The Administrative Director shall appoint as QMEs all
applicants who meet the requirements set forth in Labor Code Section
139.2(b)
and all applicants:
(a) Shall submit
the required supporting documentation:
(1)
Copy of current license to practice in California;
(2) For Medical Doctors, or Doctors of
Osteopathy:
(A) A copy of the applicant's
certificate of completion of postgraduate specialty training at an institution
recognized by the Accreditation Council for Graduate Medical Education or the
osteopathic equivalent as defined pursuant to Section
12, or;
(B) A copy of the applicant's Board
certification by a specialty board recognized by the Administrative Director or
as defined pursuant to Section
12, or;
(C) A declaration under penalty of perjury
accompanied by supporting documentation that the physician has qualifications
that the Administrative Director and the Medical Board of California or the
Osteopathic Medical Board of California both deem to be equivalent to board
certification in a specialty.
(3) If a psychologist, (i) a copy of a
doctoral degree in psychology or a doctoral degree deemed equivalent for
licensure by the Board of Psychology pursuant to Section
2914
of the Business and Professions Code, and has not had less than five years
postdoctoral experience in the treatment of emotional and mental disorders or
(ii) served as an AME on eight or more occasions prior to January 1, 1990 and
has not less than five years postdoctoral experience in the diagnosis and
treatment of emotional and mental disorders.
(4) For Doctors of Chiropractic, the
physician shall provide a copy of a current or otherwise valid certificate in
California Workers Compensation Evaluation by either a California professional
chiropractic association or an accredited California college recognized by the
Administrative Director (i.e. Workers' Compensation Evaluation Certificate with
a minimum 25 hours completed). For purposes of this subsection, a current or
otherwise valid certificate in California Workers Compensation Evaluation is
one that has been obtained within the three years prior to the current
application to become certified as a QME.
(5) Or, for other physicians, a copy of the
physician's professional diploma.
(b)
(1)
Shall, prior to appointment as a QME, complete a course of at least sixteen
(16) hours in disability evaluation report writing pursuant to section
11.5 of this Article. Doctors of
Chiropractic who submit documentation showing compliance with section 11(a)(4)
are exempt from this requirement; and
(2) Shall accurately and fully report on the
SFI Form 124 attached to the application (QME Form 100) to the best of the
applicant's knowledge the information required by section
of Title
829 of
Title 8 of the California Code of
Regulations, regarding applicant's specified financial interests.
(c) Shall provide supplemental
information and/or documentation to the Administrative Director after an
application, QME Form 100 (see, 8 Cal. Code Regs. §
100), is submitted if requested to
verify an applicant's eligibility for appointment.
(d) Shall agree that during a QME evaluation
exam he, she or they will not treat or offer or solicit to provide medical
treatment for that injury for which he, she or they have done a QME evaluation
for an injured worker unless a medical emergency arises as defined under
subdivision (a) or (b) of section
1317.1
of the Health and Safety Code. A QME may also provide treatment if requested by
the employee pursuant to section
4600 of the
Labor Code, but he, she or they shall not offer or solicit to provide it. A QME
who solicits an injured worker to receive direct medical treatment or to become
the primary treating physician of that employee shall be subject to
disciplinary action pursuant to section
60.
(e) Shall declare under penalty of perjury on
the QME application that he, she or they:
(1)
Has an unrestricted California license and is not currently on probation from
the state licensing board, or, if the applicant has a California restricted
license or is currently on probation, state all the restrictions on the license
and all terms of probation; and
(2)
Devotes at least one-third of his, her or their total practice time to
providing direct medical treatment during each year of the applicant's term of
appointment. This requirement shall not apply if the applicant qualifies for
appointment because the applicant served as an AME on 8 or more occasions in
the year prior to application and in each year of the applicant's term; or if
the applicant meets the requirements of section
15; and
(3) Has not performed a QME evaluation
without QME certification;
(4) Has
accurately and fully reported on QME Form 124 to the best of the applicant's
knowledge the specified financial interest information required by section
of Title
829 of
Title 8 of the California Code of
Regulations.
(f) Shall
pass the QME Competency Examination, or if an acupuncturist, shall pass the QME
Competency Examination for acupuncturists.
(1) In order to take this examination, a
physician who is not currently appointed as a QME and not exempt pursuant to
Labor Code section
139(b)(1),
shall be considered to have applied to take the QME competency examination upon
submitting the properly-completed Application for Appointment Form in Section
100 (see, 8 Cal. Code Regs. section
100), and the Registration Form for
the QME Competency Examination in section
102 (see, 8 Cal. Code Regs. §
102) and the appropriate fee as
specified in section 11(f)(2).
(2)
The fee for applying to take or retake the QME competency examination is $
125.00 and may be waived by the Administrative Director at his, her or their
discretion for first time applicants.
(3) The Administrative Director shall give
appropriate public notice of the date, time and location of the examination no
fewer than sixty (60) calendar days before a competency examination is to be
given.
(4) An applicant must submit
the properly completed forms as required in section 11(f)(1) to the
Administrative Director at least forty-five (45) calendar days prior to the
date of the next scheduled competency examination unless the Administrative
Director finds good cause to grant an extension to the physician(s).
(5) The Administrative Director shall inform
the applicant in writing whether he, she or they shall be allowed to take the
examination within fifteen (15) calendar days from the date the Administrative
Director receives the properly-completed forms and appropriate fee.
(6) The Administrative Director shall inform
the applicant in writing whether or not he, she or they passed the examination
within sixty (60) calendar days from the date the applicant takes the
competency examination.
(7) An
applicant who passes the QME competency examination shall file the QME Fee
Assessment Form in Section
103 (see, 8 Cal. Code Regs. section
103) including the appropriate fee
within thirty (30) days of the date of the notice. The physician shall not be
appointed to the official QME list until the appropriate fee is paid and has
completed a disability evaluation report writing course pursuant to section
11.5. Appointments shall be for
two-year terms beginning with the date of appointment by the Administrative
Director.
(8) Any applicant, who
upon good cause shown by the test administrator, is suspected of cheating may
be disqualified from the examination and, upon a finding that the applicant did
cheat in that exam, the applicant will be denied further admittance to any QME
examination for a period of at least five years thereafter. Any applicant who
fails to follow test instructions and/or proctor instructions either before or
during or at the conclusion of an examination shall be disqualified from the
examination procedure and the applicant's exam shall be nullified.
(9) If an applicant fails the competency
examination or fails to appear for a noticed QME examination for which the
applicant has submitted a QME Exam Registration Form 102 (see, 8 Cal. Code
Regs. §
102), the applicant may apply to
take any subsequent examinations, upon submission of a new test application
form and a fee of $125. An applicant who fails the exam three times shall show
proof of having completed six (6) hours continuing education from a course
approved by the Administrative Director prior to taking the examination
again.
(10) Any applicant who
receives a failing grade on a competency exam may appeal the failing grade to
the Administrative Director. Appeals shall be considered on a case by case
basis. Appeals will be accepted immediately after a candidate has completed the
examination and until ten (10) days after the date of the examination results
letter. The appeal shall state specific facts as to why the failing grade
should be overturned. Pursuant to Section
6254(g)
of the Government Code, the Administrative Director will consider appeals of
test questions and will base his, her or their decision solely on the written
appeal including any supporting documentation submitted by the physician.
Appeals will only be accepted for the current examination period. Grounds for
appeal are:
(A) Significant procedural error
in the examination process;
(B)
Unfair Discrimination;
(C) Bias or
fraud.
(g)
Each applicant shall pay the annual fee required by section
17 of this Article prior to
appointment.
(h) Shall, prior to
appointment as a QME, complete a course of at least two (2) hours in anti-bias
training. The course shall include the following:
(1) Instruction designed to increase
awareness and understanding of differences in human experience, as well as
awareness of implicit or unconscious bias, stereotyping, and discrimination,
and the ways in which unconscious bias can unintentionally impact perceptions
and decision-making, including in medical evaluations and reporting, and lead
to disparities in health care strategies, to help eliminate or reduce implicit
bias in medical evaluations and reporting.
(2) At least one example of potential gender
bias in a fictitious QME evaluation in which an apportionment rating is made
based on an assumption about a risk factor related solely to the injured
worker's gender.
(3) At least one
example relating to an evaluation and rating of permanent disability resulting
from industrial breast cancer, taking into account the ways in which gender
bias could potentially impact an assessment of the impairment that results from
breast cancer and its treatment.
(4) The course shall include a post-course
examination based on the program material. Credit for the course may be given
only for a passing rate of no lower than 70 percent correct responses. The
administrative director may audit physicians' examinations and scores.
NOTE: Forms referred to above are 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.
Notes
Cal. Code
Regs. Tit. 8, §
11
Note: Authority cited: Sections 133, 139.2, 4060, 4062
and 5307.3, Labor Code. Reference: Section 139.2, Labor Code; and Section 6254,
Government Code.
Note: Authority cited: Sections
133,
139.2,
4060,
4062 and
5307.3, Labor
Code. Reference: Section
139.2, Labor
Code; and Section
6254,
Government Code.
1. New section filed
8-1-94; operative 8-31-94 (Register 94, No. 31).
2. New subsections
(a)-(c) and subsection relettering, amendment of newly designated subsections
(d)-(f)(6), new subsections (f)(7) and (f)(8) and subsection renumbering,
amendment of newly designated subsections (f)(9) and (f)(10), and new
subsection (g) filed 8-23-96; operative 9-22-96 (Register 96, No.
34).
3. Change without regulatory effect amending section (f)(5)
filed 6-20-97 pursuant to section 100, title 1, California Code of Regulations
(Register 97, No. 25).
4. Amendment filed 4-14-2000; operative
5-14-2000 (Register 2000, No. 15).
5. Amendment of section heading
and section filed 8-23-2001; operative 8-23-2001 pursuant to Government Code
section
11343.4
(Register 2001, No. 34).
6. Amendment of section and Note filed
1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
7. Amendment
of subsection (a)(4) and Note 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.
8. Amendment of subsection (a)(4) and Note 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.
9. Certificate of Compliance as to 7-1-2013 order transmitted
to OAL 8-2-2013 and filed 9-16-2013 (Register 2013, No. 38).
10.
Amendment of subsections (a)(4), (b)(1), (d), (e), (e)(2), (f)(2), (f)(4)-(6)
and (f)(10) and new subsections (h)-(h)(4) filed 2-26-2024; operative
2/26/2024
pursuant to Government Code section 11343.4(b)(3) (Register
2024, No. 9).