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 - Unavailability of QME

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A QME who
				  will be unavailable to schedule or perform comprehensive medical evaluations as
				  a Panel QME for a period of 14 days, or up to a maximum of 120 days during a
				  calendar year, for any reason shall notify the Medical Director by submitting
				  the form in section
				  109 (Notice of Qualified Medical
				  Evaluator Unavailability) at least 30 days before the period of unavailability
				  is to begin. The Medical Director may, in his or her or their discretion, grant
				  unavailable status within the 30-day notice period for good cause, including
				  but not limited to medical or family emergency or the QME's inability to
				  schedule any new medical-legal evaluation appointments within 90 days of the
				  initial appointment request because of time commitments related to existing
				  medical-legal evaluation appointments. For purposes of this subsection, a "new
				  medical-legal evaluation appointment" is one that is not currently scheduled at
				  the time that the physician requests unavailability status. Both Comprehensive
				  Medical-Legal Evaluations and Follow-Up Medical-Legal Evaluations are
				  considered new medical-legal evaluation appointments for purposes of this
				  section.
(b) At the time of
				  requesting unavailable status, the QME shall provide the Medical Director with
				  a list of any and all comprehensive medical/legal evaluation examinations
				  already scheduled during the time requested for unavailable status. The QME
				  shall indicate whether each such examination is being rescheduled or the QME
				  plans to complete the exam and report while in unavailable status.
(c) A QME who is unavailable as provided in
				  subdivision (a) shall not perform any new evaluation examinations as a QME
				  until the physician returns to active QME status. Such a QME may complete
				  medical-legal examinations and reports already scheduled and reported to the
				  Medical Director, as well as reports for evaluation examinations performed
				  prior to becoming unavailable under subdivision (a). Such a QME also may
				  complete supplemental reports.
(d)
				  It shall not be an acceptable reason for unavailability that a QME does not
				  intend to perform comprehensive medical-legal evaluations for unrepresented
				  workers. A QME who has filed notifications for unavailability totaling more
				  than one hundred and twenty (120) days during the QME calendar year without
				  good cause may be denied reappointment subject to section
				  51(a)(3). Good
				  cause includes, but is not limited to, sabbaticals, or death or serious illness
				  of an immediate family member.
(e)
				  If a QME fails to notify the Medical Director, by submitting the form in
				  section 109 (Notice of Qualified Medical
				  Evaluator Unavailability), of his or her or their unavailability at a medical
				  office at least thirty (30) days prior to the period the evaluator becomes
				  unavailable, the Medical Director may designate the QME to be unavailable at
				  that location for thirty (30) days from the date the Medical Director learns of
				  the unavailability.
(f) Whenever
				  the Medical Director is notified by a party seeking an appointment with a
				  Qualified Medical Evaluator, or otherwise becomes aware, that the QME is not
				  available and not responding to calls or mail at a location listed for the QME,
				  a certified letter will be sent to the QME by the Medical Director regarding
				  his/her or their unavailability. If the Medical Director does not receive a
				  response within fifteen (15) days of the date the certified letter is mailed,
				  then the QME will be made unavailable at that location. The time a QME is
				  placed on unavailable status pursuant to this subdivision shall count toward
				  the one hundred and twenty (120) day limit in section 33(a).
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.
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.
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.