				  constitutes a violation of Labor Code Sections
				  4628,
				  139.3, or
				  139.31.
(12) Having violated section
				  41(a)(5) on three
				  or more occasions during the most recent period of appointment.
(13) Participating in any intentional act
				  that is not a necessary part of the physical examination that causes physical
				  harm or injury to the injured worker.
(14) Failure to notify the Administrative
				  Director within 90 days that the physician's license to practice has been
				  encumbered by suspension or probation by the relevant licensing authority. The
				  90 days to notify the Administrative Director shall run from the effective date
				  of the order imposing the suspension or probation.
(15) Failure to comply with the continuing
				  education requirements in section
				  55.
(16) Any grounds that would provide a basis
				  for suspending or terminating a Physician's privilege to participate in the
				  workers' compensation system pursuant to Labor Code section
				  139.21(a)(1).