A QME shall complete within the previous 24 months of his,
her or their term of appointment 16 hours of continuing education in disability
evaluation, or workers' compensation related medical dispute evaluation, or
other workers' compensation related topics approved by the Administrative
Director, given by a provider accredited by the Administrative Director. This
section shall apply to applications for reappointment received on or after
April 1, 2026.
(a) There are two types
of continuing education programs:
(1) On-site
programs, in which the instructor and QME are in the same location. On site
programs can also be accomplished electronically where the instructor and the
QME are in the same virtual location as long as the virtual location provides a
means for the instructor to continuously track who is attending the class
virtually to ensure that attendees remain in the virtual location for the
entirety of the actual instruction. In order to provide accreditation for
virtual in person instruction, the provider and the QME must satisfy all of the
requirements for distance learning as contained in subsection (a)(2) of this
regulation; and
(2) Distance
learning programs.
(A) Providers of distance
learning programs shall give either a pre- or post-course self-examination
based on the program material. The provider shall grade the QME's test. Credit
for the course can be given only for a passing rate of no lower than 70 percent
correct responses. The Administrative Director may audit physicians'
examinations and scores.
(B) Credit
for distance learning courses shall be granted for the actual time spent
viewing, listening to or participating in the program and for the reasonable
and necessary time to take the examinations for up to eight hours per program.
Credit for the same distance learning program may be taken only once.
(C) All distance learning materials shall
bear a date of release and shall be updated every three years. The provider
shall notify the Administrative Director in writing of the revision.
(b) The 16 hours of
continuing education shall be in disability evaluation, workers' compensation
related medical dispute evaluation, or other workers' compensation related
topics approved by the Administrative Director. The 16 hours of instruction in
continuing education shall include,
(1) A
minimum of 4 hours of instruction in disability impairment rating;
(2) A minimum of 3 hours of instruction in
medical-legal report writing;
(3) A
minimum of 2 hour of instruction in anti-bias training which meets the
qualifications outlined in Section
11(h);
(4) A minimum of 2 hours in of instruction
consisting of a review of workers' compensation case law;
(5) A minimum of 1 hour of instruction in
proper application of the medical-legal fee schedule or in QME adherence to
regulatory clerical requirements;
(6) The remaining 4 hours may include credit
earned as follows:
(A) A physician may earn a
maximum of 2 hours of credit for having their reports reviewed by an approved
educational provider. The review shall consist of actual discussion between the
physician and the educational provider involving critical review of a report or
reports authored by the physician and submitted to the educational provider for
critique involving assessment of the report quality in relation to assessment
of factors outlined in Title 8, California Code of Regulations §
10682. The educational provider
shall produce a written checklist as part of the report review indicating their
assessment of the individual report. The checklist shall include the factors
outlined in Title 8, California Code of Regulations §
10682. The educational provider
shall give a copy of the completed checklist to the physician along with any
certification of completion of the report review.
(B) The DWC may provide on its website
annually a list of recommended educational topics for QME certification based
on review of medical-legal reports in the previous year.
(C) Credit may be received for physician time
spent in activities enumerated in section (c).
(c) In addition to granting credit for
attending a course or program which it gives, the Administrative Director may
grant credit for:
(1) Participating in a
panel on the development or review of the QME competency examination. A
physician may receive one hour credit for each hour of participation on a
panel. The QME shall obtain documentation of participation from the test
administrator for submission to the Administrative Director.
(2) Instructing in a program given for QME
credit by a provider accredited by the Administrative Director. The instructor
may receive two hours of credit for each hour of instruction in an accredited
provider's program or one hour of credit for each hour of participation on a
panel. Credit for the same presentation may be taken only once during each
calendar year. The QME shall submit documentation of participation from the
program provider to the Administrative Director.
(3) Attending a program which is accepted by
the QME's licensing board for renewal of his or her professional license,
provided the subject matter is directly related to California impairment
evaluation or workers' compensation medical dispute evaluation.
To request credit for this type of course, the QME must
submit:
(A) proof of
attendance;
(B) written material
which describes the program content and program faculty; and
(C) documentation that the program is for
continuing education credit by the physician's licensing board.
(4) Passing the QME competency
examination. A QME may be granted six hours of continuing education credit for
passing this examination for the purpose of receiving an initial appointment as
a QME.
(5) Participating in a panel
created by the DWC Medical Director to review medical-legal reports for
quality. A physician may receive one hour credit for each hour of participation
on a panel not to exceed 4 hours in a calendar year. The QME shall obtain
documentation of participation from the Medical Director or their designee for
submission to the Administrative Director.
(d) To apply to the Administrative Director
for accreditation, a provider shall submit to the Administrative Director, at
least 60 calendar days before any public advertisement of the applicant's
program or course is made:
(1) a completed
form 118, in section
118 of these regulations.
(2) A curriculum vitae for each proposed
instructor or author (for paper-based programs). A proposed instructor or
author shall have education and/or training and recent work experience relevant
to the subject of his/her presentation.
(3) The proposed promotional material for the
program.
(4) An outline of course
content, or actual course content, consistent with the topics in section
of Title
855(b) or
11.5(a) and (i) of
Title 8 of the California Code of Regulations.
(e) The Administrative Director shall
accredit an applicant who meets the definition of an education provider in
Section
1(p); submits a
completed, signed and dated application which demonstrates past experience in
providing continuing education programs; and proposes a program which meets the
requirements of section
55(b) or a course
which meets the requirements of section
11.5(a) and (i).
Proposed content for continuing education program credit must relate directly
to disability evaluation or California workers' compensation-related medical
dispute evaluation, or other workers' compensation related topics approved by
the Administrative Director. No credit shall be recognized by the
Administrative Director for material solely discussing the business aspects of
workers' compensation medical practice such as billing, coding and marketing
that is not regulated or described in a regulation related to practice as a QME
that is promulgated by the Administrative Director.
(f) The Administrative Director shall notify
the applicant within 30 calendar days after receipt of the application
containing all the information listed in section
55(d) whether that
provider has been accredited for a two year period. Incomplete applications
will be returned to the applicant.
(g) A provider that has been accredited by
the Administrative Director will be given a number which must be displayed on
any public advertisements of QME continuing education programs for that
provider with the statement "Accredited by the Administrative Director of the
California Division of Workers' Compensation for Qualified Medical Evaluator
continuing education. Physicians may report up to _____ hours of credit for QME
reappointment."
(h) On or before
the date the program is first presented or distributed, the provider shall
submit the program syllabus (all program handouts) to the Administrative
Director. Each distance learning program shall also submit one copy of the
examinations and one copy of the audio/video tapes, computer program or each
issue of the journal or newsletter for which credit is to be granted.
(i) A provider may offer different QME
continuing education programs during the two-year accreditation period provided
the subject matter is in disability evaluation or workers' compensation related
medical dispute resolution. The provider shall send the Administrative Director
the program outlined and faculty for each new program at least forty-five (45)
days prior to the date of presentation of the new program. The Administrative
Director may require submission of program syllabi. The Administrative Director
may require changes in the program based on its review of the program outline,
program syllabi, promotional material or faculty if the Administrative Director
finds that any aspect of the program is not in compliance with these
regulations.
(j) Promotional
materials for a program must state the educational objectives; the professional
qualifications of program faculty (at least all relevant professional degrees);
the content of program activities; the maximum number of credit hours to be
granted; and the intended audience.
(k) Joint sponsorship of education programs
(as between an accredited and an unaccredited provider) must be approved by the
Administrative Director prior to presentation of the program.
(l) Accredited providers that cease to offer
education programs shall notify the Administrative Director in
writing.
(m) Instructors shall not
recruit members or promote commercial products or services immediately before,
during or after a course. Providers or vendors may display/sell educational
related to workers' compensation or applications for membership in an area
adjoining a course. A course provider or faculty member shall disclose on QME
Form 119 (Faculty Disclosure of Commercial Interest), located in section
119 of
Title 8 of the California
Code of Regulations, any significant financial interest in or affiliation with
any commercial product or service held by faculty and discussed in a course and
that interest or affiliation must be disclosed to all attendees. A provider
shall file every Form 119 in its possession or in its control with the
Administrative Director.
(n) The
provider shall issue a certificate of completion to each QME who successfully
completes a continuing education program. The certificate must list the
provider; provider number; date(s); location and title of the continuing
education program; and the number of hours in attendance for which credit is to
be granted. Credit shall be granted only for the actual time of attendance at
or participation in a program. Each accredited provider may in its sole
discretion limit the amount of credit hours that a course will be granted to
less than the amount of time actually spent in attendance in the
course.
(o) To apply for
re-accreditation, a provider must submit a completed QME Form 118 (Application
for Accreditation or Re-Accreditation as Education Provider) (See, 8 Cal. Code
Regs. §
118). The provider may complete
section
2 of the form using a new program
or course or one which was given by the provider during the recent
accreditation period. The Administrative Director shall give the provider
ninety (90) days' notice of the need to seek re-accreditation.
(p) The provider shall maintain attendance
records for each continuing education program for a period of no less than
three (3) years after the program is given. A physician attending the program
must be identified by signature. The provider must submit a copy of the
signature list to the Administrative Director within sixty (60) days of
completion of the program.
(q) The
provider is required to give the QME's Evaluation Form 117 (Qualified Medical
Evaluator Continuing Education Response Form) (See, 8 Cal. Code Regs. §
117) to program attendees and
request they submit the form to the Administrative Director. This information
shall not be used in lieu of a certification of completion given by the
provider, as specified pursuant to section (m). Destruction by a provider or
its employee of a QME's Evaluation Form or failure by such provider or its
employee to distribute Form 117 as part of its program shall constitute grounds
for revocation of a provider's accredited status. The Administrative Director
shall tabulate the responses and return a summary to the provider within ninety
(90) days of completion of the program.
(r) The Administrative Director may audit a
provider's program(s) at the request of the medical director to determine if
the provider meets the criteria for accreditation. The Administrative Director
may audit programs randomly, when a complaint is received, or on the basis of
responses on QME Form 117 (Qualified Medical Evaluator Continuing Education
Response Form) (See, 8 Cal. Code Regs. §
117). An auditor shall not receive
QME credit for an audited program. The Administrative Director shall make
written results of the audit available to the provider no more than thirty (30)
days after the audit is complete.
(s) The Administrative Director may withdraw
accreditation of a provider or deny such a provider's application for
accreditation on the following grounds (in addition to failure to meet the
relevant requirements of subdivision
of Title
811.5(a) or
55(d) of
Title 8
of the California Code of Regulations):
(1)
Conviction of a felony or any offense substantially related to the activities
of the provider.
(2) Any material
misrepresentation of fact made by the provider.
(3) Failure to comply with Administrative
Director regulations.
(4) False or
misleading advertising.
(5) Failure
to comply with Administrative Director recommendations following an
audit.
(6) Failure to distribute
QME Form 117 (Qualified Medical Evaluator Continuing Education Response Form)
(See, 8 Cal. Code Regs. §
117) cards to program attendees.
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.