(a) A
replacement QME to a panel, or at the discretion of the Medical Director a
replacement of an entire panel of QMEs, shall be selected at random by the
Medical Director and provided upon request whenever any of the following
occurs:
(1) A QME on the panel issued does not
practice in the specialty requested by the party holding the legal right to
request the panel.
(2) A QME on the
panel issued cannot schedule an examination for the employee within ninety (90)
days of the initial request for an appointment, or if the 90 day scheduling
limit has been waived pursuant to section
31.3(e) of
Title 8
of the California Code of Regulations, the QME cannot schedule the examination
within one-hundred and twenty (120) days of the date of the initial request for
an appointment.
(3) The injured
worker has changed his or her residence address since the QME panel was issued
and prior to date of the initial evaluation of the injured worker.
(4) A physician on the QME panel is a member
of the same group practice as defined by Labor Code section
139.3 as
another QME on the panel.
(5) The
QME is unavailable pursuant to section
33 (Unavailability of the
QME).
(6) The evaluator who
previously reported in the case is no longer available.
(7) A QME named on the panel is currently, or
has been, the employee's primary treating physician or secondary physician as
described in section
9785 of
Title 8 of the California
Code of Regulations for the injury currently in dispute.
(8) The claims administrator, or if none the
employer, and the employee agree in writing, for the employee's convenience
only, that a new panel may be issued in the geographic area of the employee's
work place and a copy of the employee's agreement is submitted with the panel
replacement request.
(9) The
Medical Director, upon written request, finds good cause that a replacement QME
or a replacement panel is appropriate for reasons related to the medical nature
of the injury. For purposes of this subsection, "good cause" is defined as a
documented medical or psychological impairment.
(10) The Medical Director, upon written
request, filed with a copy of the Doctor's First Report of Occupational Injury
or Illness (Form DLSR 5021 [see 8 Cal. Code Regs. §§
14006 and
14007] ) and the most recent DWC
Form PR-2 ("Primary Treating Physician's Progress Report" [See 8 Cal. Code
Regs. §
9785.2] ) or narrative report filed
in lieu of the PR-2, determines after a review of all appropriate records that
the specialty chosen by the party holding the legal right to designate a
specialty is medically or otherwise inappropriate for the disputed medical
issue(s). The Medical Director may request either party to provide additional
information or records necessary for the determination.
(11) The evaluator has violated section
34 (Appointment Notification and
Cancellation) of
Title 8 of the California Code of Regulations, except that the
evaluator will not be replaced for this reason whenever the request for a
replacement by a party is made more than fifteen (15) calendar days from either
the date the party became aware of the violation of section
34 of
Title 8 of the California
Code of Regulations or the date the report was served by the evaluator,
whichever is earlier.
(12) The
evaluator failed to meet the deadlines specified in Labor Code section
4062.5 and
section
38 (Medical Evaluation Time Frames)
of
Title 8 of the California Code of Regulations and the party requesting the
replacement objected to the report on the grounds of lateness prior to the date
the evaluator served the report. A party requesting a replacement on this
ground shall attach to the request for a replacement a copy of the party's
objection to the untimely report.
(13) The QME has a disqualifying conflict of
interest as defined in section
41.5 of
Title 8 of the California
Code of Regulations.
(14) The
Administrative Director has issued an order pursuant to section
10164(c) of
Title
8 of the California Code of Regulations (order for additional QME
evaluation).
(15) The selected
medical evaluator, who otherwise appears to be qualified and competent to
address all disputed medical issues refuses to provide, when requested by a
party or by the Medical Director, either: A) a complete medical evaluation as
provided in Labor Code sections
4062.3(i)
and
4062.3(k),
or B) a written statement that explains why the evaluator believes he or she is
not medically qualified or medically competent to address one or more issues in
dispute in the case.
(16) The QME
panel list was issued more than twenty four (24) months prior to the date the
request for a replacement is received by the Medical Unit, and none of the QMEs
on the panel list have examined the injured worker.
(b) Whenever the Medical Director determines
that a request made pursuant to subdivision
31.5(a) for a QME
replacement or QME panel replacement is valid, the time limit for an
unrepresented employee to select a QME and schedule an appointment under
section Labor Code section
4062.1(c)
and the time limit for a represented employee to strike a QME name from the QME
panel under Labor Code section
4062.2(c),
shall be tolled until the date the replacement QME name or QME panel is
issued.