Cal. Code Regs. Tit. 8, § 29 - Specified Financial Interests that May Affect Assignment to QME Panels
(a) Every physician
seeking appointment or reappointment as a Qualified Medical Evaluator shall
disclose specified financial interests, as defined in section
1 (dd) and
29(b) of Title 8
of the California Code of Regulations.
(b) "Specified Financial Interests" means
being a general partner or limited partner in, or having an interest of five
(5) percent or more in, or receiving or being legally entitled to receive a
share of five (5) percent or more of the profits from, any medical practice,
group practice, medical group, professional corporation, limited liability
corporation, clinic or other entity that provides treatment or medical
evaluation, goods or services for use in the California workers' compensation
system.
(c) "SFI Form 124", as used
in sections
1 though 159 of Title 8 of the
California Code of Regulations, means the QME SFI Form 124 that is completed
and filed as an attachment to QME Form 100, 103 or 104 by the physician or QME
with the Medical Director of the Division of Workers' Compensation.
(d) Specified financial interests shall be
disclosed on QME SFI Form 124, respectively, when applying for appointment on
QME Form 100, at the time of paying the annual fee on QME Form 103 or when
applying for reappointment on QME Form 104.
(e) The completed QME SFI Form 124 shall be
filed along with the QME Form 100, 103 or 104, respectively, when the form is
filed with the Medical Director of the Division of Workers'
Compensation.
(f) Failure of a
Qualified Medical Evaluator to complete and file a QME SFI Form 124 with the
Medical Director when required by this section shall be grounds for
disciplinary action pursuant to section
60 of Title 8 of the California
Code of Regulations.
(g) The
Administrative Director shall use the information provided by physicians
pursuant to this section to avoid assigning QMEs who share specified financial
interests to the same QME panel. If two or more QMEs assigned to a panel share
specified financial interests as defined in this section, any party may request
a replacement QME. If three QMEs share specified financial interests as defined
in this section, two of the QMEs shall be replaced. If two QMEs share specified
financial interests as defined in this section, one of the QMEs shall be
replaced. The QMEs that must be replaced shall be randomly selected by the
Medical Director.
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
Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, 4060, 4061, 4062, 4062.1, 4062.2 and 4067, Labor Code.
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