SELECTED PROVISIONS Of The CALIFORNIA CODE OF REGULATIONS · SELECTED PROVISIONS Of The CALIFORNIA...

SELECTED PROVISIONSOf The

CALIFORNIA CODE OFREGULATIONS

TITLE 8INDUSTRIAL RELATIONS

DIVISION 1Department of Industrial Relations

CHAPTER 1

DIVISION OF WORKERS’

COMPENSATION—QUALIFIED

MEDICAL EVALUATOR

REGULATIONS

ARTICLE 1

General

§1. Definitions.As used in the regulations in Chapter 1:(a) “Accreditation” means the conferring of

recognized status as a provider of physicianeducation by the Administrative Director.

(b) “ACOEM” shall have the same mean-ing as section 9792.20(a), and “ACOEM Prac-tice Guidelines” shall have the same meaning assection 9792.20(b) of Title 8 of the CaliforniaCode of Regulations.

(c) “Administrative Director” means theadministrative director of the Division of Work-ers’ Compensation of the State of CaliforniaDepartment of Industrial Relations, and includeshis or her designee.

(d) “Agreed Panel QME” means the Qual-ified Medical Evaluator described in LaborCode section 4062.2(c), that the claims admin-istrator, or if none the employer, and a repre-

sented employee agree upon and select from aQME panel list issued by the Medical Directorwithout using the striking process. An AgreedPanel QME shall be entitled to be paid at thesame rate as an Agreed Medical Evaluator undersection 9795 of Title 8 of the California Code ofRegulations for medical/legal evaluation proce-dures and medical testimony.

(e) “AMA Guides” means American Med-ical Association, Guides to the Evaluation ofPermanent Impairment [Fifth Edition].

(f) “AME” means Agreed Medical Evalua-tor, a physician selected by agreement betweenthe claims administrator, or if none the em-ployer, and a represented employee to resolvedisputed medical issues referred by the parties ina workers’ compensation proceeding.

(g) “Appeals Board” means the Workers’Compensation Appeals Board within the Stateof California Department of Industrial Rela-tions.

(h) “Audit” means a formal evaluation of acontinuing education program, disability evalu-ation report writing course, or an accreditededucation provider which is conducted at therequest of the Medical Director.

(i) “Comprehensive Medical-Legal Evalu-ation” means a medical evaluation performedpursuant to Labor Code Sections 4060, 4061,4062, 4062.1, 4062.2 or 4067 and meeting the

1

requirements of section 9793(c) of Title 8 of theCalifornia Code of Regulations.

(j) “Claims Administrator” means the per-son or entity responsible for the payment ofcompensation for any of the following: a self-administered insurer providing security for thepayment of compensation required by Divisions4 and 4.5 of the Labor Code, a self-administeredself-insured employer, a group self-insurer, aninsured employer, the director of the Depart-ment of Industrial Relations as administrator forthe Uninsured Employers Benefits Trust Fund(UEBTF) and for the Subsequent Injuries Ben-efit Trust Fund (SIBTF), a third-party claimsadministrator for a self-insured employer, in-surer, legally uninsured employer, group self-insurer, or joint powers authority, and the Cali-fornia Insurance Guarantee Association (CIGA).The UEBTF shall only be subject to theseregulations after proper service has been madeon the uninsured employer and the AppealsBoard has obtained jurisdiction over the UEBTFby joinder as a party.

(k) “Continuing Education Program”means a systematic learning experience (such asa course, seminar, or audiovisual or computerlearning program) which serves to develop,maintain, or increase the knowledge, skills andprofessional performance of physicians whoserve as Qualified Medical Evaluators in theCalifornia workers’ compensation system.

(l ) “Course” means the 12 hours of in-struction in disability evaluation report writingwhich is required of a Qualified Medical Eval-uator prior to appointment. A course must beapproved by the Administrative Director.

(m) “Credit Hour” means a sixty minutehour. A credit hour may include time for ques-tions and answers related to the presentation.

(n) “Direct medical treatment” means thatspecial phase of the physician-patient relation-ship during which the physician: (1) attempts toclinically diagnose and to alter or modify theexpression of a non-industrial illness, injury orpathological condition; or (2) attempts to cure orrelieve the effects of an industrial injury.

(o) “Distance Learning” means an educa-tion program in which the instructor and studentare in different locations, as in programs basedon audio or video tapes, computer programs, orprinted educational material.

(p) “DEU” is the Disability EvaluationUnit under the Administrative Director respon-sible for issuing summary disability ratings.

(q) “Education Provider” means the indi-vidual or organization which has been accred-ited by the Administrative Director to offerphysician education programs. There are twocategories of providers: (1) the AdministrativeDirector; and (2) individuals, partnerships, orcorporations, hospitals, clinics or other patientcare facilities, educational institutions, medicalor health-related organizations whose member-ship includes physicians as defined in LaborCode section 3209.3, organizations of non-med-ical participants in the California workers’ com-pensation system, and governmental agencies.In the case of a national organization seekingaccreditation, the California Chapter or organi-zation affiliated with the national organizationshall be accredited by the Administrative Direc-tor in lieu of the national organization.

(r) “Employer” means any employer withinthe meaning of Labor Code section 3300, in-cluding but not limited to, any of the following:(1) an uninsured employer and the UninsuredEmployers Benefits Trust Fund (UEBTF) pursu-ant to Labor Code Section 3716, (2) an insuredemployer, (3) a self-insured employer and (4) alawfully uninsured employer. The UEBTF shallonly be subject to these regulations after properservice has been made on the uninsured em-ployer and the Appeals Board has obtainedjurisdiction over the UEBTF by joinder as aparty.

(s) “Evaluator” means any of the follow-ing: “Qualified Medical Evaluator”, “AgreedMedical Evaluator”, “Agreed Panel QME” or“Panel QME”, as appropriate in a specific case.

(t) “Follow-up comprehensive medical-le-gal evaluation” means a medical evaluationperformed pursuant to Labor Code sections4060, 4061, 4062, 4062.1, 4062.2 or 4067 andmeeting the requirements of Section 9793(f) ofTitle 8 of the California Code of Regulations.

(u) “Medical Treatment Utilization Sched-ule” or “MTUS” means the treatment utilizationscheduled adopted by the Administrative Direc-tor of the Division of Workers’ Compensation asrequired by Labor Code section 5307.27 andsections 9792.20 et seq of Title 8 of the Califor-nia Code of Regulations.

(v) “Medical Director” means the MedicalDirector appointed by the Administrative Direc-

2TITLE 8, CALIFORNIA CODE OF REGS.8 CCR §1

tor pursuant to Labor Code section 122 andincludes any Associate Medical Directors whenacting as his or her designee.

(w) “Mental health record” means a medi-cal treatment or evaluation record created orreviewed by a licensed physician as defined inLabor Code section 3209.3 in the course oftreating or evaluating a mental disorder.

(x) “Panel QME” means the physician,from a QME panel list provided by the MedicalDirector, who is selected under Labor Codesection 4062.1(c) when the injured worker is notrepresented by an attorney, and when the injuredworker is represented by an attorney, the physi-cian whose name remains after completion ofthe striking process or who is otherwise selectedas provided in Labor Code section 4062.2(c)when the parties are unable to agree on anAgreed Panel QME.

(y) “Physician’s office” means a bona fideoffice facility which is identified by a streetaddress and any other more specific designationsuch as a suite or room number and whichcontains the usual and customary equipment forthe evaluation and treatment appropriate to thephysician’s medical specialty or practice.

(z) “Qualified Medical Evaluator (QME)”means a physician licensed by the appropriatelicensing body for the state of California andappointed by the Administrative Director pursu-ant to Labor Code section 139.2, providedhowever, that acupuncturist QMEs shall notperform comprehensive medical-legal evalua-tions to determine disability.

(aa) “QME competency examination”means an examination administered by the Ad-ministrative Director for the purpose of demon-strating competence in evaluating medical-legalissues in the workers’ compensation system.This examination shall be given at least as oftenas twice annually.

(bb) “QME competency examination foracupuncturists” means an examination adminis-tered by the Administrative Director for thepurpose of demonstrating competence in evalu-ating medical-legal issues in the workers’ com-pensation system which are not pertinent to thedetermination of disability, but should be under-stood by acupuncturist QMEs. This examinationshall be given at least as often as twice annually.

(cc) “Significant Financial Interest or Affil-iation Held by Faculty”, as used in sections 11.5,14, 55, 118 and 119 pertaining to faculty of

approved disability report writing or continuingeducation courses under these regulations,means grant or research support; status as aconsultant, member of a speakers’ bureau, ormajor stock shareholder; or other financial ormaterial interest for the program faculty mem-ber or his or her family.

(dd) “Specified Financial Interests” meanshaving a shared financial interest that must bereported or disclosed pursuant to sections 11, 17,29, 50 or on the “SFI Form 124” attached toQME Form 100, 103 or 104 as required by theseregulations.

(ee) “Supplemental medical-legal evalua-tion” means a medical evaluation performedpursuant to Labor Code sections 4060, 4061,4062, 4062.1, 4062.2 or 4067 and meeting therequirements of section 9793(l ) of Title 8 of theCalifornia Code of Regulations.

(ff) “Treating physician” means a physicianwho has provided direct medical treatment to anemployee which is reasonably required to cureor relieve the effects of an industrial injurypursuant to section 4600 of the Labor Code.

(gg) “Unrepresented employee” means anemployee not represented by an attorney.

Note: Authority cited: Sections 53, 133, 139.2,4060, 4061, 4062, 4062.1, 4062.2 and 5307.3, LaborCode. Reference: Sections 139.2, 139.3, 139.31,139.4, 139.43, 3716, 4060, 4061, 4061.5, 4062,4062.1, 4062.2, 4062.3, 4062.5, 4067, 4600, 4604.5and 4660-4664, Labor Code.

History: 1. Repealer and new section filed 8-1-94;operative 8-31-94 (Register 94, No. 31). For priorhistory, see Register 93, No. 38.2. Change without regulatory effect amending subsec-tions (c), (g), (h), (k) and (p) filed 9-19-94 pursuant tosection 100, title 1, California Code of Regulations(Register 94, No. 38).3. Amendment of subsections (d) and (f), repealer andnew subsection (m), amendment of subsections (n)and (o), new subsections (p) and (q) and subsectionrelettering, and amendment of newly designated sub-section (r) filed 8-23-96; operative 9-22-96 (Register96, No. 34).4. New subsection (s) and subsection relettering filed6-3-97; operative 7-3-97 (Register 97, No. 23).5. Amendment of subsections (f) and (r) filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).6. New subsections (a) and (e), repealer of formersubsection (f), new subsections (h), (j), (k), (m), (r)and (x) and subsection relettering filed 10-16-2000 asan emergency; operative 1-1-2001 (Register 2000, No.42). A Certificate of Compliance must be transmittedto OAL by 5-1-2001 or emergency language will berepealed by operation of law on the following day.

3 QUALIFIED MEDICAL EVALUATOR REGULATIONS 8 CCR §1

7. New subsections (a) and (e), repealer of formersubsection (f), new subsections (h), (j), (k), (r) and (x)and subsection relettering refiled 5-2-2001 as anemergency; operative 5-2-2001 (Register 2001, No.18). A Certificate of Compliance must be transmittedto OAL by 8-30-2001 or emergency language will berepealed by operation of law on the following day.8. Certificate of Compliance as to 5-2-2001 order,including further amendment of section, transmitted toOAL 7-12-2001 and filed 8-23-2001 (Register 2001,No. 34).9. Amendment of chapter heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

ARTICLE 2

QME Eligibility

§10. Appointment of QMEs.(a) Applications for appointment as a QME

shall be submitted on the form in section 100(QME Form 100). The completed applicationform, and any supporting documentation asrequired by the application, shall be filed at theAdministrative Director’s office listed on theform in section 100. Upon his or her approval ofeach application form and supporting documen-tation, the Administrative Director shall certify,as eligible to sit for the QME competencyexamination, those applicants who meet all ofthe statutory and regulatory eligibility require-ments. Any application for appointment may berejected if it is incomplete, contains false infor-mation or does not contain the required support-ing documentation listed in section 11.

(b) The Administrative Director may denyappointment or reappointment to any physicianwho has performed a QME evaluation or exam-ination without valid QME certification at thetime of examining the injured worker or the timeof signing the initial or follow-up evaluationreport. An applicant serving a period of proba-tion imposed by the applicant’s professionallicensing board or agency may be allowed totake the QME examination while on probation-ary license status. Applications for appointmentor reappointment from physicians who are onprobationary license status with a Californialicensing board or agency while the QME ap-plication is pending shall be reviewed by theMedical Director on a case-by-case basis con-sistent with the provisions of Labor Code sec-tion 139.2(m).

(c) No physician who has been convictedof a felony or misdemeanor related to his or herpractice shall be appointed or reappointed as aQME. An applicant who has been convicted ofany other type of felony or misdemeanor may bedenied appointment or reappointment.

(d) Any physician who, while under inves-tigation or after the service of a statement ofissues or accusation for alleged violations ofthese regulations or the Labor Code, withdrawshis or her application for appointment or reap-pointment, resigns or fails to seek reappoint-ment as a QME, shall be subject to having thedisciplinary process reactivated whenever anapplication for appointment or re-appointment issubsequently filed. In the event any of thealleged violations are found to have occurred,the physician’s application for appointment orreappointment may be denied by the Adminis-trative Director.NOTE: Form is available at no charge bydownloading 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 and5307.3, Labor Code; and Section 730, Business andProfessions Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1 and 4062.2, Labor Code; andSection 730, Business and Professions Code.

History: 1. Relocation of article 2 heading andnew section filed 8-1-94; operative 8-31-94 (Register94, No. 31).2. Amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§10.5. Limitations on Certification asQualified Medical Evaluators.[Repealed]

Note: Authority cited: Sections 139 and 139.2.Reference: 8 U.S.C. Sections 1621, 1641 and 1642;Sections 139.2, 5307.3 and 5307.4, Labor Code; andSection 11507 et seq., Government Code.

History: 1. New section filed 11-5-98; operative12-5-98 (Register 98, No. 45).2. Change without regulatory effect repealing andadding new Form 10.5, Rev. 5/99 (incorporated byreference) filed 7-12-99 pursuant to section 100, title1, California Code of Regulations (Register 99, No.29).3. Amendment of subsections (e)(1), (e)(3) and (i)and repealer of subsections (i)(1)-(6) filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).


4. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§11. Eligibility Requirements forInitial Appointment as a QME.

The Administrative Director shall appoint asQMEs all applicants who meet the requirementsset forth in Labor Code Section 139.2(b) and allapplicants:

(a) Shall submit the required supportingdocumentation:

(1) Copy of current license to practice inCalifornia;

(2) For Medical Doctors, or Doctors ofOsteopathy:

(A) A copy of the applicant’s certificate ofcompletion of postgraduate specialty training atan institution recognized by the AccreditationCouncil for Graduate Medical Education or theosteopathic equivalent as defined pursuant toSection 12, or;

(B) A copy of the applicant’s Board certi-fication by a specialty board recognized by theAdministrative Director or as defined pursuantto Section 12, or;

(C) A declaration under penalty of perjuryaccompanied by supporting documentation thatthe physician has qualifications that the Admin-istrative Director and the Medical Board ofCalifornia or the Osteopathic Medical Board ofCalifornia both deem to be equivalent to boardcertification in a specialty.

(3) If a psychologist, (i) a copy of a doc-toral degree in psychology or a doctoral degreedeemed equivalent for licensure by the Board ofPsychology pursuant to Section 2914 of theBusiness and Professions Code, and has not hadless than five years postdoctoral experience inthe treatment of emotional and mental disordersor (ii) served as an AME on eight or moreoccasions prior to January 1, 1990 and has notless than five years postdoctoral experience inthe diagnosis and treatment of emotional andmental disorders.

(4) For Doctors of Chiropractic, the physi-cian shall provide (1) a copy of a current orotherwise valid certificate in California WorkersCompensation Evaluation by either a Californiaprofessional chiropractic association or an ac-credited California college recognized by theAdministrative Director (i.e. Workers’ Compen-sation Evaluation Certificate with a minimum 44hours completed) or; (2) a certificate of comple-

tion of a chiropractic postgraduate specialtyprogram of at least 300 hours taught by a schoolor college recognized by the AdministrativeDirector, the Board of Chiropractic Examinersand the Council on Chiropractic Education.

(5) Or, for other physicians, a copy of thephysician’s professional diploma.

(b)(1) Shall, prior to appointment as aQME, complete a course of at least twelve (12)hours in disability evaluation report writingpursuant to section 11.5 of this Article. Doctorsof Chiropractic who submit documentationshowing compliance with section 11(a)(4)(1) areexempt from this requirement; and

(2) Shall accurately and fully report on theSFI Form 124 attached to the application (QMEForm 100) to the best of the applicant’s knowl-edge the information required by section 29 ofTitle 8 of the California Code of Regulations,regarding applicant’s specified financial inter-ests.

(c) Shall provide supplemental informationand/or documentation to the Administrative Di-rector after an application, QME Form 100 (see,8 Cal. Code Regs. § 100), is submitted ifrequested to verify an applicant’s eligibility forappointment.

(d) Shall agree that during a QME evalua-tion exam he or she will not treat or offer orsolicit to provide medical treatment for thatinjury for which he or she has done a QMEevaluation for an injured worker unless a med-ical emergency arises as defined under subdivi-sion (a) or (b) of section 1317.1 of the Healthand Safety Code. A QME may also providetreatment if requested by the employee pursuantto section 4600 of the Labor Code, but he or sheshall not offer or solicit to provide it. A QMEwho solicits an injured worker to receive directmedical treatment or to become the primarytreating physician of that employee shall besubject to disciplinary action pursuant to section60.

(e) Shall declare under penalty of perjuryon the QME application that he or she:

(1) Has an unrestricted California licenseand is not currently on probation from the statelicensing board, or, if the applicant has a Cali-fornia restricted license or is currently on pro-bation, state all the restrictions on the licenseand all terms of probation; and

(2) Devotes at least one-third of his or hertotal practice time to providing direct medical


treatment during each year of the applicant’sterm of appointment. This requirement shall notapply if the applicant qualifies for appointmentbecause the applicant served as an AME on 8 ormore occasions in the year prior to applicationand in each year of the applicant’s term; or if theapplicant meets the requirements of section 15;and

(3) Has not performed a QME evaluationwithout QME certification;

(4) Has accurately and fully reported onQME Form 124 to the best of the applicant’sknowledge the specified financial interest infor-mation required by section 29 of Title 8 of theCalifornia Code of Regulations.

(f) Shall pass the QME Competency Exam-ination, or if an acupuncturist, shall pass theQME Competency Examination for acupunctur-ists.

(1) In order to take this examination, aphysician who is not currently appointed as aQME and not exempt pursuant to Labor Codesection 139(b)(1), shall be considered to haveapplied to take the QME competency examina-tion upon submitting the properly-completedApplication for Appointment Form in Section100 (see, 8 Cal. Code Regs. section 100), andthe Registration Form for the QME CompetencyExamination in section 102 (see, 8 Cal. CodeRegs. § 102) and the appropriate fee as specifiedin section 11(f)(2).

(2) The fee for applying to take or retakethe QME competency examination is $ 125.00and may be waived by the Administrative Di-rector at his or her discretion for first timeapplicants.

(3) The Administrative Director shall giveappropriate public notice of the date, time andlocation of the examination no fewer than sixty(60) calendar days before a competency exam-ination is to be given.

(4) An applicant must submit the properlycompleted forms as required in section 11(f)(1)to the Administrative Director at least thirty (30)calendar days prior to the date of the nextscheduled competency examination unless theAdministrative Director finds good cause togrant an extension to the physician(s).

(5) The Administrative Director shall in-form the applicant in writing whether he or sheshall be allowed to take the examination withinfifteen (15) calendar days from the date the

Administrative Director receives the properly-completed forms and appropriate fee.

(6) The Administrative Director shall in-form the applicant in writing whether or not heor she passed the examination within sixty (60)calendar days from the date the applicant takesthe competency examination.

(7) An applicant who passes the QMEcompetency examination shall file the QME FeeAssessment Form in Section 103 (see, 8 Cal.Code Regs. section 103) including the appropri-ate fee within thirty (30) days of the date of thenotice. The physician shall not be appointed tothe official QME list until the appropriate fee ispaid and has completed a disability evaluationreport writing course pursuant to section 11.5.Appointments shall be for two-year terms be-ginning with the date of appointment by theAdministrative Director.

(8) Any applicant, who upon good causeshown by the test administrator, is suspected ofcheating may be disqualified from the examina-tion and, upon a finding that the applicant didcheat in that exam, the applicant will be deniedfurther admittance to any QME examination fora period of at least five years thereafter. Anyapplicant who fails to follow test instructionsand/or proctor instructions either before or dur-ing or at the conclusion of an examination shallbe disqualified from the examination procedureand the applicant’s exam shall be nullified.

(9) If an applicant fails the competencyexamination or fails to appear for a noticedQME examination for which the applicant hassubmitted a QME Exam Registration Form 102(see, 8 Cal. Code Regs. § 102), the applicantmay apply to take any subsequent examinations,upon submission of a new test application formand a fee of $125. An applicant who fails theexam three times shall show proof of havingcompleted six (6) hours continuing educationfrom a course approved by the AdministrativeDirector prior to taking the examination again.

(10) Any applicant who receives a failinggrade on a competency exam may appeal thefailing grade to the Administrative Director.Appeals shall be considered on a case by casebasis. Appeals will be accepted immediatelyafter a candidate has completed the examinationand until ten (10) days after the date of theexamination results letter. The appeal shall statespecific facts as to why the failing grade shouldbe overturned. Pursuant to Section 6254(g) of


the Government Code, the Administrative Di-rector will consider appeals of test questions andwill base his or her decision solely on thewritten appeal including any supporting docu-mentation submitted by the physician. Appealswill only be accepted for the current examina-tion period. Grounds for appeal are:

(A) Significant procedural error in the ex-amination process;

(B) Unfair Discrimination;(C) Bias or fraud.(g) Each applicant shall pay the annual fee

required by section 17 of this Article prior toappointment.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Section 139.2, LaborCode; and Section 6254, Government Code.

History: 1. New section filed 8-1-94; operative8-31-94 (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 sub-section renumbering, amendment of newly designatedsubsections (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 filed8-23-2001; operative 8-23-2001 pursuant to Govern-ment 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).

§11.5. Disability Evaluation ReportWriting Course.

Prior to appointment as a QME, a physicianshall complete a course of at least twelve hoursof instruction in disability evaluation reportwriting. The course curriculum shall be speci-fied by the Administrative Director. Only reportwriting courses which are offered by educationproviders as defined in subdivision 1(q) of Title8 of the California Code of Regulations shallqualify to satisfy this requirement.

(a) An education provider applicant shallsubmit:

(1) a completed QME Form 118 (Applica-tion for Accreditation) (see, 8 Cal. Code Regs.§ 118) which contains:

(A) the applicant’s name; address; directorof education with contact information; type oforganization; length of time in business; natureof business; and past experience providing con-tinuing education courses (including a list ofother accrediting agencies that have approvedsuch courses);

(B) a description of the proposed educationprogram or course which includes the title; type(continuing education program or disabilityevaluation report writing course); location(s);date(s); length of training in clock hours; edu-cational objectives; a complete description ofthe program or course content; faculty; and thenames of other accrediting agencies that haveapproved the program.

(2) A curriculum vitae for each proposedinstructor. A proposed instructor shall have ed-ucation and/or training and recent work experi-ence relevant to the subject of his/her presenta-tion.

(3) The application for accreditation as aneducation provider, along with all required sup-porting documents, shall be submitted to theAdministrative Director, at least 60 calendardays before any public advertisement of theapplicant’s course.

(b) The Administrative Director shall ac-credit an applicant that: meets the definition ofan education provider; submits a completed,signed and dated application which demon-strates past experience in providing continuingeducation programs; and proposes a programwhich meets the requirements of section 55(c)or a course which meets the requirements ofsection 11.5(a) and (i). The applicant mustdemonstrate that adequate time is allocated tothe curriculum set forth in section 11.5(i) for thecourse to be approved by the AdministrativeDirector. Proposed content for continuing edu-cation program credit must relate directly todisability evaluation or California workers’compensation-related medical dispute evalua-tion. No credit shall be recognized by theAdministrative Director for material primarilydiscussing the business aspects of workers’compensation medical practice, including butnot limited to billing, coding and marketing.

(c) The Administrative Director shall notifythe applicant within 20 calendar days after

7 QUALIFIED MEDICAL EVALUATOR REGULATIONS 8 CCR §11.5

receipt of the application containing all theinformation listed in section 11.5(a) whetherthat education provider has been accredited for atwo year period and the proposed course hasbeen approved. Incomplete applications will bereturned to the applicant.

(d) Each education provider that has beenaccredited by the Administrative Director willbe given a number which must be displayed oncourse promotional material.

(e) On or before the date the course is firstpresented, the education provider shall submitthe program syllabus (all program handouts) tothe Administrative Director.

(f) An approved course may be offered fortwo (2) years. An accredited education providershall notify the Administrative Director in writ-ing of any change to the faculty in an approvedcourse. The provider shall send the Administra-tive Director the program outline, promotionalmaterial and faculty for each offering of theprogram at least 45 days prior to the date of thepresentation of the program. The AdministrativeDirector may require submission of the programsyllabi. The Administrative Director may re-quire changes in the program based on itsreview of the program outline, program syllabi,promotional material or faculty if the Adminis-trative Director finds that any aspect of theprogram is not in compliance with these regu-lations.

(g) To apply for re-accreditation, the edu-cation provider applicant must submit a com-pleted QME Form 118 (Application for Accred-itation) (see, 8 Cal. Code Regs. § 118), using theapplication process in 11.5(a). The applicantmay complete section 2 of the form using a newprogram or course or one which was given bythe applicant during the recent accreditationperiod. The Administrative Director shall givethe provider 90 days’ notice of the need to seekre-accreditation.

(h) Promotional materials for a course muststate the education provider’s educational objec-tives; the professional qualifications of coursefaculty (at the least, all relevant professionaldegrees); the content of course activities; andthe intended audience.

(i) The minimum of 12 hours of instructionin disability evaluation report writing shall in-clude:

(1) The Qualified Medical Evaluator’s Rolein the Disability Evaluation Process (minimumrecommended 1 hour)

How disability evaluation reports are usedThe reasons why reports must be clear, com-

plete and timelyThe QME’s role as an expert witnessImpact of the QME’s report on the injured

workerQME ethics and the Confidentiality of Med-

ical Information Act(2) Elements of the Medical-Legal Report

(minimum recommended 1 hour)The Labor Code and regulatory requirements

for medical-legal reports(3) The Language of Reports (minimum

recommended 4 hours)Evaluation of disability in California (impair-

ment and disability)The occupational historyThe physician examination and the role of

testingThe Medical Treatment Utilization Schedule

(MTUS) adopted by the Administrative Directorpursuant to Labor Code section 5307.27, foundin section 9792.20 et seq of Title 8 of theCalifornia Code of Regulations, and relevantportions of the ACOEM Practice Guidelines

Providing opinions that resolve disputedmedical treatment issues consistent with theevaluation criteria specified in section 35.5(d) ofTitle 8 of the California Code of Regulations

Packard Thurber’s Evaluation of IndustrialDisability, section 43 through 47 and section9725 through 9727 of Title 8 of the CaliforniaCode of Regulations (for cases with dates ofinjury not subject to the AMA guide-basedimpairment rating system, described below)

Factors of disability, including subjective andobjective factors, loss of pre-injury capacity andwork restrictions, for cases involving dates ofinjury not subject to the AMA guide-basedimpairment rating system

Activities of Daily Living, for cases subjectto the AMA Guides

Work restrictionsWork CapabilitiesAmerican Medical Association, Guides to the

Evaluation of Permanent Impairment, [FifthEdition] (AMA Guides) and its use in determin-ing permanent disability in accordance with theSchedule for Rating Permanent Disabilities [ef-

8TITLE 8, CALIFORNIA CODE OF REGS.8 CCR §11.5

fective January 1, 2005] (for all claims withdates of injury on or after January 1, 2005, andfor those compensable claims arising beforeJanuary 1, 2005, in which either there is nocomprehensive medical-legal report or no reportby a treating physician indicating the existenceof permanent disability, or when the employer isnot required to provide the notice to the injuredworker required by Labor Code section 4061)

CausationDetermination of permanent and stationary

statusVocational rehabilitation (for claims with

dates of injury prior to January 1, 2004)Apportionment including the requirements of

Labor Code sections 4660, 4663 and 4664added by SB 899 (Stats. 2004, ch. 34)

Future medical treatment using the MedicalTreatment Utilization Schedule

Review of recordsProviding sufficient support for conclusions(4) The Administrative Director’s Disabil-

ity Evaluation Protocols (minimum recom-mended 1 hour)

An overview of the Neuromusculoskeletal,Pulmonary, Cardiac, Immunologic, or Psychiat-ric protocols, and an in-depth discussion ofmeasurement of impairment, calculations andrationale for rating under the AMA Guides, asrelevant.

(5) The Third Party Perspective (minimumrecommended 1 hour)

The report from the perspective of those whoread it:

Judge(s), attorney(ies), insurer(s), rater(s),employer(s), qualified rehabilitation representa-tive(s).

(6) Anatomy of a Good Report (smallgroup or other interactive sessions — minimumrecommended 3 hours)

Discussion of examples of good reports andidentification of weaknesses in reports

Opportunities for the practitioner to critiqueand/or correct reports.

If feasible, physician should have the oppor-tunity to write a sample report.

Review of results of Administrative Direc-tor’s annual report review and identification ofcommon problems with reports.

(7) Mechanics of Report Writing (mini-mum recommended 1 hour)

The QME Process

Face to face timeTimelines for submission of reportCompletion of required formsService of reportsFinal questions and answers(8) Submission and Critique of Written

Medical/legal Report. As a condition of comple-tion of the course taken to satisfy the require-ments of this section, each physician enrolleeshall draft at least one practice written medical/legal report, based on a sample case library ofmaterials, which written report shall be critiquedwith notations by the course education provider.

(j) All audio or video tapes, computer pro-grams and printed educational material used inthe course must be submitted to the Administra-tive Director on or before the date the course isfirst given. Up to the full twelve hours ofinstruction may be completed by distance learn-ing whenever the Administrative Director hasapproved the submitted course prior to the firstday the course is given. All distance learningmaterials shall bear a date of release and shall beupdated yearly. The education provider shallnotify the Administrative Director in writing ofthe revision.

(k) No one shall recruit members or pro-mote commercial products or services in theinstruction room immediately before, during, orimmediately after the presentation of a course.Education providers or vendors may display/selleducational materials related to workers’ com-pensation or applications for membership in anarea adjoining a course. A course provider orfaculty member shall disclose on QME Form119 (Faculty Disclosure of Commercial Interest)(see, 8 Cal. Code Regs. § 119) any significantfinancial interest held by faculty in or affiliationwith any commercial product or service which isdiscussed in a course and that interest or affili-ation must be disclosed to all attendees. Aneducation provider shall file every Form 119 inits possession with the Administrator Director.

(l ) The provider shall maintain attendancerecords for each disability evaluation reportwriting course for a period of no less than threeyears after the course is given. A physicianattending the course must be identified by sig-nature. The provider must submit a copy of thesignature list to the Administrative Directorwithin 60 days of completion of the course.

(m) The provider is required to give theQME Evaluation Form 117 (Qualified Medical


Evaluator Continuing Education ResponseForm) (see, 8 Cal. Code Regs. § 117) to courseattendees and request they submit the form tothe Administrative Director. This informationshall not be used in lieu of a certification ofcompletion given by the provider, as specifiedpursuant to section (n). Destruction by a pro-vider or its employee of a QME’s EvaluationForm or failure by such provider or its employeeto distribute Form 117 as part of its course shallconstitute grounds for revocation of a provider’saccredited status. The Administrative Directorshall tabulate the responses and return a sum-mary to the provider within 90 days of comple-tion of the course.

(n) The provider shall issue a certificate ofcompletion to the physician that states the nameof the provider, the provider’s number, thedate(s) and location and title of the course. To beeligible for appointment as a QME, a physicianmust complete no less than 12 hours of thecurriculum specified in Section 11.5(i) and mustsubmit a copy of that certificate to the Admin-istrative Director.

(o) Joint sponsorship of courses (as be-tween an accredited and an unaccredited pro-vider) must be approved by the AdministrativeDirector prior to presentation of the course.

(p) The Administrative Director may audita provider’s course(s) at the request of themedical director to determine if the providermeets the criteria for accreditation. The Admin-istrative Director may audit courses given byproviders randomly, when a complaint is re-ceived, or on the basis of responses on QMEForm 117 (Qualified Medical Evaluator Contin-uing Education Response Form) (see, 8 Cal.Code Regs. § 117). An auditor shall not receiveQME credit for auditing a course. The Admin-istrative Director shall make written results ofthe audit available to the provider no more than30 days after the audit is completed.

(q) Accredited providers that cease to offerdisability evaluation report writing courses shallnotify the Administrative Director in writing nolater than 60 days prior to the discontinuing anapproved course.

(r) The Administrative Director may with-draw accreditation of a provider or deny such aprovider’s application for accreditation on thefollowing grounds (in addition to failure to meetthe relevant requirements of subsections 11.5(a):

(1) Conviction of a felony or any offensesubstantially related to the activities of theprovider.

(2) Any material misrepresentation of factmade by the provider.

(3) Failure to comply with AdministrativeDirector regulations.

(4) False or misleading advertising.(5) Failure to comply with Administrative

Director’s recommendations following an audit.(6) Failure to distribute QME Form 117

(Qualified Medical Evaluator Continuing Edu-cation Response Form) (see, 8 Cal. Code Regs.§ 117) cards to course attendees.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2, 4060,4061, 4062, 4062.1, 4062.2 and 5307.3, Labor Code.Reference: Sections 139.2, 4060, 4061, 4061.5, 4062,4062.1, 4062.2, 4062.3 and 4067, Labor Code.

History: 1. New section filed 10-16-2000 as anemergency; operative 1-1-2001 (Register 2000, No.42). A Certificate of Compliance must be transmittedto OAL by 5-1-2001 or emergency language will berepealed by operation of law on the following day.2. New section refiled 5-2-2001 as an emergency;operative 5-2-2001 (Register 2001, No. 18). A Certif-icate of Compliance must be transmitted to OAL by8-30-2001 or emergency language will be repealed byoperation of law on the following day.3. Certificate of Compliance as to 5-2-2001 order,including further amendment of section, transmitted toOAL 7-12-2001 and filed 8-23-2001 (Register 2001,No. 34).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§12. Recognition of Specialty Boards.The Administrative Director shall recognize

only those specialty boards recognized by therespective California licensing boards for phy-sicians as defined in Labor Code section 3209.3.

Note: Authority cited: Sections 133, 139.2, 139.4,139.43, 139.45 and 5307.3, Labor Code. Reference:Sections 139.2(b)(3)(A) and 3209.3, Labor Code;Section 651(i), Business and Professions Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).


§13. Physician’s Specialty.A physician’s specialty(ies) is one for which

the physician is board certified or, one for whicha medical doctor or doctor of osteopathy hascompleted a postgraduate specialty training asdefined in Section 11(a)(2)(A) or held an ap-pointment as a QME in that specialty on June30, 2000, pursuant to Labor Code Section 139.2.To be listed as a QME in a particular specialty,the physician’s licensing board must recognizethe designated specialty board and the applicantfor QME status must have provided to theAdministrative Director documentation from therelevant board of certification or qualification.

Note: Authority cited: Sections 133, 139.2, 139.4,139.43, 139.45 and 5307.3, Labor Code. Reference:Section 139.2(b)(3)(A), Labor Code; and Section651(i), Business and Professions Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Amendment filed 8-23-2001; operative 8-23-2001pursuant to Government Code section 11343.4 (Reg-ister 2001, No. 34).5. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§14. Doctors of Chiropractic:Certification in Workers’Compensation Evaluation.

(a) All doctors of chiropractic shall be cer-tified in workers’ compensation evaluation byeither a California professional chiropractic as-sociation, or an accredited California collegerecognized by the Administrative Director. Thecertification program shall include instruction indisability evaluation report writing that meetsthe standards set forth in section 11.5.

(b) California professional chiropractic as-sociations or accredited California colleges ap-plying to be recognized by the AdministrativeDirector for the purpose of providing theserequired courses to chiropractors in Californiaworkers’ compensation evaluation, shall meetthe following criteria:

(1) The provider’s courses shall be admin-istered and taught by a California professionalchiropractic association or a California chiro-practic college accredited by the Council onChiropractic Education. Instructors shall be li-censed or certified in their profession or if a

member of a non-regulated profession have atleast two years experience in their area ofinstruction regarding workers’ compensation is-sues.

(2) The provider’s method of instructionand testing shall include all of the following:

(A) Lecture, didactic sessions and groupdiscussion including an initial 8 hours of over-view of the workers’ compensation system and36 additional hours in medical-legal issues fortotal minimum class time of 44 hours. Up to 4hours of the instruction covering the regulationsaffecting QMEs and/or writing ratable reportsmay be satisfied by distance learning. The initial8 hours of overview are transferable to any otherapproved program provider for credit;

(B) Passing a written test at the completionof the program to determine proficiency andapplication of course material;

(C) Writing a narrative conclusion to med-ical-legal issues in response to facts presented ora narrative report, in appropriate format, whichwould meet the standards of a ratable report;

(3) The initial 8 hours of the course mate-rial shall cover the following information:

(A) Overview of California Labor Code,DWC (Division of Workers’ Compensation ofthe California Department of Industrial Rela-tions) and the regulations of the Division ofWorkers’ Compensation and of the Workers’Compensation Appeals Board governing QMEs,medical-legal reports and evaluations;

(B) Obligations of the treating and evaluat-ing physicians;

(C) Review of appropriate workers’ com-pensation terminology;

(4) The remaining 36 hours shall includebut not be limited to the following:

(A) History and examination procedure re-quirements, including all relevant treatment,treatment utilization and evaluation guidelinesand regulations adopted by the AdministrativeDirector;

(B) The subjects outlined in subdivision11.5(i) not already addressed in the first 8 hours,including but not limited to, proper use of theAMA Guides, the medical treatment utilizationschedule (MTUS) adopted pursuant to LaborCode section 5307.27, and relevant portions ofthe ACOEM practice guidelines;

(C) Apportionment, including the changesin Labor Code sections 4660, 4663 and 4664 bySB 899 (Stats. 2004, ch. 34);


(D) Vocational rehabilitation;(E) Continued and future medical care.(5) The provider’s course material and tests

shall be submitted to the Administrative Direc-tor for annual review and the AdministrativeDirector shall monitor a provider’s course asnecessary to determine if the provider meets thecriteria for recognition.

(6) The provider’s course advertising shallclearly state whether or not the course is recog-nized to satisfy the requirement for chiropracticCalifornia workers’ compensation evaluation bythe Administrative Director.

(c) Course Material shall also cover at aminimum, the material within the text of the“Physicians Guide to Medical Practice in theCalifornia Workers’ Compensation System(Current Edition).”

(d) No one shall recruit members or pro-mote commercial products or services in theinstruction room immediately before, during, orimmediately after the presentation of a course.Education providers or vendors may display/selleducational materials related to workers’ com-pensation or applications for membership in anarea adjoining a course. A course provider orfaculty member shall disclose on QME Form119 (Faculty Disclosure of Commercial Interest)(see, 8 Cal. Code Regs. §119) any significantfinancial interest held by faculty in or affiliationwith any commercial product or service which isdiscussed in a course and that interest or affili-ation must be disclosed to all attendees. Aneducation provider shall file every Form 119 inits possession with the Administrator Director.NOTE: The “Physicians’ Guide” does not ap-pear as a part of this regulation. Copies areavailable through the Medical Director Divisionof Workers’ Compensation, Attention: MedicalUnit, P. O. Box 71010, Oakland, CA 94612.

Note: Authority cited: Sections 122, 133, 139.2,139.3 and 5307.3, Labor Code. Reference: Sections139.2, 4060, 4061, 4062, 4062.1, 4062.2, 4062.3 and4067, Labor Code.

History: 1. New section filed 4-9-93 as an emer-gency; operative 4-9-93 (Register 93, No. 15). ACertificate of Compliance must be transmitted to OAL8-9-93 or emergency language will be repealed byoperation of law on the following day.2. Editorial correction amending subsections (a)(1)and (b) and Note (Register 93, No. 17).3. New section refiled 9-16-93 with amendment ofsubsections (a)(1)-(b) as an emergency; operative9-16-93 (Register 93, No. 38). A Certificate of Com-

pliance must be transmitted to OAL by 1-14-94 oremergency language will be repealed by operation oflaw on the following day.4. Certificate of Compliance as to 9-16-93 orderincluding amendment of subsections (b) and (c) trans-mitted to OAL 10-28-93 and filed 12-14-93 (Register93, No. 51).5. Relocation of article 2 filed 8-1-94; operative8-31-94 (Register 94, No. 31).6. Amendment of subsections (a)(1) and (a)(2), re-pealer of subsections (b)-(b)(2) and subsection relet-tering, and amendment of newly designated subsec-tions (b) and (c) filed 8-23-96; operative 9-22-96(Register 96, No. 34).7. Amendment filed 6-7-99 as an emergency; opera-tive 6-7-99 (Register 99, No. 24). A Certificate ofCompliance must be transmitted to OAL by 10-5-99or emergency language will be repealed by operationof law on the following day.8. Reinstatement of section as it existed prior to6-7-99 emergency amendment by operation of Gov-ernment Code section 11346.1(f) (Register 2000, No.3).9. Amendment filed 1-19-2000; operative 1-19-2000pursuant to Government Code section 11343.4(d)(Register 2000, No. 3).10. Renumbering of former section 14 to section 16filed 4-14-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 15).11. Renumbering and amendment of former section13.5 to section 14 filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).12. Amendment of subsections (a), (b), (b)(4) and(b)(6) and redesignation and amendment of formersubsection (b)(7) as new subsection (c) filed 8-23-2001; operative 8-23-2001 pursuant to GovernmentCode section 11343.4 (Register 2001, No. 34).13. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§15. Appointment of Retired orTeaching Physicians.

In order to be considered for appointment as aQME pursuant to Labor Code Section 139.2(c),a physician shall pass the QME competencyexamination and submit written documentationto the Administrative Director that he or shemeets either (a), (b) or (c) of this section.

The physician shall:(a) Be a current salaried faculty member at

an accredited university or college, have acurrent license to practice as a physician and beengaged in teaching, lecturing, published writ-ing or medical research at that university orcollege in the area of his or her specialty for notless than one-third of his or her professional


time. The physician’s practice in the three con-secutive years immediately preceding the timeof application shall not have been devoted solelyto the forensic evaluation of disability.

(b) Be retired from full-time practice; re-tain a current license to practice in California asa physician with his or her licensing board; and

(1) Have a minimum of 25 years’ experi-ence in his or her practice as a physician; and

(2) Have had a minimum of 10 years’experience in workers’ compensation medicalissues; and

(3) Be practicing currently fewer than 10hours per week on direct medical treatment as aphysician; and

(4) Not have engaged in a practice devotedsolely to the forensic evaluation of disabilityduring the three consecutive years immediatelypreceding the time of application.

(c) Be retired from active practice due to adocumented medical or physical disability asdefined pursuant to Government Code section12926 and currently practice in his or herspecialty fewer than 10 hours per week. Thephysician shall have 10 years experience inworkers’ compensation medical issues as a phy-sician. The physician’s practice in the threeconsecutive years immediately preceding thetime of application shall not have been devotedsolely to the forensic evaluation of disability.

(d) A physician appointed under section 11of Title 8 of the California Code of Regulationsor this section shall, notify the AdministrativeDirector of changes in his or her status and shallcomplete the requirements for continuing edu-cation pursuant to section 55 of Title 8 of theCalifornia Code of Regulations prior to reap-pointment.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Section 139.2, LaborCode.

History: 1. New section filed 4-9-93 as an emer-gency; operative 4-9-93 (Register 93, No. 15). ACertificate of Compliance must be transmitted to OAL8-9-93 or emergency language will be repealed byoperation of law on the following day.2. Editorial correction amending subsection (b) andNote (Register 93, No. 17).3. New section refiled 9-16-93 with amendment ofsubsections (a)(1)-(b) as an emergency; operative9-16-93 (Register 93, No. 38). A Certificate of Com-pliance must be transmitted to OAL by 1-14-94 oremergency language will be repealed by operation oflaw on the following day.

4. Certificate of Compliance as to 9-16-93 orderincluding amendment of subsection (b) transmitted toOAL 10-28-93 and filed 12-14-93 (Register 93, No.51).5. Amendment filed 6-7-99 as an emergency; opera-tive 6-7-99 (Register 99, No. 24). A Certificate ofCompliance must be transmitted to OAL by 10-5-99or emergency language will be repealed by operationof law on the following day.6. Reinstatement of section as it existed prior to6-7-99 emergency amendment by operation of Gov-ernment Code section 11346.1(f) (Register 2000, No.3).7. Amendment filed 1-19-2000; operative 1-19-2000pursuant to Government Code section 11343.4(d)(Register 2000, No. 3).8. Renumbering of former section 15 to section 17filed 4-14-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 15).9. Renumbering and amendment former section 13.7to section 15 filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).10. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§16. Determination of Fees for QMEEligibility.

(a) For purposes of establishing the annualfee for any qualified medical evaluator pursuantto Article 2, physicians (as defined under Sec-tion 3209.3 of the Labor Code) shall be classi-fied into one of three categories:

(1) QMEs who meet all applicable require-ments under Article 2 and 5 and who haveconducted 0-10 comprehensive medical-legalevaluations in the twelve months prior to theassessment of the fee. Comprehensive medical-legal evaluations are evaluations as definedunder Section (1)(i) of this Chapter performedby a physician.

(2) QMEs who meet all applicable require-ments under Article 2 and 5 and who haveconducted 11-24 comprehensive medical-legalevaluations in the twelve months prior to assess-ment of the fee. Comprehensive medical-legalevaluations are evaluations as defined underSection (1)(i) of this Chapter performed by aphysician.

(3) QMEs who meet all applicable require-ments under Article 2 and 5 and who haveconducted 25 or more comprehensive medical-legal evaluations in the twelve months prior toassessment of the fee. Comprehensive medical-legal evaluations are evaluations as defined


under Section (1)(i) of this Chapter performedby a physician.

(b) The evaluations shall be conducted incompliance with all applicable statutes andregulations.

(c) Verification of the number of examina-tions shall be made by the Administrative Di-rector using The Qualified or Agreed MedicalEvaluator Findings Summary Form in section111 (See, 8 Cal. Code Regs. § 111), as well asany other relevant records or sources of infor-mation. Misrepresentation of the number ofevaluations performed for purposes of establish-ing a physician’s QME fee shall constitutegrounds for disciplinary proceedings under sec-tion 60 of this chapter.NOTE: Form referred to above is available at nocharge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at1-800-794-6900.


History: 1. New section filed 4-9-93 as an emer-gency; operative 4-9-93 (Register 93, No. 15). ACertificate of Compliance must be transmitted to OAL8-9-93 or emergency language will be repealed byoperation of law on the following day.2. Editorial correction amending Note (Register 93,No. 17).3. New section refiled 9-16-93 with amendment ofsubsection (a) as an emergency; operative 9-16-93(Register 93, No. 38). A Certificate of Compliancemust be transmitted to OAL by 1-14-94 or emergencylanguage will be repealed by operation of law on thefollowing day.4. Certificate of Compliance as to 9-16-93 orderincluding amendments transmitted to OAL 10-28-93and filed 12-14-93 (Register 93, No. 51).5. Amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).6. Amendment filed 6-7-99 as an emergency; opera-tive 6-7-99 (Register 99, No. 24). A Certificate ofCompliance must be transmitted to OAL by 10-5-99or emergency language will be repealed by operationof law on the following day.7. Reinstatement of section as it existed prior to6-7-99 emergency amendment by operation of Gov-ernment Code section 11346.1(f) (Register 2000, No.3).8. Amendment filed 1-19-2000; operative 1-19-2000pursuant to Government Code section 11343.4(d)(Register 2000, No. 3).9. Renumbering of former section 16 to section 18and renumbering of former section 14 to number 16

filed 4-14-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 15).10. Amendment of subsection (c) and Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§17. Fee Schedule for QME.(a) All physicians seeking QME status

shall be required to pay to the Workers’ Com-pensation Administration Revolving Fund, thefollowing fee:

(1) QMEs performing 0-10 comprehensivemedical-legal evaluations, $110 during each ofthe years or any part of a year the physicianretains his or her eligibility on the approvedQME list.

(2) QMEs performing 11-24 comprehen-sive medical-legal evaluations, $125 duringeach of the years or any part of a year thephysician retains his or her eligibility on theapproved QME list.

(3) QMEs performing 25 or more compre-hensive medical-legal evaluations, $250 duringeach of the years or any part of a year thephysician retains his or her eligibility on theapproved QME list.

(b) Individual QMEs who perform compre-hensive medical-legal evaluations at more thanone physician’s office location shall be requiredto pay an additional $100 annually per addi-tional office location. Each physician’s officelisted with the Medical Director must be locatedwithin California, be identified by a street ad-dress and any other more specific location suchas a suite or room number, and must contain theusual and customary equipment for the type ofevaluation appropriate to the QME’s medicalspecialty or scope of practice. This requirementapplies to all QMEs regardless of whether theQME is a sole practitioner, or corporation, orpartnership pursuant to Corporations CodeChapter 2 (sections 15501-15533), Chapter 3(sections 15611-15723) and/or Chapter 5 (sec-tions 16100-16962).

(c) The Administrative Director may waiveor return the statutory fee in the amount of $110for the completion of a survey of QMEs tovalidate the QME competency examination. Theterm “completion of the survey” means thereturn of the survey to the testing agency des-ignated by the Administrative Director on orbefore the date for the return of the survey.

(d) At the time of paying the appropriateQME annual fee, each QME shall also complete


and forward to the Medical Director with theannual fee a completed QME SFI Form 124,providing updated information about the QME’sspecified financial interests as defined in section29 of Title 8 of the California Code of Regula-tions.


History: 1. New section filed 4-9-93 as an emer-gency; operative 4-9-93 (Register 93, No. 15). ACertificate of Compliance must be transmitted to OAL8-9-93 or emergency language will be repealed byoperation of law on the following day.2. Editorial correction amending Note (Register 93,No. 17).3. New section refiled 9-16-93 with amendments asan emergency; operative 9-16-93 (Register 93, No.38). A Certificate of Compliance must be transmittedto OAL by 1-14-94 or emergency language will berepealed by operation of law on the following day.4. Certificate of Compliance as to 9-16-93 orderincluding amendments transmitted to OAL 10-28-93and filed 12-14-93 (Register 93, No. 51).5. Renumbering former section 17 to new section 19filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).6. Renumbering of former section 15 to section 17filed 4-14-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 15).7. New subsection (c) and amendment of Note filed2-14-2002 as an emergency; operative 2-14-2002(Register 2002, No. 7). A Certificate of Compliancemust be transmitted to OAL by 6-14-2002 or emer-gency language will be repealed by operation of lawon the following day.8. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§18. QME Fee Due Dates.(a) All physicians, regardless of the num-

ber of comprehensive medical-legal evaluationsperformed under section 17 of Title 8 of theCalifornia Code of Regulations shall pay therequired QME fees at yearly intervals within 30days of receipt of notice from the AdministrativeDirector that the QME fee for the next 12months is due and payable. No physician whohas passed the competency examination shall beplaced on the active QME roster until theappropriate fee under section 17 has been paid.

(b) Any QME who fails to pay the requiredstatutory fee within 30 days of receipt of a finalnotice that the fee is due shall be notified that heor she shall be terminated from the official QMEroster of physicians within 30 days and shall not

perform any panel QME or represented QMEcomprehensive medical-legal evaluation untilthe fee is paid.

(c) If the QME fee is not paid within twoyears from the due date in the final fee noticefrom the Administrative Director to the QME orQME applicant that the fee is due, then thephysician shall resubmit a new application pur-suant to Sections 10 and 11 of Title 8 of theCalifornia Code of Regulations, pass the QMEcompetency examination and pay the appropri-ate fee prior to regaining or obtaining QMEactive status.


History: 1. New section filed 4-9-93 as an emer-gency; operative 4-9-93 (Register 93, No. 15). ACertificate of Compliance must be transmitted to OAL8-9-93 or emergency language will be repealed byoperation of law on the following day.2. Editorial correction amending subsections (b) and(b)(1) and Note (Register 93, No. 17).3. New section refiled 9-16-93 with amendment ofsection heading and text as an emergency; operative9-16-93 (Register 93, No. 38). A Certificate of Com-pliance must be transmitted to OAL by 1-14-94 oremergency language will be repealed by operation oflaw on the following day.4. Certificate of Compliance as to 9-16-93 orderincluding amendments transmitted to OAL 10-28-93and filed 12-14-93 (Register 93, No. 51).5. Repealer filed 8-23-96; operative 9-22-96 (Register96, No. 34).6. Renumbering of former section 16 to section 18filed 4-14-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 15).7. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§19. Certificate of QME Status.(a) Upon receipt of the QME fees and

review by the Administrative Director to ensurecurrent compliance with section 139.2 of LaborCode and any other applicable regulations pro-mulgated by the Administrative Director con-cerning QME eligibility, the Administrative Di-rector shall within 45 days send to the physiciana Qualified Medical Evaluator certificate. TheQME certificate shall be displayed in a conspic-uous manner at the QME’s office location at alltimes during the period the QME is appointedby the Administrative Director to conduct evalu-ations.


(b) It shall be unlawful for any physicianwho has been terminated or suspended from theQME list or who has failed to pay the requiredQME fee pursuant to sections 17 and 18 of Title8 of the California Code of Regulations todisplay a Qualified Medical Evaluator certifi-cate.


History: 1. Renumbering and amendment of for-mer section 17 to new section 19 filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

ARTICLE 2.5

Time Periods for Processing

Applications for QME Status

§20. Time Periods.(a) Within 45 days of receipt of an appli-

cation for QME status, the Administrative Di-rector shall either inform the applicant, in writ-ing, that the application is complete and ac-cepted for filing, or that the application isdeficient and what specific information is re-quired.

(b) Within 45 days of receipt of a com-pleted application, the Administrative Directorshall inform the applicant, in writing, of itsdecision to allow or not to allow the applicant toproceed to take the required QME competencyexamination as per Section 11(f) of Title 8 of theCalifornia Code of Regulations.

(c) Within 45 days of receipt of a com-pleted application, the Administrative Directormust inform the applicant, in writing, of itsdecision to grant or deny the application.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 4060, 4061,4062, 4062.1, 4062.2 and 4067, Labor Code.

History: 1. New article 2.5 and section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

ARTICLE 3

Assignment of Qualified Medical

Evaluators, Evaluation Procedure

§29. Specified Financial Interests ThatMay Affect Assignment to QME Panels.

(a) Every physician seeking appointment orreappointment as a Qualified Medical Evaluator

shall disclose specified financial interests, asdefined in section 1(dd) and 29(b) of Title 8 ofthe California Code of Regulations.

(b) “Specified Financial Interests” meansbeing a general partner or limited partner in, orhaving an interest of five (5) percent or more in,or receiving or being legally entitled to receive ashare of five (5) percent or more of the profitsfrom, any medical practice, group practice, med-ical group, professional corporation, limited li-ability corporation, clinic or other entity thatprovides treatment or medical evaluation, goodsor services for use in the California workers’compensation system.

(c) “SFI Form 124”, as used in sections 1though 159 of Title 8 of the California Code ofRegulations, means the QME SFI Form 124 thatis completed and filed as an attachment to QMEForm 100, 103 or 104 by the physician or QMEwith the Medical Director of the Division ofWorkers’ Compensation.

(d) Specified financial interests shall bedisclosed on QME SFI Form 124, respectively,when applying for appointment on QME Form100, at the time of paying the annual fee onQME Form 103 or when applying for reappoint-ment on QME Form 104.

(e) The completed QME SFI Form 124shall be filed along with the QME Form 100,103 or 104, respectively, when the form is filedwith the Medical Director of the Division ofWorkers’ Compensation.

(f) Failure of a Qualified Medical Evaluatorto complete and file a QME SFI Form 124 withthe Medical Director when required by thissection shall be grounds for disciplinary actionpursuant to section 60 of Title 8 of the CaliforniaCode of Regulations.

(g) The Administrative Director shall usethe information provided by physicians pursuantto this section to avoid assigning QMEs whoshare specified financial interests to the sameQME panel. If two or more QMEs assigned to apanel share specified financial interests as de-fined in this section, any party may request areplacement QME. If three QMEs share speci-fied financial interests as defined in this section,two of the QMEs shall be replaced. If twoQMEs share specified financial interests as de-fined in this section, one of the QMEs shall bereplaced. The QMEs that must be replaced shallbe randomly selected by the Medical Director.


NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2 and 4067, Labor Code.

History: 1. New section filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§30. QME Panel Requests.(a) Unrepresented cases. Whenever an in-

jured worker is not represented by an attorneyand either the employee or the claims adminis-trator requests a QME panel pursuant to LaborCode section 4062.1, the request shall be sub-mitted on the form in section 105 (Request forQME Panel under Labor Code Section 4062.1)(See, 8 Cal. Code Regs. § 105). The claimsadministrator (or if none the employer) shallprovide Form 105 along with the Attachment toForm 105 (How to Request a Qualified MedicalEvaluator if you do not have an Attorney) to theunrepresented employee by means of personaldelivery or by first class or certified mailing.

(b) Represented cases. Requests for a QMEpanel in a represented case, for all cases with adate of injury on or after January 1, 2005, andfor all other cases where represented partiesagree to obtain a panel of Qualified MedicalEvaluators pursuant to the process in LaborCode section 4062.2, shall be submitted on theform in section 106 (Request for a QME Panelunder Labor Code Section 4062.2) (See, 8 Cal.Code Regs. § 106). The party requesting a QMEpanel shall: 1) identify the disputed issue thatrequires a comprehensive medical/legal reportto be resolved; 2) attach a copy of the writtenproposal, naming one or more physicians to bean Agreed Medical Evaluator, that was sent tothe opposing party once the dispute arose; 3)designate a specialty for the QME panel re-quested; 4) state the specialty preferred by theopposing party, if known; and 5) state thespecialty of the treating physician. In repre-sented cases with dates of injury prior to January1, 2005, and only upon the parties’ agreement toobtain a QME panel pursuant to Labor Codesection 4062.2, the party requesting a QMEpanel shall submit QME Form 106 in compli-ance with this section and provide written evi-dence of the parties’ agreement. Once such apanel in a represented case with a date of injuryprior to January 1, 2005, is issued, the parties

shall be bound by the timelines and process asdescribed in Labor Code section 4062.2.

(c) In the event a request form is incom-plete, or improperly completed, so that a QMEpanel selection cannot properly be made, therequest form shall be returned to the requestingparty with an explanation of why the QMEpanel selection could not be made. The MedicalDirector also may delay issuing a new QMEpanel, if necessary, until the Medical Directorreceives additional reasonable information re-quested from a party or both parties, needed toresolve the panel request. Reasonable informa-tion as used in this subdivision includes but isnot limited to whether a QME panel previouslyissued to the injured worker was used.

(d)(1) After a claim form has been filed, theclaims administrator, or if none the employer,may request a panel of Qualified Medical Evalu-ators only as provided in Labor Code section4060, to determine whether to accept or reject aclaim within the ninety (90) day period forrejecting liability in Labor Code section5402(b), and only after providing evidence ofcompliance with Labor Code Section 4062.1 or4062.2.

(d)(2) Once the claims administrator, or ifnone the employer, has accepted as compensa-ble injury to any body part in the claim, arequest for a panel QME may only be filedbased on a dispute arising under Labor Codesection 4061 or 4062.

(d)(3) Whenever an injury or illness claimof an employee has been denied entirely by theclaims administrator, or if none by the employer,only the employee may request a panel ofQualified Medical Evaluators, as provided inLabor Code sections 4060(d) and 4062.1 ifunrepresented, or as provided in Labor Codesections 4060(c) and 4062.2 if represented.

(d)(4) After the ninety (90) day periodspecified in Labor Code section 5402(b) fordenying liability has expired, a request from theclaims administrator, or if none from the em-ployer, for a QME panel to determine compen-sability shall only be issued upon presentation ofa finding and decision issued by a Workers’Compensation Administrative Law Judge thatthe presumption in section 5402(b) has beenrebutted and an order that a QME panel shouldbe issued to determine compensability. Theorder shall also specify the residential or, ifapplicable, the employment-based zip code


from which to select evaluators and either themedical specialty of the panel or which partymay select the medical specialty.

(e) If the request form is submitted by or onbehalf of an employee who no longer resideswithin the state of California, the geographicarea of the QME panel selection within the stateshall be determined by agreement between theclaims administrator, or if none the employer,and the employee. If no agreement can bereached, the geographic area of the QME panelselection shall be determined for an unrepre-sented employee by the employee’s former res-idence within the state, and for a representedemployee by the office of the employee’s attor-ney.

(f) To compile a panel list of three (3)independent QMEs randomly selected from thespecialty designated by the party holding thelegal right to request a QME panel, the MedicalDirector shall exclude from the panel, to theextent feasible, any QME who is listed byanother QME as a business partner or as havinga shared specified financial interest, as thoseterms are defined in sections 1 and 29 of Title 8of the California Code of Regulations.

(g) The panel request in a represented casemust be sent to the Medical Unit address on theQME Form 106 by means of first class maildelivered by the United States postal service.The Medical Unit will not accept panel requestsin represented cases that are delivered in personby a party, the party’s attorney, any other personor by other commercial courier or deliveryservices.

(h) The time periods specified in LaborCode sections 4062.1(c) and 4062.2(c), respec-tively, for selecting an evaluator from a QMEpanel and for scheduling an appointment, shallbe tolled whenever the Medical Director asks aparty for additional information needed to re-solve the panel request. These time periods shallremain tolled until the date the Medical Directorissues either a new QME panel or a decision onthe panel request.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2, 4061,4062 and 5307.3, Labor Code. Reference: Sections139.2, 4061, 4062, 4062.1, 4062.2, 4062.3, 4064 and4067, Labor Code.

History: 1. New article 3 and section filed 8-1-94;operative 8-31-94 (Register 94, No. 31).2. Amendment of subsection (b) and new subsections(d)-(e) filed 8-23-96; operative 9-22-96 (Register 96,No. 34).3. Amendment of subsections (a), (c) and (d)(1) filed4-14-2000; operative 5-14-2000 (Register 2000, No.15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§30.5. Specialist Designation.The Medical Director shall utilize in the QME

panel selection process the type of specialist(s)indicated by the requestor on the Request forQualified Medical Evaluator Form 105 or 106 ofTitle 8 of the California Code of Regulations,unless otherwise provided in these regulations.

Note: Authority cited: Sections 133, 139.2, 4061,4062 and 5307.3, Labor Code. Reference: Sections139.2, 4061, 4062, 4062.1, 4062.2, 4064 and 4067,Labor Code.

History: 1. Renumbering and amendment of for-mer section 32 to new section 30.5 filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§31. QME Panel Selection.(a) The panels shall be selected randomly

from the appropriate specialty identified by theparty who holds the legal right to designate thespecialty, with consideration given to the prox-imity of the QME’s medical office to the em-ployee’s residence.

(b) The Medical Director shall excludefrom the panel selection process any QME whohas informed the Medical Director that he or sheis unavailable pursuant to section 33 of Title 8 ofthe California Code of Regulations.

(c) Any physician who has served as aprimary treating physician or secondary physi-cian and who has provided treatment to theemployee in accordance with section 9785 ofTitle 8 of the California Code of Regulations forthe disputed injury shall not perform a QMEevaluation on that employee. Whenever thatphysician’s name appears on a QME panel, heor she shall disqualify him or herself if con-tacted by a party to perform the evaluation.Either party may request a replacement QMEfor this reason pursuant to section 31.5 of Title8 of the California Code of Regulations.


(d) To issue a panel in a selected specialtythere shall be at least five active QMEs in thespecialty at the time the panel selection isrequested. In the event less than five QMEs areactive in a requested specialty, the MedicalDirector shall contact the party who holds thelegal right to designate the specialty for analternate specialty selection.

Note: Authority cited: Sections 133, 139.2, 4061,4062 and 5307.3, Labor Code. Reference: Sections139.2, 4060, 4061, 4062, 4062.1, 4062.2, 4064 and4067, Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Repealer of subsection (d) and subsection reletter-ing, and amendment of newly designated subsection(d) filed 8-23-96; operative 9-22-96 (Register 96, No.34).3. Amendment of subsections (b) and (d) filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§31.1. QME Panel Selection Disputesin Represented Cases.

(a) When the Medical Director receivestwo or more panel selection forms pursuant toLabor Code section 4062.2 on the same day andthe forms designate different physician special-ties for the QME panel, the Medical Directorshall use the following procedures:

1) If one party requests the same specialtyas that of the treating physician, the panel shallbe issued in the specialty of the treating physi-cian unless the Medical Director is persuaded bysupporting documentation provided by the re-questor that explains the medical basis for therequested specialty;

2) If no party requests a panel in the spe-cialty of the treating physician, the MedicalDirector shall select a specialty appropriate forthe medical issue in dispute and issue a panel inthat specialty.

3) Upon request by the Medical Director,the party requesting the panel shall provideadditional medical records to assist the MedicalDirector in determining the appropriate spe-cialty.

(b) In the event a party in a representedcase wishes to request a QME panel pursuant toLabor Code section 4062.2 in a specialty otherthan the specialty of the treating physician, theparty shall submit with the panel request formany relevant documentation supporting the rea-son for requesting a different specialty.

(c) In the event the Medical Director isunable to issue a QME panel in a representedcase within thirty (30) calendar days of receiv-ing the request, either party may seek an orderfrom a Workers’ Compensation AdministrativeLaw Judge that a QME panel be issued. Anysuch order shall specify the specialty of theQME panel or the party to be designated toselect the specialty.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 4060, 4061,4062, 4062.2, 4064 and 4067, Labor Code.

History: 1. New section filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3). For prior history,see Register 2000, No. 15.

§31.3. Scheduling Appointment withPanel QME.

(a) When the employee is not representedby an attorney, the unrepresented employeeshall, within ten (10) days of having beenfurnished with the form, select a QME from thepanel list, contact the QME to schedule anappointment and inform the claims administra-tor of the QME selection and the appointment.

(b) Neither the employer, nor the claimsadministrator nor any other representative of theemployer shall discuss the selection of the QMEwith an unrepresented worker who has the legalright to select the QME.

(c) If, within ten (10) days of the issuanceof a QME panel, the unrepresented employeefails to select a QME from the QME panel orfails to schedule an appointment with the se-lected QME, the claims administrator mayschedule an appointment with a panel QMEonly as provided in Labor Code section4062.1(c), and shall notify the employee of theappointment as provided in that section.

(d) Whenever the employee is representedby an attorney and the parties have completedthe conferring and striking processes describedin Labor Code section 4062.2(c), the repre-sented employee shall schedule the appointmentwith the physician selected from the QMEpanel. If the represented employee fails to do sowithin ten (10) business days of the date a QMEis selected from the panel, the claims adminis-trator or administrator’s attorney may arrangethe appointment and notify the employee andemployee’s attorney.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 4060, 4061,4062, 4062.1, 4062.2, 4064 and 4067, Labor Code.



§31.5. QME Replacement Requests.(a) A replacement QME to a panel, or at the

discretion of the Medical Director a replacementof an entire panel of QMEs, shall be selected atrandom by the Medical Director and providedupon request whenever any of the followingoccurs:

(1) A QME on the panel issued does notpractice in the specialty requested by the partyholding the legal right to request the panel.

(2) A QME on the panel issued cannotschedule an examination for the employeewithin sixty (60) days of the initial request foran appointment, or if the 60 day scheduling limithas been waived pursuant to section 33(e) ofTitle 8 of the California Code of Regulations,the QME cannot schedule the examinationwithin ninety (90) days of the date of the initialrequest for an appointment.

(3) The injured worker has changed his orher residence address since the QME panel wasissued and prior to date of the initial evaluationof the injured worker.

(4) A physician on the QME panel is amember of the same group practice as definedby Labor Code section 139.3 as another QMEon the panel.

(5) The QME is unavailable pursuant tosection 33 (Unavailability of the QME).

(6) The evaluator who previously reportedin the case is no longer available.

(7) A QME named on the panel is currently,or has been, the employee’s primary treatingphysician or secondary physician as described insection 9785 of Title 8 of the California Code ofRegulations for the injury currently in dispute.

(8) The claims administrator, or if none theemployer, and the employee agree in writing, forthe employee’s convenience only, that a newpanel may be issued in the geographic area ofthe employee’s work place and a copy of theemployee’s agreement is submitted with thepanel replacement request.

(9) The Medical Director, upon written re-quest, finds good cause that a replacement QMEor a replacement panel is appropriate for reasonsrelated to the medical nature of the injury. Forpurposes of this subsection, “good cause” isdefined as a documented medical or psycholog-ical impairment.

(10) The Medical Director, upon writtenrequest, filed with a copy of the Doctor’s FirstReport of Occupational Injury or Illness (FormDLSR 5021 [see 8 Cal. Code Regs. §§ 14006and 14007) and the most recent DWC FormPR-2 (“Primary Treating Physician’s ProgressReport” [See 8 Cal. Code Regs. § 9785.2) ornarrative report filed in lieu of the PR-2, deter-mines after a review of all appropriate recordsthat the specialty chosen by the party holdingthe legal right to designate a specialty is medi-cally or otherwise inappropriate for the disputedmedical issue(s). The Medical Director mayrequest either party to provide additional infor-mation or records necessary for the determina-tion.

(11) The evaluator has violated section 34(Appointment Notification and Cancellation) ofTitle 8 of the California Code of Regulations,except that the evaluator will not be replaced forthis reason whenever the request for a replace-ment by a party is made more than fifteen (15)calendar days from either the date the partybecame aware of the violation of section 34 ofTitle 8 of the California Code of Regulations orthe date the report was served by the evaluator,whichever is earlier.

(12) The evaluator failed to meet the dead-lines specified in Labor Code section 4062.5 andsection 38 (Medical Evaluation Time Frames) ofTitle 8 of the California Code of Regulationsand the party requesting the replacement ob-jected to the report on the grounds of latenessprior to the date the evaluator served the report.A party requesting a replacement on this groundshall attach to the request for a replacement acopy of the party’s objection to the untimelyreport.

(13) The QME has a disqualifying conflictof interest as defined in section 41.5 of Title 8 ofthe California Code of Regulations.

(14) The Administrative Director has is-sued an order pursuant to section 10164(c) ofTitle 8 of the California Code of Regulations(order for additional QME evaluation).

(15) The selected medical evaluator, whootherwise appears to be qualified and competentto address all disputed medical issues refuses toprovide, when requested by a party or by theMedical Director, either: A) a complete medicalevaluation as provided in Labor Code sections4062.3(i) and 4062.3(j), or B) a written state-ment that explains why the evaluator believes he


or she is not medically qualified or medicallycompetent to address one or more issues indispute in the case.

(16) The QME panel list was issued morethan twenty four (24) months prior to the datethe request for a replacement is received by theMedical Unit, and none of the QMEs on thepanel list have examined the injured worker.

(b) Whenever the Medical Director deter-mines that a request made pursuant to subdivi-sion 31.5(a) for a QME replacement or QMEpanel replacement is valid, the time limit for anunrepresented employee to select a QME andschedule an appointment under section LaborCode section 4062.1(c) and the time limit for arepresented employee to strike a QME namefrom the QME panel under Labor Code section4062.2(c), shall be tolled until the date thereplacement QME name or QME panel is is-sued.

(c) In the event the parties in a representedcase have struck two QME names from a paneland subsequently a valid ground under subdivi-sion 31.5 arises to replace the remaining QME,none of the QMEs whose names appeared on theearlier QME panel shall be included in thereplacement QME panel.

Note: Authority cited: Sections 133, 139.2, 4061,4062, 4062.3, 4062.5, 5307.3 and 5703.5, Labor Code.Reference: Sections 139.2, 4060, 4061, 4062, 4062.1,4062.2, 4062.3, 4064 and 4067, Labor Code.

History: 1. New section filed 8-23-96; operative9-22-96 (Register 96, No. 34).2. Amendment of subsections (b), (b)(1) and (b)(3)and new subsections (b)(4)-(5) filed 4-14-2000; oper-ative 5-14-2000 (Register 2000, No. 15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§31.7. Obtaining Additional QMEPanel in a Different Specialty.

(a) Once an Agreed Medical Evaluator, anAgreed Panel QME, or a panel Qualified Med-ical Evaluator has issued a comprehensive med-ical/legal report in a case and a new medicaldispute arises, the parties, to the extent possible,shall obtain a follow-up evaluation or a supple-mental evaluation from the same evaluator.

(b) Upon a showing of good cause that apanel of QME physicians in a different specialtyis needed to assist the parties reach an expedi-tious and just resolution of disputed medicalissues in the case, the Medical Director shallissue an additional panel of QME physicians

selected at random in the specialty requested.For the purpose of this section, good causemeans:

(1) An order by a Workers’ CompensationAdministrative Law Judge for a panel of QMEphysicians that also either designates a party toselect the specialty or states the specialty to beselected and the residential or employment-based zip code from which to randomly selectevaluators; or

(2) The AME or QME selected advises theparties and the Medical Director, or his or herdesignee, that she or he has completed or willcomplete a timely evaluation of the disputedmedical issues within his or her scope of prac-tice and areas of clinical competence but recom-mends that a new evaluator in another specialtyis needed to evaluate one or more remainingdisputed medical conditions, injuries or issuesthat are outside of the evaluator’s areas ofclinical competence, and either the injuredworker is unrepresented or the parties in arepresented case have been unable to select anAgreed Medical Evaluator for that purpose; or

(3) A written agreement by the parties in arepresented case that there is a need for anadditional comprehensive medical legal reportby an evaluator in a different specialty, thatattempts to select an Agreed Medical Evaluatorpursuant to Labor Code section 4062.2 for thatpurpose have failed and the specialty that theparties have agreed upon for the additionalevaluation; or

(4) In an unrepresented case, that the par-ties have conferred with an Information andAssistance Officer, have explained the need foran additional QME evaluator in another spe-cialty to address disputed issues and, as noted bythe Information and Assistance Officer on thepanel request form, the parties have reachedagreement in the presence of and with theassistance of the Officer on the specialty re-quested for the additional QME panel. Theparties may confer with the Information andAssistance Officer in person or by conferencecall.

Note: Authority cited: Sections 133, 139.2, 4061,4062, 4062.3, 4062.5, 5307.3 and 5703.5, Labor Code.Reference: Sections 139.2, 4061, 4062, 4062.1,4062.2, 4062.3, 4064 and 4067, Labor Code.



§32. Consultations.(a) In any case where an acupuncturist has

been selected by the injured worker from athree-member panel and an issue of disability isin dispute, the acupuncturist shall request aconsult from a QME defined under section 1(z)to evaluate the disability issue(s). The acupunc-turist shall evaluate all other issues as requiredfor a complete evaluation. If requested by theQME acupuncturist to obtain a QME to providethe consulting evaluation, the Medical Directorshall issue a panel within fifteen (15) days of therequest in the specialty selected by the QMEacupuncturist.

(b) Except as provided in subdivision 32(a)above, no QME may obtain a consultation forthe purpose of obtaining an opinion regardingpermanent disability and apportionment consis-tent with the requirements of Labor Code sec-tions 4660 through 4664 and the AMA Guides.

(c) For injuries occurring on or after Janu-ary 1, 1994, a QME may obtain a consultationfrom any physician as reasonable and necessarypursuant to Labor Code section 4064(a).

(d) Whenever an Agreed Panel QME or aQME determines that a consultation is necessarypursuant to this section and the physician se-lected for the consultation is not selected by theparties from a QME panel issued by the MedicalDirector, the referring QME must arrange theconsultation appointment and advise the injuredemployee and the claims administrator, or ifnone the employer, and each party’s attorney ifany, in writing of the appointment date, time andplace by use of QME Form 110 (QME Appoint-ment Notification Form) (See, 8 Cal. CodeRegs. § 110).

(e) The consulting physician shall serve theconsulting report on the referring QME. Uponreceipt of the consulting physician’s report, thereferring evaluator shall review the consultingphysician’s report, incorporate that report byreference into the referring evaluator’s medical-legal report and comment on the consultingphysician’s findings and conclusions in the dis-cussion sections of the evaluator’s report.

(f) The referring QME shall file the com-prehensive medical-legal report within the timeperiods specified in section 38 of Title 8 of theCalifornia Code of Regulations. In the event aconsulting physician’s report has not been re-ceived, or will not be received, in time tocomply with the time periods, the referring

QME shall serve the comprehensive medical-legal report timely, and upon receipt of theconsulting physician’s report, the referring eval-uator shall, within fifteen (15) calendar days ofreceipt of the consulting report, issue a supple-mental report that incorporates the consultingphysician’s report by reference, and commentson whether and how the findings in the consult-ing report change the referring evaluator’s opin-ions. The referring evaluator shall list, in thereport commenting on a consulting physician’sreport, all reports and information received fromeach party for the consulting physician, indicatewhether each item was forwarded to the consult-ing physician, and for items not forwarded thereason the referring evaluator determined it wasnot necessary to forward the item to the consult-ing physician.

(g) With the exception of verbal communi-cations between an injured worker and theconsulting physician in the course of the con-sulting examination, all other communicationsby the parties, as well as any reports and otherinformation from the parties for the consultingphysician, if any, shall be made in writingdirected only to the referring QME, who mayforward such communications on to the consult-ing physician as appropriate. With the exceptionof deposing the consulting physician if neces-sary and except as provided in this subdivision,neither party nor a party’s attorney, shall com-municate directly with nor send correspondenceor records directly to the consulting physician.NOTE: Form referred to above is available at nocharge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at1-800-794-6900.

Note: Authority cited: Sections 133, 139.2, 4061,4062, 4064, 5307.3 and 5703.5, Labor Code. Refer-ence: Sections 3209.3, 4061, 4062, 4062.1, 4062.2,4064, 4067 and 5703.5, Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Renumbering of former section 32 to new section30.5 and renumbering and amendment of formersection 32.5 to section 32 filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§32.5. Rebuttal QME Examinations.[Repealed]

Note: Authority cited: Sections 139.2, 4061, 4062and 4064, Labor Code. Reference: Sections 4061 and4062, Labor Code.


History: 1. New section filed 8-23-96; operative9-22-96 (Register 96, No. 34).2. Renumbering of former section 32.5 to section 32and renumbering and amendment of former section32.7 to section 32.5 filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).3. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§32.6. Additional QME EvaluationsOrdered by the Appeals Board.

The Medical Director shall issue a panel ofQualified Medical Evaluators upon receipt of anorder of a Workers’ Compensation Administra-tive Law Judge or the Appeals Board, thatincludes a finding that an additional evaluationis reasonable and necessary to resolve disputedissues under Labor Code sections 4060, 4061 or4062. The order shall specify the residential oremployment-based zip code from which to ran-domly select evaluators, specify the specialtyfor the QME panel or designate the party whoshall select the specialty of the QME panel, andspecify who shall select a new specialty in theevent there are too few QMEs in the specialtyinitially selected to issue a panel in accordancewith section 31(d) of Title 8 of the CaliforniaCode of Regulations.

Note: Authority cited: Sections 133, 139.2, 4061,4062, 4064, 5307.3, 5703 and 5703.5, Labor Code.Reference: Sections 139.2, 4060, 4061, 4062, 4062.1,4062.2 and 4064, Labor Code.


§33. Unavailability of QME.(a) A QME who will be unavailable to

schedule or perform comprehensive medicalevaluations as an Agreed Panel QME or as aPanel QME for a period of 14 days, or up to amaximum of 90 days during a one year feeperiod, for any reason shall notify the MedicalDirector by submitting the form in Section 109(Notice of Qualified Medical Evaluator Unavail-ability) (see, 8 Cal. Code Regs. § 109) at least 30days before the period of unavailability is tobegin. The Medical Director may, in his or herdiscretion, grant unavailable status within the30-day notice period for good cause, includingbut not limited to medical or family emergency.

(b) At the time of requesting unavailablestatus, the QME shall provide the MedicalDirector with a list of any and all comprehensivemedical/legal evaluation examinations already

scheduled during the time requested for unavail-able status. The QME shall indicate whethereach such examination is being rescheduled orthe QME plans to complete the exam and reportwhile in unavailable status.

(c) A QME who is unavailable as providedin subdivision (a) shall not perform any newevaluation examinations as a QME until thephysician returns to active QME status. Such aQME may complete medical-legal examinationsand reports already scheduled and reported tothe Medical Director, as well as reports forevaluation examinations performed prior to be-coming unavailable under subdivision (a). Sucha QME also may complete supplemental re-ports.

(d) It shall not be an acceptable reason forunavailability that a QME does not intend toperform comprehensive medical-legal evalua-tions for unrepresented workers. A QME whohas filed notifications for unavailability totalingmore than ninety (90) days during the QME feeperiod without good cause may be denied reap-pointment subject to section 52 of Title 8 of theCalifornia Code of Regulations. Good causeincludes, but is not limited to, sabbaticals, ordeath or serious illness of an immediate familymember.

(e) If a party with the legal right to sched-ule an appointment with a QME is unable toobtain an appointment with a selected QMEwithin sixty (60) days of the date of the appoint-ment request, that party may waive the right toa replacement in order to accept an appointmentno more than ninety (90) days after the date ofthe party’s initial appointment request. Whenthe selected QME is unable to schedule theevaluation within ninety (90) days of the date ofthat party’s initial appointment request, eitherparty may report the unavailability of the QMEand the Medical Director shall issue a replace-ment pursuant to section 31.5 of Title 8 of theCalifornia Code of Regulations upon request,unless both parties agree in writing to waive theninety (90) day time limit for scheduling theinitial evaluation.

(f) If a QME fails to notify the MedicalDirector, by submitting the form in section 109(Notice of Qualified Medical Evaluator Unavail-ability) (see, 8 Cal. Code Regs. § 109), of his orher unavailability at a medical office at leastthirty (30) days prior to the period the evaluatorbecomes unavailable, the Medical Director maydesignate the QME to be unavailable at that


location for thirty (30) days from the date theMedical Director learns of the unavailability.

(g) Whenever the Medical Director is noti-fied by a party seeking an appointment with aQualified Medical Evaluator, or otherwise be-comes aware, that the QME is not available andnot responding to calls or mail at a locationlisted for the QME, a certified letter will be sentto the QME by the Medical Director regardinghis/her unavailability. If the Medical Directordoes not receive a response within fifteen (15)days of the date the certified letter is mailed,then the QME will be made unavailable at thatlocation. The time a QME is placed on unavail-able status pursuant to this subdivision shallcount toward the ninety (90) day limit in subdi-vision 33(a) of Title 8 of the California Code ofRegulations.NOTE: Form referred to above is available at nocharge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4062.5 and 4067, LaborCode.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§34. Appointment Notification andCancellation.

(a) Whenever an appointment for a com-prehensive medical evaluation is made with aQME, the QME shall complete an appointmentnotification form by submitting the form inSection 110 (QME Appointment NotificationForm) (See, 8 Cal. Code Regs. § 110). Thecompleted form shall be postmarked or sent byfacsimile to the employee and the claims admin-istrator, or if none the employer, within 5business days of the date the appointment wasmade. In a represented case, a copy of thecompleted form shall also be sent to the attorneywho represents each party, if known. Failure tocomply with this requirement shall constitutegrounds for denial of reappointment under sec-tion 51 of Title 8 of the California Code ofRegulations.

(b) The QME shall schedule an appoint-ment for a comprehensive medical-legal exam-

ination which shall be conducted only at themedical office listed on the panel selection form.However, upon written request by the injuredworker and only for his or her convenience, theevaluation appointment may be moved to an-other medical office of the selected QME if it islisted with the Medical Director as an additionaloffice location.

(c) The QME shall include within the noti-fication whether a Certified Interpreter, as de-fined by Labor Code Section 5811 and subject tothe provisions of section 9795.3 of Title 8 of theCalifornia Code of Regulations, is required andspecify the language. The interpreter shall bearranged by the party who is to pay the cost asprovided for in Section 5811 of the Labor Code.

(d) An evaluator, whether an AME, AgreedPanel QME or QME, shall not cancel a sched-uled appointment less than six (6) business daysprior to the appointment date, except for goodcause. Whenever an evaluator cancels a sched-uled appointment, the evaluator shall advise theparties in writing of the reason for the cancella-tion. The Appeals Board shall retain jurisdictionto resolve disputes among the parties regardingwhether an appointment cancellation pursuant tothis subdivision was for good cause. The Ad-ministrative Director shall retain jurisdiction totake appropriate disciplinary action against anyAgreed Panel QME or QME for violations ofthis section.

(e) An Agreed Panel QME or a QME whocancels a scheduled appointment shall resched-ule the appointment to a date within thirty (30)calendar days of the date of cancellation. There-scheduled appointment date may not be morethan sixty (60) calendar days from the date ofthe initial request for an appointment, unless theparties agree in writing to accept the datebeyond the sixty (60) day limit.

(f) An Agreed Medical Evaluator who can-cels a scheduled appointment shall reschedulethe appointment within sixty (60) calendar daysof the date of the cancellation, unless the partiesagree in writing to accept an appointment dateno more than thirty (30) calendar days beyondthe sixty (60) day limit.

(g) Failure to receive relevant medicalrecords, as provided in section 35 of Title 8 ofthe California Code of Regulations and section4062.3 of the Labor Code, prior to a scheduledappointment shall not constitute good causeunder this section for the evaluator to cancel the


appointment, unless the evaluator is a psychia-trist or psychologist performing an evaluationregarding a disputed injury to the psyche whostates in the evaluation report that receipt ofrelevant medical records prior to the evaluationwas necessary to conduct a full and fair evalu-ation.

(h) An appointment scheduled with anevaluator, whether an AME, Agreed Panel QMEor QME shall not be cancelled or rescheduled bya party or the party’s attorney less than six (6)business days before the appointment date, ex-cept for good cause. Whenever the claims ad-ministrator, or if none the employer, or theinjured worker, or either party’s attorney, can-cels an appointment scheduled by an evaluator,the cancellation shall be made in writing, statethe reason for the cancellation and be served onthe opposing party. Oral cancellations shall befollowed with a written confirming letter that isfaxed or mailed by first class U.S. mail withintwenty four hours of the verbal cancellation andthat complies with this section. An injuredworker shall not be liable for any missed ap-pointment fee whenever an appointment is can-celled for good cause. The Appeals Board shallretain jurisdiction to resolve disputes regardingwhether an appointment cancellation by a partypursuant to this subdivision was for good cause.

(i) The date of cancellation shall be deter-mined from the date of postmark, if mailed, orfrom the facsimile receipt date as shown on therecipient’s fax copy.NOTE: Form referred to above is available at nocharge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 4060, 4061,4062, 4062.1, 4062.2 and 4067, Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of subsections (a) and (c) filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).3. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§35. Exchange of Information and ExParte Communications.

(a) The claims administrator, or if none theemployer, shall provide, and the injured workermay provide, the following information to the

evaluator, whether an AME, Agreed panel QMEor QME:

(1) All records prepared or maintained bythe employee’s treating physician or physicians;

(2) Other medical records, including anyprevious treatment records or information,which are relevant to determination of the med-ical issue(s) in dispute;

(3) A letter outlining the issues that theevaluator is requested to address in the evalua-tion, which shall be served on the opposingparty no less than 20 days in advance of theevaluation;

(4) Whenever the treating physician’s rec-ommended medical treatment is disputed, acopy of the treating physician’s report recom-mending the medical treatment with all support-ing documents, a copy of claims administrator’s,or if none the employer’s, decision to approve,delay, deny or modify the disputed treatmentwith the documents supporting the decision, andall other relevant communications about thedisputed treatment exchanged during the utiliza-tion review process required by Labor Codesection 4610;

(5) Non-medical records, including filmsand videotapes, which are relevant to determi-nation of medical issue(s) in dispute, after com-pliance with subdivision 35(c) of Title 8 of theCalifornia Code of Regulations.

(b)(1) All communications by the partieswith the evaluator shall be in writing and sentsimultaneously to the opposing party when sentto the medical evaluator, except as otherwiseprovided in subdivisions (c), (k) and (l ) of thissection.

(2) Represented parties who have selectedan Agreed Medical Evaluator or an AgreedPanel QME shall, as part of their agreement,agree on what information is to be provided tothe AME or the Agreed Panel QME, respec-tively.

(c) At least twenty (20) days before theinformation is to be provided to the evaluator,the party providing such medical and non-medical reports and information shall serve it onthe opposing party. Mental health records thatare subject to the protections of Health andSafety Code section 123115(b) shall not beserved directly on the injured employee, butmay be provided to a designated health careprovider as provided in section 123115(b)(2),and the injured employee shall be notified in


writing of this option for each such record to beprovided to the evaluator. In both unrepresentedand represented cases the claims administratorshall attach a log to the front of the records andinformation being sent to the opposing party thatidentifies each record or other information to besent to the evaluator and lists each item in theorder it is attached to or appears on the log. In arepresented case, the injured worker’s attorneyshall do the same for any records or otherinformation to be sent to the evaluator directlyfrom the attorney’s office, if any. The claimsadministrator, or if none the employer, shallinclude a cover letter or other document whenproviding such information to the employeewhich shall clearly and conspicuously includethe following language: “Please look carefullyat the enclosed information. It may be used bythe doctor who is evaluating your medical con-dition as it relates to your workers’ compensa-tion claim. If you do not want the doctor to seethis information, you must let me know within10 days.”

(d) If the opposing party objects within 10days to any non-medical records or informationproposed to be sent to an evaluator, thoserecords and that information shall not be pro-vided to the evaluator unless so ordered by aWorkers’ Compensation Administrative LawJudge.

(e) In no event shall any party forward tothe evaluator: (1) any medical/legal reportwhich has been rejected by a party as untimelypursuant to Labor Code section 4062.5; (2) anyevaluation or consulting report written by anyphysician other than a treating physician, theprimary treating physician or secondary physi-cian, or an evaluator through the medical-legalprocess in Labor Code sections 4060 through4062, that addresses permanent impairment,permanent disability or apportionment underCalifornia workers’ compensation laws, unlessthat physician’s report has first been ruled ad-missible by a Workers’ Compensation Adminis-trative Law Judge; or (3) any medical report orrecord or other information or thing which hasbeen stricken, or found inadequate or inadmis-sible by a Workers’ Compensation Administra-tive Law Judge, or which otherwise has beendeemed inadmissible to the evaluator as a matterof law.

(f) Either party may use discovery to estab-lish the accuracy or authenticity of non-medicalrecords or information prior to the evaluation.

(g) Copies of all records being sent to theevaluator shall be sent to all parties except asotherwise provided in section (d) and (e). Fail-ure to do so shall constitute ex parte communi-cation within the meaning of subdivision (k)below by the party transmitting the informationto the evaluator.

(h) In the event that the unrepresented em-ployee schedules an appointment within 20 daysof receipt of the panel, the employer or if none,the claims administrator shall not be required tocomply with the 20 day time frame for sendingmedical information in subsection (c) provided,however, that the unrepresented employee isserved all non-medical information in subdivi-sion (c) 20 days prior to the information beingserved on the QME so the employee has anopportunity to object to any non-medical infor-mation.

(i) In the event that a party fails to provideto the evaluator any relevant medical recordwhich the evaluator deems necessary to performa comprehensive medical-legal evaluation, theevaluator may contact the treating physician orother health care provider, to obtain suchrecord(s). If the party fails to provide relevantmedical records within 10 days after the date ofthe evaluation, and the evaluator is unable toobtain the records, the evaluator shall completeand serve the report to comply with the statutorytime frames under section 38 of Title 8 of theCalifornia Code of Regulations. The evaluatorshall note in the report that the records were notreceived within the required time period. Uponrequest by a party, or the Appeals Board, theevaluator shall complete a supplemental evalu-ation when the relevant medical records arereceived. For a supplemental report the evalua-tor need not conduct an additional physicalexamination of the employee if the evaluatorbelieves a review of the additional records issufficient.

(j) The evaluator and the employee’s treat-ing physician(s) may consult as necessary toproduce a complete and accurate report. Theevaluator shall note within the report new oradditional information received from the treat-ing physician.

(k) The Appeals Board shall retain jurisdic-tion in all cases to determine disputes arisingfrom objections and whether ex parte contact inviolation of Labor Code section 4062.3 or thissection of Title 8 of the California Code ofRegulations has occurred. If any party commu-


nicates with an evaluator in violation of LaborCode section 4062.3, the Medical Director shallprovide the aggrieved party with a new panel inwhich to select a new QME or the aggrievedparty may elect to proceed with the originalevaluator. Oral or written communications bythe employee, or if the employee is deceased bythe employee’s dependent, made in the course ofthe examination or made at the request of theevaluator in connection with the examinationshall not provide grounds for a new evaluatorunless the Appeals Board has made a specificfinding of an impermissible ex parte communi-cation.

(l ) In claims involving a date of injuryprior to 1/1/2005 where the injured worker isrepresented by an attorney and the parties havedecided to each select a separate QualifiedMedical Evaluator, the provisions of this sectionshall not apply to the communications between aparty and the QME selected by that party.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4062.3, 4064 and 4067,Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. New subsection (c) and subsection relettering,amendment of newly designated subsections (d) and(e) and new subsection (f) filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. New subsection (b)(3) and amendment of subsec-tion (e) filed 4-14-2000; operative 5-14-2000 (Regis-ter 2000, No. 15).4. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§35.5. Compliance by AMEs andQMEs with Administrative DirectorEvaluation and Reporting Guidelines.

(a) Each evaluation examination and reportcompleted pursuant to Labor Code sections4060, 4061, 4062, 4062.1, 4062.2, 4064, 4067or 5703.5 shall be performed in compliance withall appropriate evaluation procedures pursuantto this Chapter.

(b) Each reporting evaluator shall state inthe body of the comprehensive medical-legalreport the date the examination was completedand the street address at which the examinationwas performed. If the evaluator signs the reporton any date other than the date the examinationwas completed, the evaluator shall enter the date

the report is signed next to or near the signatureon the report.

(c) The evaluator shall address all con-tested medical issues arising from all injuriesreported on one or more claim forms prior to thedate of the employee’s appointment with themedical evaluator that are issues within theevaluator’s scope of practice and areas of clin-ical competence. The reporting evaluator shallattempt to address each question raised by eachparty in the issue cover letter sent to the evalu-ator as provided in subdivision 35(a)(3).

(d) At the evaluator’s earliest opportunityand no later than the date the report is served,the evaluator shall advise the parties in writingof any disputed medical issues outside of theevaluator’s scope of practice and area of clinicalcompetency in order that the parties may initiatethe process for obtaining an additional evalua-tion pursuant to section 4062.1 or 4062.2 of theLabor Code and these regulations in anotherspecialty. In the case of an Agreed Panel QMEor a panel QME, the evaluator shall send a copyof the written notification provided to the partiesto the Medical Director at the same time. How-ever, only a party’s request for an additionalpanel, with the evaluator’s written notice underthis section attached, or an order by a Workers’Compensation Administrative Law Judge, willbe acted upon by the Medical Director to issue anew QME panel in another specialty in theclaim.

(e) In the event a new injury or illness isclaimed involving the same type of body part orbody system and the parties are the same, or inthe event either party objects to any new medi-cal issue within the evaluator’s scope of practiceand clinical competence, the parties shall utilizeto the extent possible the same evaluator whoreported previously.

(f) Unless the Appeals Board or a Workers’Compensation Administrative Law Judge ordersotherwise or the parties agree otherwise, when-ever a party is legally entitled to depose theevaluator, the evaluator shall make himself orherself available for deposition within at leastone hundred twenty (120) days of the notice ofdeposition and, upon the request of the unrep-resented injured worker and whenever consis-tent with Labor Code section 5710, the deposi-tion shall be held at the location at which theevaluation examination was performed, or at afacility or office chosen by the deposing party


that is not more than 20 miles from the locationof the evaluation examination.

(g) Whenever an Agreed Medical Evalua-tor or Qualified Medical Evaluator provides anopinion in a comprehensive medical/legal reporton a disputed medical treatment issue, the evalu-ator’s opinion shall be consistent with and applythe standards of evidence-based medicine setout in Division 1, Chapter 4.5, Subchapter 1,sections 9792.20 et seq of Title 8 of the Califor-nia Code of Regulations (Medical TreatmentUtilization Schedule). In the event the disputedmedical treatment, condition or injury is notaddressed by the Medical Treatment UtilizationSchedule, the evaluator’s medical opinion shallbe consistent with and refer to other evidence-based medical treatment guidelines, peer re-viewed studies and articles, if any, and other-wise shall explain the medical basis for theevaluator’s reasoning and conclusions.

Note: Authority cited: Sections 133, 139.2, 4062.3and 5307.3, Labor Code. Reference: Sections 139.2,4060, 4061, 4062, 4062.1, 4062.2, 4064, 4067,4604.5, 4628, 5703.5, 5307.27 and 5710, Labor Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Amendment of section heading and section andnew Note filed 1-13-2009; operative 2-17-2009 (Reg-ister 2009, No. 3).

§36. Service of ComprehensiveMedical–Legal Evaluation Reports byMedical Evaluators Including ReportsUnder Labor Code Section 4061.

(a) Whenever an injured worker is repre-sented by an attorney, the evaluator shall serveeach comprehensive medical-legal evaluationreport, follow-up comprehensive medical-legalevaluation report and supplemental evaluationreport on the injured worker, his or her attorneyand on the claims administrator, or if none theemployer, by completing QME Form 122 (AMEor QME Declaration of Service of Medical-Legal Report Form) (See, 8 Cal. Code Regs.§ 122) and attaching QME Form 122 to thereport, unless section 36.5 of Title 8 of theCalifornia Code of Regulations applies. If appli-cable in a claim involving disputed injury to thepsyche, the evaluator shall comply with therequirements of section 36.5 of Title 8 of theCalifornia Code of Regulations (Service ofComprehensive Medical-Legal Report inClaims of Injury to the Psyche) (See, 8 Cal.Code Regs. §§ 36.5, 120 and 121).

(b) Whenever an injured worker is notrepresented by an attorney, the Qualified Medi-cal Evaluator shall serve each comprehensivemedical-legal evaluation report, follow-up eval-uation report or supplemental report that ad-dresses only disputed issues outside of the scopeof Labor Code section 4061, by completing thequestions and declaration of service on the QMEForm 111 (QME Findings Summary Form)(See, 8 Cal. Code Regs. § 111), and by servingthe report with the QME Form 111 attached, onthe injured worker and the claims administrator,or if none on the employer, unless section 36.5of Title 8 of the California Code of Regulationsapplies. If applicable in a claim involving dis-puted injury to the psyche, the evaluator shallcomply with the requirements of section 36.5 ofTitle 8 of the California Code of Regulations(Service of Comprehensive Medical-Legal Re-port in Claims of Injury to the Psyche) (See, 8Cal. Code Regs. §§ 36.5, 120 and 121.)

(c) Whenever the evaluator is serving amedical-legal evaluation report that addresses ordescribes findings and conclusions pertaining topermanent impairment, permanent disability orapportionment of an unrepresented injuredworker, the evaluator shall serve the evaluationreport, the completed QME Form 111 (QMEFindings Summary Form) (See, 8 Cal. CodeRegs. § 111), DWC-AD Form 100 (DEU) (Em-ployee’s Disability Questionnaire) (See, 8 Cal.Code Regs. §§ 10160 and 10161) and DWC-ADForm 101 (DEU) (Request for Summary RatingDetermination of Qualified Medical Evaluator’sReport) (See, 8 Cal. Code Regs. §§ 10160 and10161), with the document cover sheet,DWC-CA form 10232.1 (see, 8 Cal. Code Regs.§ 10232.1), and separator sheet, DWC-CA form10232.2 (see, 8 Cal. Code Regs. § 10232.2), asrequired by Title 8, California Code of Regula-tions section 10160(d)(4), on the local DEUoffice, at the same time as serving the report,QME Form 111, DWC-AD Form 100 (DEU)and DWC-AD Form 101 (DEU) on the claimsadministrator, or if none the employer, and onthe unrepresented employee within the timeframes specified in section 38 of Title 8 of theCalifornia Code or Regulations, unless section36.5 of Title 8 of the California Code of Regu-lations applies. If applicable, in cases involvingdisputed injury to the psyche, the evaluator shallfollow the procedures described in section 36.5of Title 8 of the California Code of Regulations(Service of Comprehensive Medical-Legal Re-


port in Claims of Injury to the Psyche) (See, 8Cal. Code Regs. §§ 36.5, 120 and 121).

(d) If an evaluation report is completed foran unrepresented employee, in which the QMEdetermines that the employee’s condition hasnot become permanent and stationary as of thedate of the evaluation, the parties shall requestany further evaluation from the same QME ifthe QME is currently an active QME andavailable at the time of the request for theadditional evaluation. If the QME is unavail-able, a new panel may be issued to resolve anydisputed issue(s). If the evaluator is no longer aQME, he/she may issue a supplemental report aslong as a face-to-face evaluation (as defined insection 49(b) of Title 8 of the California Code ofRegulations) with the injured worker is notrequired. In no event shall a physician who isnot a QME or no longer a QME perform afollow up evaluation on an unrepresented in-jured worker.

(e) After a Qualified Medical Evaluator hasserved a comprehensive medical-legal reportthat finds and describes permanent impairment,permanent disability or apportionment in thecase of an unrepresented injured worker, theQME shall not issue any supplemental report onany of those issues in response to a party’srequest until after the Disability Evaluation Unithas issued an initial summary rating report, orunless the evaluator is otherwise directed toissue a supplemental report by the DisabilityEvaluation Unit, by the Administrative Directoror by a Workers’ Compensation AdministrativeLaw Judge. A party wishing to request a supple-mental report pursuant to subdivision 10160(f)of Title 8 of the California Code of Regulations,based on the party’s objection to or need forclarification of the evaluator’s discussion ofpermanent impairment, permanent disability orapportionment, may do so only by sending thedetailed request, within the time limits of sub-division 10160(f), directly to the DEU officewhere the report was served by the evaluatorand not to the evaluator until after the initialsummary rating has been issued.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 4060, 4061,4062, 4062.1, 4062.2, 4064, 4067, 4600 and 4660-4664, Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of section heading, section and Notefiled 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).3. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§36.5. Service of ComprehensiveMedical/Legal Report in Claims ofInjury to the Psyche.

(a) For any evaluation involving a claimedor disputed injury to the psyche, the injuredworker shall be advised by the evaluator that theemployee’s copy of the comprehensive medical-legal report, and any follow up or supplementalreports, from the evaluation may be servedeither directly on the injured worker or insteadon a physician designated in writing by theinjured worker prior to leaving the evaluator’soffice, for the purpose of reviewing and discuss-ing the evaluation report with the injuredworker. The evaluator shall explain that thedesignated physician may be but need not be theinjured worker’s primary treating physician inthe workers’ compensation claim and that theemployer will be responsible for payment forone office visit with the designated physician forthis purpose.

(b) Whenever injury to the psyche isclaimed and in the course of the evaluation, theevaluator makes a determination pursuant toHealth and Safety Code section 123115(b) thatthere is a substantial risk of significant adverseor detrimental medical consequences to theinjured worker from seeing or receiving a copyof part or all of evaluation report which is amental health record, the evaluator shall do allof the following:

(1) Complete QME Form 121 (DeclarationRegarding Protection of Mental Health Record);

(2) Advise the injured worker that the de-termination under Health and Safety Code123115(b) has been made regarding the evalua-tion report as a mental health record and that theevaluator only may serve the injured worker’scopy of the evaluation report on a person who isa licensed physician, as defined in Labor Codesection 3209.3, whose name the injured workermay designate in writing prior to leaving theevaluator’s office, or on the employee’s attor-ney, if any;


(3) Permit inspection and copying of themental health record(s) subject to the Health andSafety Code section 123115(b) determination,only by a licensed physician as defined in LaborCode section 3209.3 or another health careprovider as defined in Health and Safety Codesection 123105(a);

(4) Complete the QME Form 121 and enterthe name and address of the physician desig-nated in writing by the injured worker on thisform;

(5) Attach a completed copy of QME Form121 (Declaration Regarding Protection of Men-tal Health Record) to the copy of the evaluationreport in the injured worker’s medical or medi-cal-legal file;

(6) Serve the completed comprehensivemedical-legal evaluation report, follow-up med-ical-legal report or supplemental medical-legalreport(s) subject to the provisions of this sec-tion, with the completed QME Form 121 (Dec-laration Regarding Protection of Mental HealthRecord) attached, on the licensed physiciandesignated by the injured worker on QME Form121, and on the claims administrator, and oneach party’s attorney, if any, as provided insection 36, and within the time periods insection 38, of Title 8 of the California Code ofRegulations. In the event the injured workerdesignates a physician on QME Form 121 otherthan the current primary treating physician in hisor her workers’ compensation claim, the evalu-ator shall also serve a copy of the report with theQME Form 121 attached on the primary treatingphysician;

(7) Whenever the report addresses any per-manent impairment, permanent disability or ap-portionment and the injured worker is not rep-resented by an attorney, a copy of the report withthe completed QME Form 121 attached shallalso be served on the appropriate office of theDisability Evaluation Unit, along with the QMEForm 111 (QME’s Findings Summary Form),and DWC-AD form 100 (DEU) (Employee’sDisability Questionnaire) (See, 8 Cal. CodeRegs. §§ 10160 and 10161) and DWC-AD form101 (DEU) (Request for Summary Rating De-termination of Qualified Medical Evaluator’sReport) (See, 8 Cal. Code Regs. §§10160 and10161), with the document cover sheet,DWC-CA form 10232.1 (see, 8 Cal. Code Regs.§ 10232.1), and separator sheet, DWC-CA form10232.2 (see, 8 Cal. Code Regs. § 10232.2), as

required by Title 8, California Code of Regula-tions section 10160(d)(4);

(8) Whenever the report addresses perma-nent impairment, permanent disability or appor-tionment and the injured worker is representedby an attorney, a copy of the report with thecompleted QME Form 121 attached shall beserved with QME Form 122 (AME or QMEDeclaration of Service of Medical-Legal Re-port) on the physician designated by the injuredworker, the injured worker’s attorney and on theclaims administrator’s attorney, or if none on theclaims administrator.

(c) “Mental health record” for the purposesof this subdivision means a medical treatment orevaluation record created by or received andreviewed by a licensed physician, as defined inLabor Code section 3209.3, in the course oftreating or evaluating the injured worker in aworkers’ compensation claim, and includes forthe purposes of this subdivision but is notlimited to, treatment records and comprehensivemedical-legal reports.

(d) Upon serving the employee’s copy ofthe medical-legal report in compliance withsubdivisions 36.5(b)(6), 36.5(b)(7) or 36.5(b)(8)of Title 8 of the California Code of Regulationson the physician designated by the employee onthe QME Form 121 (Declaration RegardingProtection of Mental Health Record), the evalu-ator’s obligation to serve the report on theinjured worker under Labor Code sections139.2(j)(1) and 4061(c), and section 36 of Title8 of the California Code of Regulation, shall bedeemed satisfied.

(e) Mental health records subject to a de-termination under Health and Safety Code sec-tion 123115(b) and this subdivision shall be keptconfidential by the claims administrator and allparties’ attorneys in the case unless orderedotherwise by a Workers’ Compensation Admin-istrative Law Judge. Whenever such a mentalhealth record is filed by a party at the Workers’Compensation Appeals Board, the party filingsuch a record shall request and obtain a protec-tive order from a Workers’ Compensation Ad-ministrative Law Judge that shall specify inwhat manner the mental health record may beinspected, copied and entered into evidence.

(f) Whenever the injured worker advisesthe evaluator that he or she prefers to have theevaluation report served on a designated physi-cian as provided in subdivision 36.5(b) above,


and the evaluator does not make a determinationpursuant to Health and Safety Code section123115(b), the evaluator shall provide QMEForm 120 (Voluntary Directive for AlternateService of Medical-Legal Report) (See, 8 Cal.Code Regs. § 120) to the injured worker andshall request the injured worker to complete theform before leaving the evaluator’s office.

(g) Upon receipt by the evaluator of a QMEForm 120 completed by the injured worker, theevaluator shall attach the original executedQME Form 120 to the original medical-legalreport for service on the claims administrator, orif none on the employer. The evaluator shallserve the evaluation report with QME Form 120attached by completing the questions and thedeclaration of proof of service on QME Form111 (Qualified Medical Evaluator’s FindingsSummary Form) (See, 8 Cal. Code Regs. § 111).In the case of an unrepresented injured worker,the evaluator shall serve the report with therequired forms as provided in subdivision36.5(b)(7) of Title 8 of the California Code ofRegulations. In the case of a represented injuredworker, the evaluator shall serve the report withQME Form 120 attached, by completing thedeclaration of service on QME Form 122 (AMEor QME Declaration of Service of Medical-Legal Report) (See, 8 Cal. Code § 122) andserving it with the report.

(h) Whenever an evaluation report is beingserved on a designated physician with QMEForm 120 (Voluntary Directive for AlternateService of Medical-Legal Report) (See, 8 Cal.Code Regs. § 120), the evaluator shall serve twocopies of the medical-legal report with the QMEForm 120 attached on the physician designatedon the form by the injured worker, at the sametime as serving the copies of the medical-legalreport on the claims administrator, or if none onthe employer, and on the injured worker’s attor-ney if any. Service of a medical-legal report byan evaluator in compliance with this subdivisionshall satisfy the evaluator’s obligation to serve acopy of the report on the employee under LaborCode sections 139.2(j)(1) and 4061(c,) and sec-tion 36 of Title 8 of the California Code ofRegulations.

(i) The physician designated by the injuredworker in writing and listed on QME Form 120or QME Form 121 shall not be limited to theprimary treating physician in the disputed work-ers’ compensation claim. As an additional med-ical treatment expense incurred in the claim

within the meaning of section 4600 of the LaborCode, the claims administrator, or if none theemployer, shall reimburse the physician desig-nated by the injured worker and listed on eitherthe QME Form 121 (Declaration RegardingProtection of Mental Health Record) or theQME Form 120 (Voluntary Directive for Alter-nate Service of Medical-Legal Evaluation Re-port on Disputed Injury to the Psyche), for oneoffice visit, when used, for the purpose ofreviewing and discussing the evaluator’s reportwith injured worker, at the applicable rate undersection 9789.11 (Physician Services Renderedon or After July 1, 2004) of Title 8 of theCalifornia Code of Regulations for an officevisit and may include, as appropriate, recordreview, any necessary face-to-face time duringthe visit in excess of that specified in theapplicable CPT office visit code, and charges,for time required to prepare a treatment reportpertaining to the office visit, if necessary.

(j) Whenever the comprehensive medical-legal report is served by the evaluator on aphysician pursuant to subdivision 36.5(f) withthe QME Form 120 (Voluntary Directive forAlternate Service of Medical-Legal Report onDisputed Injury to the Psyche) attached, one ofthe two copies of the medical-legal report servedon the designated physician shall be provided tothe injured worker by the designated physicianduring the office visit.

(k) In the event the injured worker refusesor fails to designate a physician in writing to belisted on either QME Form 120 or QME Form121, the evaluator shall serve the report asappropriate under section 36 or section 36.5, andwithin the time periods under section 38, of Title8 of the California Code of Regulations, exceptthat the injured worker’s copy of the reportwhich is subject to a finding under Health andSafety Code § 123115(b) shall then be servedonly on the injured worker’s attorney, if repre-sented, or if not represented on the injuredworker’s primary treating physician.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 56-56.37,Civil Code; Sections 4060, 4061, 4062, 4062.1,4062.2, 4064, 4067, 4600 and 4660-4664, LaborCode; Section 123115(b), Health and Safety Code.



§37. Treating Physician’sDetermination of Medical Issues Form.[Repealed]

Note: Sections 139, 4061 and 4061.5, Labor Code.Reference: Sections 139(e)(9), 4061 and 4061.5, La-bor Code.

History: 1. New section and forms filed 5-17-95;operative 5-24-95 pursuant to Government Code sec-tion 11343.4(d) (Register 95, No. 20).2. Repealer of section and forms filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§38. Medical Evaluation TimeFrames; Extensions for QMEs andAMEs.

(a) The time frame for an initial or afollow-up comprehensive medical-legal evalua-tion report to be prepared and submitted shallnot exceed thirty (30) days after the QME,Agreed Panel QME or AME has seen theemployee or otherwise commenced the compre-hensive medical-legal evaluation procedure. Ifan evaluator fails to prepare and serve the initialor follow-up comprehensive medical-legal eval-uation report within thirty (30) days and theevaluator has failed to obtain approval from theMedical Director for an extension of time pur-suant to this section, the employee or the em-ployer may request a QME replacement pursu-ant to section 31.5 of Title 8 of the CaliforniaCode of Regulations. Neither the employee northe employer shall have any liability for pay-ment for the medical evaluation which was notcompleted within the timeframes required underthis section unless the employee and the em-ployer each waive the right to a new evaluationand elect to accept the original evaluation, inwriting or by signing and returning to theMedical Director either QME Form 113 (Noticeof Denial of Request For Time Extension) orQME Form 116 (Notice of Late QME/AMEReport – No Extension Requested) (See, 8 Cal.Code Regs. §§ 113 and 116).

(b) All requests by an evaluator for exten-sions of time shall be made on form 112(QME/AME Time Frame Extension Request)(See, 8 Cal. Code Regs. § 112). If the evaluationwill not be completed on the original due date,the evaluator may request an extension from theMedical Director, not to exceed an additional 30

days. An extension of the time for completingthe report shall be approved, as follows:

(1) When the evaluator has not receivedtest results or the report of a consulting physi-cian, necessary to address all disputed medicalissues in time to meet the initial 30-day dead-line, an extension of up to thirty (30) days shallbe granted;

(2) When the evaluator has good cause, asdefined in Labor Code section 139.2(j)(1)(B), anextension of fifteen (15) days shall be granted.

(c) Not later than 5 days before the initial30-day period to complete and serve the reportexpires, the evaluator shall notify the MedicalDirector, the employee and the claims adminis-trator, or if none, the employer, of the request foran extension by use of QME Form 112 (QME/AME Time Extension Request) (See, 8 Cal.Code Regs. § 112).

(d) The Medical Director shall notify therequesting evaluator and the parties of the deci-sion on the extension request by completion ofthe box at the bottom of QME Form 112(QME/AME Time Frame Extension Request)(See, 8 Cal. Code Regs. § 112). In the event thata request for an extension of time is denied, theMedical Director shall also send the partiesQME Form 113 (Notice of Denial of Request forTime Extension) (See, 8 Cal. Code Regs. § 113)to be used by each party to state whether theparty wishes to request a new evaluator or toaccept the late report of the original evaluator.

(e) Whenever the Medical Director be-comes aware that the report of a QualifiedMedical Evaluator or an Agreed Medical Eval-uator has not been completed within the re-quired time under section 38 and no extension oftime was requested by the evaluator, the Medi-cal Director shall send the parties a Notice ofLate QME/AME Report – No Extension Re-quested (QME Form 116) (See, 8 Cal. CodeRegs. § 116). Each party shall complete the formand return it to the Medical Director in order toindicate whether or not the party wishes toaccept the late report.

(f) Good cause, as defined in Labor Codesection 139.2(j)(1)(B) and section 38(b)(2) ofTitle 8 of the California Code of Regulations,means:

(1) medical emergencies of the evaluator orthe evaluator’s family;

(2) death in the evaluator’s family;


(3) natural disasters or other communitycatastrophes that interrupt the operation of theevaluator’s office operations;

(g) Extensions shall not be granted becauserelevant medical information/records (includingDisability Evaluation Form 101 (Request forSummary Determination of Qualified MedicalEvaluator’s Report) (See, 8 Cal. Code Regs.§ 10161)) have not been received. The evaluatorshall complete the report based on the informa-tion available and state that the opinions and/orconclusions may or may not change after reviewof the relevant medical information/records.

(h) The time frame for supplemental re-ports shall be no more than sixty (60) days fromthe date of a written or electronically transmittedrequest to the physician by a party. The requestfor a supplemental report shall be accompaniedby any new medical records that were unavail-able to the evaluator at the time of the originalevaluation and which were properly served onthe opposing party as required by Labor Codesection 4062.3. An extension of the sixty (60)day time frame for completing the supplementalreport, of no more than thirty (30) days, may beagreed to by the parties without the need torequest an extension from the Medical Director.

(i) Evaluators requesting time extensionswill be monitored and advised by the MedicalDirector when such a request appears unreason-able or excessive. Failure to comply with thissection may constitute grounds for denial of theQME’s request for reappointment pursuant tosection 51 of Title 8 of the California Code ofRegulations.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2(j)(1),4061, 4062 and 5307.3, Labor Code. Reference:Sections 139.2, 4061, 4062, 4062.1, 4062.2, 4062.5,4064 and 4067, Labor Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of subsections (a) and (b), new sub-sections (c)-(c)(3) and subsection relettering, andamendment of newly designated subsection (d) filed8-23-96; operative 9-22-96 (Register 96, No. 34).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§39. Destruction of Records by theMedical Director.

The Medical Director may destroy any formsfiled pursuant to these regulations five yearsafter the date of receipt, provided that thecompleted “Application for Appointment asQualified Medical Evaluator” form shall bepreserved for each QME during the period(s) ofhis or her appointment as a QME. The “Requestfor Qualified Medical Evaluator” forms may bedestroyed by the Medical Director two yearsafter the date of receipt.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061 and 4062, Labor Code; and Section 14755,Government Code.

History: 1. New section filed 8-1-94; operative8-31-94 (Register 94, No. 31).2. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§39.5. Retention of Records byQMEs.

(a) All QMEs shall retain a copy of allcomprehensive medical-legal reports completedby the QME for a period of five years from thedate of each evaluation report. A QME maysatisfy this requirement by retaining only anelectronic copy of the report, as long as theelectronic copy retained is a true and correctcopy of the original, showing the QME signa-ture, that was served on the parties. Uponwritten request, a QME is required to returnoriginal radiological films, imaging studies andoriginal medical records to the person whosupplied the original records to the QME or tothe injured worker.

(b) An evaluator shall submit all compre-hensive medical/legal reports performed as aQME under this article to the Medical Directorupon request for a review by the MedicalDirector. Failure to submit evaluations uponrequest by the Medical Director may constitutegrounds for disciplinary action pursuant to Sec-tion 60.

Note: Authority cited: Sections 133, 139.2(j)(1) and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4064 and 4062.5, LaborCode; and Section 14755, Government Code.



2. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).3. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

ARTICLE 4

Evaluation Procedures

§40. Disclosure Requirements:Injured Workers.

(a) An evaluator selected from a QMEpanel shall advise an injured worker prior to orat the time of the actual evaluation of thefollowing:

(1) That he or she is entitled to ask theevaluator and the evaluator shall promptly an-swer questions about any matter concerning theevaluation process in which the QME and theinjured worker are involved;

(2) That subject to section 41(g), the in-jured worker may discontinue the evaluationbased on good cause. Good cause includes: (A)discriminatory conduct by the evaluator towardsthe worker based on race, sex, national origin,religion, or sexual preference, (B) abusive, hos-tile or rude behavior including behavior thatclearly demonstrates a bias against injuredworkers, and (C) instances where the evaluatorrequests the worker to submit to an unnecessaryexam or procedure.

(b) When required as a condition of proba-tion by the Administrative Director or his/herlicensing authority, the QME shall disclose his/her probationary status. The QME shall beentitled to explain any circumstances surround-ing the probation. If at that time, the injuredworker declines to proceed with the evaluation,such termination shall be considered by theAdministrative Director to have occurred forgood cause.

(c) If the injured worker declines to ask anyquestions relating to the evaluation procedure asset forth in section 40(a), and does not otherwiseobject on the grounds of good cause to the examproceedings under section 41(a) during theexam itself, the injured worker shall have noright to object to the QME comprehensivemedical-legal evaluation based on a violation ofthis section.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2 and 4067, Labor Code.

History: 1. New article 4 heading and section filed4-11-95; operative 5-11-95 (Register 95, No. 15).2. Amendment of article 4 heading filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).3. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§41. Ethical Requirements.(a) All QMEs, regardless of whether the

injured worker is represented by an attorney,shall:

(1) Maintain a clean, professional physi-cian’s office (as defined in section 1(y) at alltimes which shall contain functioning medicalinstruments and equipment appropriate to con-ducting the evaluation within the physician’sscope of practice and a functioning businessoffice phone with the phone number listed withthe Medical Director for that location which aparty may use to schedule an examination or tohandle other matters related to a comprehensivemedical/legal evaluation.

(2) Schedule all appointments for compre-hensive medical-legal evaluations without re-gard to whether a worker is unrepresented orrepresented by an attorney. A QME shall notrefuse to schedule an appointment with aninjured worker solely because the worker is notrepresented by an attorney or because a promiseto reimburse or reimbursement is not made priorto the evaluation.

(3) Not request the employee to submit toan unnecessary exam or procedure.

(4) Refrain from treating or soliciting toprovide medical treatment, medical supplies ormedical devices to the injured worker.

(5) Communicate with the injured workerin a respectful, courteous and professional man-ner.

(6) Refrain from violating section 41.5 ofTitle 8 of the California Code of Regulations.

(7) Refrain from unilaterally rescheduling apanel QME examination more than two times inthe same case.

(8) Refrain from cancelling a QME exam-ination less than six (6) business days from thedate the exam is scheduled without good causeand without providing a new examination datewithin thirty (30) calendar days of the date ofcancellation.

(b) Evaluators selected from a QME panelprovided by the Administrative Director shall


not engage in ex parte communication in viola-tion of Labor Code section 4062.3.

(c) All QMEs, regardless of whether theinjured worker is represented by an attorney,shall with respect to his or her comprehensivemedical-legal evaluation:

(1) Refuse any compensation from anysource contingent upon writing an opinion thatin any way could be construed as unfavorable toa party to the case.

(2) Review all available relevant medicaland non-medical records and/or facts necessaryfor an accurate and objective assessment of thecontested medical issues in an injured worker’scase before generating a written report. Thereport must list and summarize all medical andnon-medical records reviewed as part of theevaluation.

(3) Render expert opinions or conclusionswithout regard to an injured worker’s race, sex,national origin, religion or sexual preference.

(4) Render expert opinions or conclusionsonly on issues which the evaluator has adequatequalifications, education, and training. All con-clusions shall be based on the facts and on theevaluator’s training and specialty-based knowl-edge and shall be without bias either for oragainst the injured worker or the claims admin-istrator, or if none the employer.

(5) Present a report that addresses all rele-vant and contested medical issues as presentedon one or more claim forms, is ratable by theDEU, if applicable, and complies with all rele-vant guidelines of the Administrative Director.

(6) Date the report on the date it is com-pleted and ready for signature and service on theparties. No report shall be dated on the date ofthe evaluation examination unless the full writ-ten text of the report is completed and ready forsignature and service on that same date.

(7) Write all portions of the report thatcontain discussion of medical issues, medicalresearch used as the basis for medical determi-nations, and medical conclusions made by theevaluator. In the event more than one evaluatorsigns a single report, each signing physicianshall clearly state those parts of the employeeevaluation examination performed and the por-tions of the report discussion and conclusiondrafted by the signing evaluator. Where a con-sultation report is obtained by an evaluator froma physician in a different specialty, the consul-tation report shall be incorporated by reference

into the final report and appended to the refer-ring QME’s report.

(8) Serve the report as provided in theseregulations at the same time on the employeeand the claims administrator, or if none theemployer, and on each of their attorneys, respec-tively.

(d) All aspects of all physical and/or psy-chological comprehensive medical-legal evalu-ations, including history taking, shall be directlyrelated to contested medical issues as presentedby any party or addressed in the reports oftreating physician(s). No evaluator shall engagein any physical contact with the injured workerwhich is unnecessary to complete the examina-tion.

(e) No physician certified by the Adminis-trative Director as a QME, or his or her agent,shall contact an evaluator for the purpose ofinfluencing that evaluator’s opinions or conclu-sions in any comprehensive medical-legal eval-uation or report.

(f) No evaluator shall schedule appoint-ments to the extent that any injured worker willbe required to wait for more than one hour at theevaluator’s office prior to being seen for thepreviously agreed upon appointment time for anevaluation. An injured worker who is not seenby the evaluator within one hour may terminatethe exam and request a replacement evaluatorfrom the Administrative Director. No party shallbe liable for the terminated exam. The evaluatormay explain any reasons for the delay to theinjured worker and, provided both parties agree,the evaluation may proceed or be rescheduledfor a later date. If the evaluation is rescheduled,the evaluator shall provide notice of the newdate of the evaluation to the parties within 5business days after rescheduling the appoint-ment.

(g) If the injured worker terminates theexamination process based on an alleged viola-tion of section 35(k), 40, 41(a) or 41.5 of Title 8of the California Code of Regulations, and theAppeals Board later determines that good causedid not exist for the termination, the cost of theevaluation shall be deducted from the injuredworker’s award. A violation of section 40 or ofany part of section 41(a) or 41.5 by the evaluatorshall constitute good cause for purposes of anAppeals Board determination. No party shall beliable for any cost for medical reports or medical


services delivered as a result of an exam termi-nated for good cause.

(h) Nothing in this section shall require anevaluator to undertake or continue a comprehen-sive medical-legal evaluation where the injuredworker or his/her representative uses abusivelanguage towards the evaluator or evaluator’sstaff or deliberately attempts to disrupt theoperation of the evaluator’s office in any way.The evaluator shall state under penalty of per-jury, the facts supporting the termination of theevaluation process. Upon request, the MedicalDirector shall investigate the facts and make afinal determination of the issue(s).

(i) Nothing in this section shall require anevaluator selected from a panel to undertake orcontinue a comprehensive medical-legal evalu-ation where the injured worker is intoxicated orunder the influence of any medication whichimpairs the injured worker’s ability to partici-pate in the evaluation process. The evaluatorshall state under penalty of perjury, the factssupporting the termination of the evaluationprocess. Upon request, the Medical Directorshall investigate the facts and make a finaldetermination of the issue(s).

Note: Authority cited: Sections 133, 139.2, 5307.3and 5307.6, Labor Code. Reference: Sections 139.2,4060, 4061, 4062, 4062.1, 4062.2, 4062.3, 4062.5,4067 and 4628, Labor Code.

History: 1. New section filed 4-11-95; operative5-11-95 (Register 95, No. 15).2. New subsection (b), subsection relettering, andamendment of redesignated subsection (b)(1) filed7-18-95 as an emergency; operative 7-18-95 (Register95, No. 29). A Certificate of Compliance must betransmitted to OAL by 11-15-95 or emergency lan-guage will be repealed by operation of law on thefollowing day.3. Certificate of Compliance as to 7-18-95 orderincluding amendment of subsection (b), deletion ofsubsection (b)(1) designator, and amendment of Notetransmitted to OAL 11-14-95 and filed 12-21-95(Register 95, No. 51).4. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).5. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§41.5. Conflicts of Interest by MedicalEvaluators.

(a) An evaluator shall not request or acceptany compensation or other thing of value fromany source that does or could create a conflictwith his or her duties as an evaluator under the

Labor Code or the regulations of the Adminis-trative Director (Title 8 of the California Codeof Regulations, Chapters 1 through 1.8, section1 et seq) or of the Workers’ CompensationAppeals Board (Title 8 of the California Code ofRegulations, Chapters 1.9, sections 10600through 10727).

(b) A conflict with the duties of an evalua-tor as used in Labor Code section 139.2(o)means having a disqualifying conflict of interestwith one or more of the persons or entitiesdescribed in subdivision (c) and failing to dis-close the fact of the conflict.

(c) The persons or entities with whom adisqualifying conflict of interest can exist are:

(1) The injured worker, or his or her attor-ney;

(2) The employer, or the employer’s attor-ney;

(3) The claims adjuster or insurer or thirdparty administrator, or their attorney, respec-tively;

(4) Any primary treating physician or sec-ondary physician for the employee, if the treat-ment provided by that physician is disputed inthe case;

(5) The utilization review physician re-viewer or expert reviewer, or utilization revieworganization, only if the opinion of that revieweror that utilization review organization is dis-puted in the case;

(6) The surgical center in which the injuredworker had, or is proposed to be used to have,surgery, only if the need for surgery is disputedin the case.

(7) Other purveyor of medical goods ormedical services, only if the medical necessityfor using such goods or services is in dispute inthe case.

(d) “Disqualifying Conflict of Interest”means the evaluator has any of the followingrelationships or interests with a person or entitylisted in subdivision 41.5(c):

(1) A familial relationship of parent, child,grandparent, grandchild, sibling, uncle, aunt,nephew, niece, spouse, financee or cohabitant;

(2) A significant disqualifying financial in-terest, as defined below, including:

(A) Employment or a promise of employ-ment;

(B) An interest of five (5) % or more in thefair market value of any form of business entityinvolved in workers’ compensation matters, or


of private real property or personal property, orin a leasehold interest;

(C) Five (5) % or more of the evaluator’sincome is received from direct referrals by orfrom one or more contracts with a person orentity listed in subdivision 41.5(c), except thatcontracts for participation in a Medical ProviderNetwork as defined under Labor Code section4616 et seq shall be excluded;

(D) A financial interest as defined in LaborCode section 139.3 that would preclude referralby the evaluator to such a person or entity;

(E) A financial interest as defined under thePhysician Ownership and Referral Act of 1993(PORA) set out in Business and ProfessionsCode sections 650.01 and 650.02 that wouldpreclude referral by the evaluator to such aperson or entity.

(3) A professional affiliation which meansthe evaluator performs services in the samemedical group or other business entity com-prised of medical evaluators who specialize inworkers’ compensation medical-legal evalua-tions;

(4) Any other relationship or interest notaddressed by subdivisions (d)(1) through (d)(3)which would cause a person aware of the factsto reasonably entertain a doubt that the evaluatorwould be able to act with integrity and impar-tiality.

(e) An Agreed Medical Evaluator or aQualified Medical Evaluator may disqualifyhimself or herself on the basis of a conflict ofinterest pursuant to this section whenever theevaluator has a relationship with a person orentity in a specific case, including doctor-pa-tient, familial, financial or professional, thatcauses the evaluator to decide it would beunethical to perform a comprehensive medical-legal evaluation examination or to write a reportin the case.

(f) An Agreed Medical Evaluator or Qual-ified Medical Evaluator who knows, or shouldknow, that he or she has a disqualifying conflictof interest with any person or entity listed insubdivision 41.5(c), that also is involved in thespecific workers’ compensation claim identifiedto the evaluator, shall send written notificationto the injured worker and the claims administra-tor, or if none the employer, or their respectiveattorneys if any, within five (5) business days ofthe evaluator becoming aware of the conflict.The written notice shall include, at a minimum:

1) disclosure that a disqualifying conflict ofinterest exists; 2) the person or entity withwhom the conflict arises; and 3) the category ofconflict, such as familial, significant financial, orother type of ethical conflict. Whenever theevaluator declines to perform an evaluation dueto disqualifying himself or herself pursuant tosubdivision 41.5(e), the parties shall be entitledto a replacement QME or, in represented cases areplacement panel pursuant to section 31.5 ofTitle 8 of the California Code of Regulations.Whenever the evaluator notifies the parties of aconflict without stating that he or she declines toperform the evaluation, the parties shall followthe procedures set out in section 41.6 of Title 8of the California Code of Regulations. In anycase in which the injured worker is not repre-sented by an attorney, the evaluator shall fax acopy of the notice of conflict to the Medical Unitof the Division of Workers’ Compensation at thesame time it is sent to the parties.

(g) Any injured worker or claims adminis-trator or if none the employer, including his orher attorney respectively, who knows of, orbecomes aware of, a potential disqualifyingconflict of interest, as defined under this section,with a specific evaluator selected to perform acomprehensive medical/legal examination andreport or a follow up examination and report,shall notify the selected evaluator in writing atthe earliest opportunity and no later than withinfive (5) business days of becoming aware of thepotential conflict, to enable the evaluator todetermine whether the disqualifying conflictexists. The notice shall include the person withwhom the alleged conflict exists and the natureof the conflict. A copy of this notice shall beserved on the opposing party at the same time asit is sent to the evaluator. The evaluator shallreview the information provided and advise theparties in writing within five (5) business daysof receipt of the notice whether the evaluator hasa conflict of interest as specified in this section.

Note: Authority cited: Sections 133, 139.2(o) and5307.3, Labor Code. Reference: Sections 139.2 and139.3, Labor Code; and Sections 650.01 and 650.02,Business and Professions Code.


§41.6. Procedures After Notice ofConflict of Interest and Waivers ofConflicts of Interest of an Evaluator.

(a) Whenever an Agreed or Qualified Med-ical Evaluator notifies the parties that a disqual-


ifying conflict of interest exists, and even if itarises after the evaluator has performed aninitial or follow up comprehensive medical-legal evaluation, the parties shall use the follow-ing procedures.

(b) An evaluator shall proceed with anyscheduled evaluation involving a physical ex-amination or supplemental report in the case,unless either the evaluator declines to proceeddue to disqualifying himself or herself pursuantto section 41.5(e) of Title 8 of the CaliforniaCode of Regulations or unless, pursuant to thissection, the injured worker or the claims admin-istrator is entitled to a replacement QME.

(c) Within five (5) business days of receiptof the evaluator’s notice of conflict:

(1) If the injured worker is not representedby an attorney, the parties shall obtain a newevaluator by following the procedure providedunder section 31.5 of Title 8 of the CaliforniaCode of Regulations and a replacement QME, orwhen necessary replacement QME panel, shallbe issued.

(2) If the injured worker is represented byan attorney, each party shall notify the evaluatorand the opposing party in writing of the party’sdecision either to waive the conflict or to objectto the evaluator on the basis of the evaluator’sconflict. Whenever either party objects to theevaluator due to a conflict, the parties shallobtain a new evaluator by following the proce-dures provided in Labor Code section 4062.2and section 31.5 of Title 8 of the CaliforniaCode of Regulations.

(3) In the event the parties in a representedcase wish to waive a conflict of interest, anysuch waiver shall be valid only if the generalnature of the conflict of interest is disclosed inwriting and on the same document, or duplicatecopies of the same document, each party hassigned a statement indicating that the signingparty understands that the evaluator has a con-flict of interest, the party understands the natureof the conflict, and the party wishes to waive theopportunity to obtain another evaluator. Thesignature of an attorney shall have the sameeffect as the signature of the party representedby the attorney, if a copy of the document signedby the attorney is served on the representedparty by the attorney or by any other party orattorney. It shall be the duty of the attorney toserve a copy of the signed document on theparty-client.

(d) Any dispute over whether a conflict ofinterest of an evaluator may affect the integrityand impartiality of the evaluator with respect toan evaluation report or supplemental report, andany dispute over waiver of an evaluator’s con-flict under this section, shall be determined by aWorkers’ Compensation Administrative LawJudge.

Note: Authority cited: Sections 133, 139.2(o) and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4064 and 4067, LaborCode.


§41.7. Gifts to Medical Evaluators.(a) No physician reporting as an Agreed

Medical Evaluator or a Qualified Medical Eval-uator shall accept gifts that have a total fairmarket value in the aggregate of three hundredsixty dollars ($ 360) or more, from any singlesource that handles California workers’ com-pensation matters, in the course of any consec-utive twelve months. The sources include, butare not limited to, one or more attorneys, phy-sicians, employers, claims administrators, med-ical or health care or insurance or utilizationreview business entities. This prohibition shallnot include reasonable and appropriate incomeearned from a Medical Provider Network asdefined in Labor Code sections 4616 et seq,from a Health Care Organization as defined inLabor Code sections 4600.3 et seq, from aPreferred Provider Organization or managedcare organization as defined in Health andSafety Code sections 1340 et seq for servicesperformed as a treating physician nor for rea-sonable and appropriate income paid for ser-vices performed as reviewing physician or med-ical director pursuant to Labor Code section4610, or for services performed as an AgreedMedical Evaluator or Qualified Medical Evalu-ator.

(b) For the purposes of this section, “Gift”means any payment to the extent that consider-ation of equal or greater value is not received. Itincludes any rebate or discount in the price ofanything of value, unless the rebate or discountis also made in the regular course of business tomembers of the public, and any loan, forgive-ness or other thing of value having a fair marketvalue in excess of $ 360 in the aggregate.

(c) Any person who claims that a payment,rebate, discount, loan, forgiveness, or other


thing of value is not a gift by reason of receipt ofconsideration has the burden of proving that theconsideration received is of equal or greatervalue.

(d) A Qualified Medical Evaluator whoviolates any portion of this section shall besubject to disciplinary action pursuant to section60 et seq of these regulations.

Note: Authority cited: Sections 133, 139.2(o) and5307.3, Labor Code. Reference: Sections 139.2 and139.3, Labor Code.


§43. Method of Evaluation ofPsychiatric Disability.

(a) For all claims arising before January 1,2005, not subject to section 43(b), the method ofmeasuring the psychiatric elements of a disabil-ity shall be as set forth below in the “PsychiatricProtocols” as adopted by the Industrial MedicalCouncil on July 16, 1992, and amended onMarch 18 and October 25, 1993. The full text ofthis document is available at no charge on theweb at www.dir.ca.gov/IMC/guidelines.html orby calling the Medical Unit at 1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the claims administrator, or ifnone the employer, is not required to provide thenotice required by section 4061 to the injuredworker, the method of evaluating the psychiatricelements of impairment shall include describingthe employee’s symptoms, social, occupationaland, if relevant, school functioning, and describ-ing the rationale for the evaluator’s assignmentto a level of impairment as published in thePermanent Disability Rating Schedule adoptedby the Administrative Director on or after Jan-uary 2005 pursuant to section 9805 of Title 8 ofthe California Code of Regulations.

[Psychiatric Protocols Not Reproduced]Note: Authority cited: Sections 133, 139.2(j)(4) and

5307.3, Labor Code. Reference: Sections 139.2(j)(4),4060, 4061, 4062, 4062.1, 4062.2, 4067, 4628 and4660, Labor Code, and Section 9805 of Title 8 of theCalifornia Code of Regulations.


2. Change without regulatory effect amending sectionfiled 3-15-94 pursuant to title 1, section 100, Califor-nia Code of Regulations (Register 94, No. 11).3. Change without regulatory effect amending sectionfiled 9-7-95 pursuant to section 100, title 1, CaliforniaCode of Regulations (Register 95, No. 36).4. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.5. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§44. Method of Evaluation ofPulmonary Disability.

(a) For all claims arising before January 1,2005, not subject to section 44(b), the method ofmeasuring the pulmonary elements of disabilityshall be as set forth below in the “Guidelines forEvaluation of Pulmonary Disability” as adoptedby the Industrial Medical Council on December4, 1997. The full text of this document isavailable at no charge on the web at www.dir.ca.gov/IMC/guidelines.html or by calling theMedical Unit at 1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the claims administrator, or ifnone the employer, is not required to provide thenotice required by section 4061 to the injuredworker, the method of measuring the pulmonaryelements of impairment shall be as described inthe American Medical Association, Guides tothe Evaluation of Permanent Impairment [FifthEdition] (AMA Guides). Permanent disabilityshall be described by applying the provisions ofthe Permanent Disability Rating Scheduleadopted by the Administrative Director pursuantto section 9805 of Title 8 of the California Codeof Regulations.

[Guidelines for Evaluation of PulmonaryDisability Not Reproduced]

Note: Authority cited: Sections 133, 139.2(j)(2) and5307.3, Labor Code. Reference: Sections 139.2(j)(2),


4060, 4061, 4062, 4062.1, 4062.2, 4067, 4628 and4660, Labor Code.

History: 1. New section filed 5-23-94; operative6-22-94 (Register 94, No. 21).2. Amendment of section and Note filed 6-19-98;operative 7-19-98 (Register 98, No. 25).3. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§45. Method of Evaluation of CardiacDisability.

(a) For all claims arising before January 1,2005, not subject to section 45(b), the method ofmeasuring the cardiac elements of disabilityshall be set forth below in the “Guidelines forEvaluation of Cardiac Disability” as adopted bythe Industrial Medical Council on December 4,1997 and updated on July 19, 1998. The full textof this document is available at no charge on theweb at www.dir.ca.gov/IMC/guidelines.html orby calling the Medical Unit at 1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the claims administrator, or ifnone the employer, is not required to provide thenotice required by section 4061 to the injuredworker, the method of measuring the cardiacelements of impairment shall be as described inthe American Medical Association, Guides tothe Evaluation of Permanent Impairment [FifthEdition] (AMA Guides). Permanent disabilityshall be described by applying the provisions ofthe Permanent Disability Rating Scheduleadopted by the Administrative Director pursuantto section 9805 of Title 8 of the California Codeof Regulations.

[Guidelines for Evaluation of CardiacDisability Not Reproduced]

Note: Authority cited: Sections 133, 139.2(j)(2) and5307.3, Labor Code. Reference: Sections 139.2(j)(2),4060, 4061, 4062, 4062.1, 4062.2, 4067, 4628 and4660, Labor Code.

History: 1. New section filed 5-23-94; operative6-22-94 (Register 94, No. 21).2. Amendment of section and Note filed 6-19-98;operative 7-19-98 (Register 98, No. 25).3. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§46. Method of Evaluation ofNeuromusculoskeletal Disability.

(a) For all claims arising before January 1,2005, not subject to section 46(b), the method ofmeasuring the neuromusculoskeletal elementsof disability shall be as set forth below in the“Guidelines for Evaluation of Neuromusculosk-eletal Disability” as adopted by the IndustrialMedical Council on October 20, 1994. The fulltext of this document is available on the web atno charge at www.dir.ca.gov/IMC/guidelines.html or by calling the Medical Unit at 1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the claims administrator, or ifnone the employer, is not required to provide thenotice required by section 4061 to the injuredworker, the method of measuring the neuromus-culoskeletal elements of impairment shall be asdescribed in the American Medical Association,Guides to the Evaluation of Permanent Impair-ment [Fifth Edition] (AMA Guides). Permanentdisability shall be described by applying theprovisions of the Permanent Disability RatingSchedule adopted by the Administrative Direc-tor pursuant to section 9805 of Title 8 of theCalifornia Code of Regulations.

[Guidelines for Evaluation ofNeuromusculoskeletal Disability Not

Reproduced]Note: Authority cited: Sections 133, 139.2(j)(2) and

5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4067, 4628 and 4660,Labor Code.


History: 1. New section filed 4-18-96; operative4-18-96 pursuant to Government Code section11343.4(d) (Register 96, No. 16).2. Change without regulatory effect amending“Guidelines for Evaluation of NeuromusculoskeletalDisability, 2nd Ed.” (incorporated by reference) filed6-6-96 pursuant to section 100, title 1, California Codeof Regulations (Register 96, No. 23).3. Change without regulatory effect amending Notefiled 8-1-96 pursuant to section 100, title 1, CaliforniaCode of Regulations (Register 96, No. 31).4. Amendment of section and Note filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).5. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.6. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§46.1. Guidelines for the Evaluationof Foot and Ankle Disability.

(a) For all claims before January 1, 2005,not subject to section 46.1(b), the method ofmeasuring the elements of foot and ankle shallbe set forth below in the “Guidelines for Eval-uation of Foot and Ankle Disability” as adoptedby the Industrial Medical Council on October28, 2000. The full text of this document isavailable on the web at no charge at www.dir.ca.gov/IMC/guidelines.html or by calling theMedical Unit at 1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the claims administrator, or ifnone the employer, is not required to provide thenotice required by section 4061 to the injuredworker, the method of measuring the elementsof foot and ankle impairment shall be describedin the American Medical Association, Guides tothe Evaluation of Permanent Impairment [FifthEdition] (AMA Guides). Permanent disabilityshall be described by applying the provisions ofthe Permanent Disability Rating Scheduleadopted by the Administrative Director pursuantto section 9805 of Title 8 of the California Codeof Regulations.

Note: Authority cited: Sections 139, 139.2, 4060,4061 and 4062, Labor Code. Reference: Sections 139,139.2, 4060, 4061, 4061.5 and 4062, Labor Code.

History: 1. New section and appendices A-C filed1-8-2003; operative 2-7-2003 (Register 2003, No. 2).2. Repealer of section and Appendices A-C and newsection filed 1-13-2009; operative 2-17-2009 (Register2009, No. 3).

§47. Method of Evaluation ofImmunologic Disability.

(a) For all claims before January 1, 2005,not subject to section 47(b), the method ofmeasuring the immunologic elements of disabil-ity shall be set forth below in the “Guidelines forImmunologic Testing” as adopted by the Indus-trial Medical Council on March 17, 1994. Thefull text of this document id available on theweb at no charge at www.dir.ca.gov/IMC/guidelines.html or by calling the Medical Unit at1-800-794-6900.

(b) For all claims having dates of injury onor after January 1, 2005, and for those compen-sable claims arising before January 1, 2005,where there has been either no comprehensivemedical-legal report or no report by a treatingphysician indicating the existence of permanentdisability, or when the employer is not requiredto provide the notice required by section 4061 tothe injured worker, the method of measuring theimmunological elements of impairment shall bedescribed in the American Medical Association,Guides to the Evaluation of Permanent Impair-ment [Fifth Edition] (AMA Guides). Permanentdisability shall be described by applying theprovisions of the Permanent Disability RatingSchedule adopted by the Administrative Direc-tor pursuant to section 9805 of Title 8 of theCalifornia Code of Regulations.

[Guidelines for Immunologic Testing NotReproduced]

Note: Authority cited: Section 139.2(j)(2), LaborCode. Reference: Sections 139.2(j)(2), 4060, 4061 and4062, Labor Code.

History: 1. New section filed 5-23-94; operative6-22-94 (Register 94, No. 21).2. Amendment of Note filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).3. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Code


of Regulations was instead printed in full in theCalifornia Code of Regulations.4. Amendment filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

ARTICLE 4.5

Minimum Time Guidelines

§49. Definitions.The following definitions apply to this Arti-

cle:(a) Cardiovascular evaluation. “Cardiovas-

cular evaluation” means the determination ofdisability due to pathological changes of theheart and/or the central circulatory system.

(b) Face to Face time. “Face to face time”means only that time the evaluator is presentwith an injured worker. This includes the time inwhich the evaluator performs such tasks astaking a history, performing a physical exami-nation or discussing the worker’s medical con-dition with the worker. Face to face time ex-cludes time spent on research, records reviewand report writing. Any time spent by the injuredworker with clinical or clerical staff who per-form diagnostic or laboratory tests (includingblood tests or x-rays) or time spent by theinjured worker in a waiting room or other areaoutside the evaluation room is not included inface to face time.

(c) Medical evaluation. “Medical evalua-tion” means a comprehensive medical-legalevaluation as defined under section 9793 ofArticle 5.6, Subchapter 1, Chapter 4.5 of Title 8of the California Code of Regulations.

(d) Neuromusculoskeletal evaluation.“Neuromusculoskeletal evaluation” means thedetermination of disability due to injury to thecentral nervous systems, the spine and extrem-ities, and the various muscle groups of the body.

(e) Psychiatric evaluation. “Psychiatricevaluation” means the determination of disabil-ity due to psychopathology, by either a psychi-atrist or psychologist following the Method ofMeasurement of Psychiatric Disability set out insection 43 of Title 8 of the California Code ofRegulations.

(f) Pulmonary evaluation. “Pulmonaryevaluation” means the determination of disabil-ity due to pathological changes of the lungsand/or other components of the respiratory sys-tem.

(g) QME. “QME” means Qualified Medi-cal Evaluator appointed by the AdministrativeDirector pursuant to Labor Code section 139.2.

(h) Uncomplicated evaluation. “Uncompli-cated evaluation” means a face to face evalua-tion in which all of the following are recorded inthe medical report: Minimal or no review ofrecords, minimal or no diagnostic studies orlaboratory testing, minimal or no research, andminimal or no medical history taking.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4067, 4628 and 4660,Labor Code.

History: 1. Change without regulatory effect relo-cating article 4.5 heading and renumbering formersection 149 to new section 49 filed 8-31-94 pursuant tosection 100, title 1, California Code of Regulations(Register 94, No. 35).2. Change without regulatory effect amending articleheading filed 9-28-94 pursuant to section 100, title 1,California Code of Regulations (Register 94, No. 39).3. Amendment of subsection (b) filed 4-14-2000;operative 5-14-2000 (Register 2000, No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§49.2. NeuromusculoskeletalEvaluation.

A medical evaluation concerning a claim forneuromusculoskeletal injury (whether specificor cumulative in nature) shall not be completedby a QME in fewer than 20 minutes of face toface time. Twenty minutes is the minimumallowable face to face time for an uncomplicatedevaluation. The evaluator shall state in theevaluation report the amount of face to face timeactually spent with the injured worker andexplain in detail any variance below the mini-mum amount of face to face time stated in thisregulation.

Note: Authority cited: Sections 133, 139.2(j) and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4067, 4628 and 4660,Labor Code.

History: 1. Change without regulatory effect re-numbering former section 149.2 to new section 49.2filed 8-31-94 pursuant to section 100, title 1, Califor-nia Code of Regulations (Register 94, No. 35).2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§49.4. Cardiovascular Evaluation.A medical evaluation concerning a claim for

cardiovascular injury (whether specific or cumu-


lative in nature) shall not be completed by aQME in fewer than 30 minutes of face to facetime. Thirty minutes is the minimum allowableface to face time for an uncomplicated evalua-tion. The evaluator shall state in the evaluationreport the amount of face to face time actuallyspent with the injured worker and explain indetail any variance below the minimum amountof face to face time stated in this regulation.

Note: Authority cited: Sections 133, 139.2(j) and5307.3, Labor Code, Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4067, 4628 and 4660,Labor Code.


§49.6. Pulmonary Evaluation.A medical evaluation concerning a claim for

pulmonary injury (whether specific or cumula-tive in nature) shall not be completed by a QMEin fewer than 30 minutes of face to face time.Thirty minutes is the minimum allowable face toface time for an uncomplicated evaluation. Theevaluator shall state in the evaluation report theamount of face to face time actually spent withthe injured worker and explain in detail anyvariance below the minimum amount of face toface time stated in this regulation.



§49.8. Psychiatric Evaluation.A medical evaluation concerning a claim for

psychiatric injury (whether specific or cumula-tive in nature) shall not be completed by a QMEin less than one hour of face to face time. Onehour is considered the minimum allowable faceto face time for an uncomplicated evaluation.The evaluator shall state in the evaluation reportthe amount of face to face time actually spentwith the injured worker and explain in detail anyvariance below the minimum amount of face toface time stated in this regulation.

Note: Authority cited: Sections 133, 139.2(j) and5307.3, Labor Code. Reference: Sections 139, 139.2,4060, 4061, 4062, 4062.1, 4062.2, 4067, 4628 and4660, Labor Code.


§49.9. Other Evaluation.A medical evaluation concerning a claim for

any injury (whether specific or cumulative innature) not specifically included in this articleshall not be completed by a QME in fewer than30 minutes of face to face time. Thirty minutesis the minimum allowable face to face time foran uncomplicated evaluation. The evaluatorshall state in the evaluation report the amount offace to face time actually spent with the injuredworker and explain in detail any variance belowthe minimum amount of face to face time statedin this regulation.



ARTICLE 5

QME Reappointment

§50. Reappointment: Requirementsand Application Form.

(a) In addition to the eligibility require-ments set forth in section 11, a physician mayseek reappointment on the basis that he or shewas an active QME on June 30, 2000. For allphysicians, applications for reappointment shallinclude a Reappointment Application Form insection 104, and the appropriate fee under sec-tion 17. The reappointment application and theappropriate fee shall be filed at the Administra-tive Director’s headquarters office listed on thereappointment form.

(b) Any Reappointment Application Formmay be rejected if it is incomplete or does notcontain the required supporting documentation


listed in section 11 and on the ReappointmentApplication Form. As part of the approval of theReappointment Application Form, the Adminis-trative Director shall verify that the QME hascomplied with all requirements under this Arti-cle.

(c) When a QME applies for reappoint-ment, he or she shall submit a statement signedunder penalty of perjury:

(1) attesting that he or she has completedthe applicable QME continuing education re-quirement; and

(2) listing the dates, locations, and titles ofthe continuing education programs and thenames of the providers of those programs whichhe or she has taken to meet the requirement ofLabor Code section 139.2(d)(3), as well as thenumber of hours of attendance at each program.The Administrative Director may randomly au-dit QMEs for documentation of program atten-dance, which supports compliance with thisrequirement; and

(3) attesting that the physician has accu-rately reported on the QME SFI Form 124 to thebest of the QME’s knowledge the informationrequired by section 29 regarding the QME’sspecified financial interests; and

(4) attesting that the physician’s license topractice as a physician, as defined under LaborCode section 3209.3, is neither restricted norencumbered by suspension or probation, nor hasthe physician been convicted of a misdemeanoror felony related to the physician’s practice or acrime of moral turpitude, and that the physicianwill notify the Administrative Director if thephysician’s license to practice is subsequentlysuspended or placed on probation or if thephysician is convicted of a misdemeanor orfelony related to the physician’s practice or of acrime of moral turpitude; and

(5) attesting that the physician shall abideby all regulations of the Administrative Directorand shall refrain from making referrals in vio-lation of those regulations; and

(6) attesting that the physician has not per-formed a QME evaluation during a time whenthe physician was not appointed as a QME.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, LaborCode.

History: 1. New article 5 and repealer and newsection filed 8-1-94; operative 8-31-94 (Register 94,No. 31). For prior history, see Register 91, No. 26.

2. Change without regulatory effect amending firstparagraph and subsection (i) filed 4-19-95 pursuant tosection 100, title 1, California Code of Regulations(Register 95, No. 16).3. Amendment of article 5 heading and renumberingof former section 50 to new section 53 and newsection filed 8-23-96; operative 9-22-96 (Register 96,No. 34).4. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).5. Amendment of section heading and section andnew Note filed 9-6-2001; operative 10-6-2001 (Reg-ister 2001, No. 36).6. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§51. Reappointment: Failure toComply with Time Frames.

All QMEs shall comply with the time framesin sections 34 and 38 as a condition for reap-pointment. The Administrative Director maydeny reappointment to any QME who has failedto comply with the evaluation time frames insections 34 and 38 on at least three occasionsduring the calendar year.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Section 139.2(d)(1),Labor Code.

History: 1. Repealer and new section filed 8-1-94;operative 8-31-94 (Register 94, No. 31). For priorhistory, see Register 91, No. 26.2. Renumbering of former section 51 to new section60 and new section filed 8-23-96; operative 9-22-96(Register 96, No. 34).3. Renumbering of former section 51 to section 53and renumbering of former section 50.1 to section 51filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§52. Reappointment: UnavailabilityNotification.

All QMEs shall comply with the unavailabil-ity notification requirements in section 33 as acondition for reappointment. The AdministrativeDirector may deny reappointment of any QMEwho has filed notification for unavailabilityunder section 33 for more than 90 calendar daysduring the calendar year, or who has on anysingle occasion refused without good cause toperform a medical-legal evaluation.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2(d) and139.2(j)(6), Labor Code.


History: 1. Repealer and new section filed 8-1-94;operative 8-31-94 (Register 94, No. 31). For priorhistory, see Register 91, No. 26.2. Renumbering of former section 52 to new section61, renumbering of former section 50.3 to new section52 and amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. Renumbering of former section 52 to section 54and renumbering of former section 50.2 to section 52filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§53. Reappointment: Failure of BoardCertification Examination. [Repealed]

History: 1. Repealer and new section filed 8-1-94;operative 8-31-94 (Register 94, No. 31). For priorhistory, see Register 91, No. 26.2. Renumbering of former section 53 to new section62, renumbering of former section 50 to new section53 and amendment of section filed 8-23-96; operative9-22-96 (Register 96, No. 34).3. Amendment filed 3-15-99; operative 4-14-99 (Reg-ister 99, No. 12).4. Renumbering of former section 53 to section 55and renumbering of former section 51 to section 53filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).5. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§54. Reappointment: EvaluationsRejected by Appeals Board.

The Administrative Director may deny reap-pointment to any QME who has had more thanfive evaluations rejected by a Workers’ Com-pensation Judge or the Appeals Board originallysubmitted at a contested hearing. The rejectionshall be based on the failure of the QME’sevaluation to prove or disprove a contested issueor failure to comply with guidelines promul-gated by the Administrative Director pursuant toLabor Code section 139.2(j)(2), (3), (4) or (5). Aspecific finding must become final and the timefor appeal must have expired before any rejectedevaluation shall be counted as one of the fiverejections.


History: 1. New section filed 5-9-91; operative5-9-91 (Register 91, No. 26). New section is exemptfrom review by OAL pursuant to Government Codesection 11351(a).

2. Repealer filed 8-1-94; operative 8-31-94 (Register94, No. 31).3. Renumbering of former section 52 to section 54filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).4. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§55. Reappointment: ContinuingEducation Programs.

A QME shall complete within the previous 24months of his or her term of appointment 12hours of continuing education in disability eval-uation or workers’ compensation related medi-cal dispute evaluation given by a provider ac-credited by the Administrative Director.

(a) There are two types of continuing edu-cation programs:

(1) On-site programs, in which the instruc-tor and QME are in the same location; and

(2) Distance learning programs.(A) Providers of distance learning pro-

grams shall give either a pre- or post-courseself-examination based on the program material.The provider shall grade the QME’s test. Creditfor the course can be given only for a passingrate of no lower than 70 percent correct re-sponses. The Administrative Director may auditphysicians’ examinations and scores.

(B) Credit for distance learning coursesshall be granted for the actual time spent view-ing, listening to or participating in the programand for the reasonable and necessary time totake the examinations for up to six hours perprogram. Credit for the same distance learningprogram may be taken only once.

(C) All distance learning materials shallbear a date of release and shall be updated everythree years. The provider shall notify the Ad-ministrative Director in writing of the revision.

(b) In addition to granting credit for attend-ing a course or program which it gives, theAdministrative Director may grant credit for:

(1) Participating in a panel on the develop-ment or review of the QME competency exam-ination. A physician may receive one hour creditfor each hour of participation on a panel. TheQME shall obtain documentation of participa-tion from the test administrator for submissionto the Administrative Director.

(2) Instructing in a program given for QMEcredit by a provider accredited by the Adminis-trative Director. The instructor may receive two


hours of credit for each hour of instruction in anaccredited provider’s program or one hour ofcredit for each hour of participation on a panel.Credit for the same presentation may be takenonly once during each calendar year. The QMEshall submit documentation of participationfrom the program provider to the AdministrativeDirector.

(3) Attending a program which is acceptedby the QME’s licensing board for renewal of hisor her professional license, provided the subjectmatter is directly related to California impair-ment evaluation or workers’ compensation med-ical dispute evaluation.

To request credit for this type of course, theQME 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’slicensing board.

(4) Passing the QME competency examina-tion. A QME may be granted six hours ofcontinuing education credit for passing thisexamination for the purpose of receiving aninitial appointment as a QME.

(c) To apply to the Administrative Directorfor accreditation, a provider shall submit to theAdministrative Director, at least 60 calendardays before any public advertisement of theapplicant’s program or course is made:

(1) a completed form 118, in section 118 ofthese regulations.

(2) A curriculum vitae for each proposedinstructor or author (for paper-based programs).A proposed instructor or author shall have edu-cation and/or training and recent work experi-ence relevant to the subject of his/her presenta-tion.

(3) The proposed promotional material forthe program.

(4) An outline of course content, or actualcourse content, consistent with the topics insection 11.5(c) of Title 8 of the California Codeof Regulations.

(d) The Administrative Director shall ac-credit an applicant who meets the definition ofan education provider in Section 1(q); submits acompleted, signed and dated application whichdemonstrates past experience in providing con-tinuing education programs; and proposes aprogram which meets the requirements of sec-

tion 55(c) or a course which meets the require-ments of section 11.5(a) and (i). Proposed con-tent for continuing education program creditmust relate directly to disability evaluation orCalifornia workers’ compensation-related med-ical dispute evaluation. No credit shall be rec-ognized by the Administrative Director for ma-terial solely discussing the business aspects ofworkers’ compensation medical practice such asbilling, coding and marketing.

(e) The Administrative Director shall notifythe applicant within 30 calendar days afterreceipt of the application containing all theinformation listed in section 55(c) whether thatprovider has been accredited for a two yearperiod. Incomplete applications will be returnedto the applicant.

(f) A provider that has been accredited bythe Administrative Director will be given anumber which must be displayed on any publicadvertisements of QME continuing educationprograms for that provider with the statement“Accredited by the Administrative Director ofthe California Division of Workers’ Compensa-tion for Qualified Medical Evaluator continuingeducation. Physicians may report up tohours of credit for QME reappointment.”

(g) On or before the date the program isfirst presented or distributed, the provider shallsubmit the program syllabus (all program hand-outs) to the Administrative Director. Each dis-tance learning program shall also submit onecopy of the examinations and one copy of theaudio/video tapes, computer program or eachissue of the journal or newsletter for whichcredit is to be granted.

(h) A provider may offer different QMEcontinuing education programs during the two-year accreditation period provided the subjectmatter is in disability evaluation or workers’compensation related medical dispute resolu-tion. The provider shall send the AdministrativeDirector the program outlined and faculty foreach new program at least forty-five (45) daysprior to the date of presentation of the newprogram. The Administrative Director may re-quire submission of program syllabi. The Ad-ministrative Director may require changes in theprogram based on its review of the programoutline, program syllabi, promotional materialor faculty if the Administrative Director findsthat any aspect of the program is not in compli-ance with these regulations.


(i) Promotional materials for a programmust state the educational objectives; the pro-fessional qualifications of program faculty (atleast all relevant professional degrees); the con-tent of program activities; the maximum numberof credit hours to be granted; and the intendedaudience.

(j) Joint sponsorship of education programs(as between an accredited and an unaccreditedprovider) must be approved by the Administra-tive Director prior to presentation of the pro-gram.

(k) Accredited providers that cease to offereducation programs shall notify the Administra-tive Director in writing.

(l ) Instructors shall not recruit members orpromote commercial products or services imme-diately before, during or after a course. Provid-ers or vendors may display/sell educationalrelated to workers’ compensation or applica-tions for membership in an area adjoining acourse. A course provider or faculty membershall disclose on QME Form 119 (Faculty Dis-closure of Commercial Interest), located in sec-tion 119 of Title 8 of the California Code ofRegulations, any significant financial interest inor affiliation with any commercial product orservice held by faculty and discussed in a courseand that interest or affiliation must be disclosedto all attendees. A provider shall file every Form119 in its possession or in its control with theAdministrative Director.

(m) The provider shall issue a certificate ofcompletion to each QME who successfully com-pletes a continuing education program. Thecertificate must list the provider; provider num-ber; date(s); location and title of the continuingeducation program; and the number of hours inattendance for which credit is to be granted.Credit shall be granted only for the actual timeof attendance at or participation in a program.Each accredited provider may in its sole discre-tion limit the amount of credit hours that acourse will be granted to less than the amount oftime actually spent in attendance in the course.

(n) To apply for re-accreditation, a providermust submit a completed QME Form 118 (Ap-plication for Accreditation or Re-Accreditationas Education Provider) (See, 8 Cal. Code Regs.§ 118). The provider may complete section 2 ofthe form using a new program or course or onewhich was given by the provider during therecent accreditation period. The Administrative

Director shall give the provider ninety (90)days’ notice of the need to seek re-accreditation.

(o) The provider shall maintain attendancerecords for each continuing education programfor a period of no less than three (3) years afterthe program is given. A physician attending theprogram must be identified by signature. Theprovider must submit a copy of the signature listto the Administrative Director within sixty (60)days of completion of the program.

(p) The provider is required to give theQME’s Evaluation Form 117 (Qualified MedicalEvaluator Continuing Education ResponseForm) (See, 8 Cal. Code Regs. § 117) toprogram attendees and request they submit theform to the Administrative Director. This infor-mation shall not be used in lieu of a certificationof completion given by the provider, as specifiedpursuant to section (m). Destruction by a pro-vider or its employee of a QME’s EvaluationForm or failure by such provider or its employeeto distribute Form 117 as part of its programshall constitute grounds for revocation of aprovider’s accredited status. The AdministrativeDirector shall tabulate the responses and return asummary to the provider within ninety (90) daysof completion of the program.

(q) The Administrative Director may audita provider’s program(s) at the request of themedical director to determine if the providermeets the criteria for accreditation. The Admin-istrative Director may audit programs randomly,when a complaint is received, or on the basis ofresponses on QME Form 117 (Qualified Medi-cal Evaluator Continuing Education ResponseForm) (See, 8 Cal. Code Regs. § 117). Anauditor shall not receive QME credit for anaudited program. The Administrative Directorshall make written results of the audit availableto the provider no more than thirty (30) daysafter the audit is completed.

(r) The Administrative Director may with-draw accreditation of a provider or deny such aprovider’s application for accreditation on thefollowing grounds (in addition to failure to meetthe relevant requirements of subdivision 11.5(a)or 55(c) of Title 8 of the California Code ofRegulations):

(1) Conviction of a felony or any offensesubstantially related to the activities of theprovider.

(2) Any material misrepresentation of factmade by the provider.


(3) Failure to comply with AdministrativeDirector 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 Edu-cation Response Form) (See, 8 Cal. Code Regs.§ 117) cards to program attendees.NOTE: Forms referred to above are available atno charge by downloading from the web atwww.dir.ca.gov/dwc/forms.html or by request-ing at 1-800-794-6900.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4062.3, 4067 and 4628,Labor Code.

History: 1. New section filed 5-9-91; operative5-9-91 (Register 91, No. 26). New section is exemptfrom review by OAL pursuant to Government Codesection 11351(a).2. Repealer filed 8-1-94; operative 8-31-94 (Register94, No. 31).3. Renumbering of former section 53 to section 55filed 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).4. Amendment of section heading and section filed9-6-2001; operative 10-6-2001 (Register 2001, No.36).5. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§56. Reappointment: Failure toComply with WCAB Order or Ruling.

The Administrative Director may deny reap-pointment to any QME who has been found inviolation of any order or ruling by a Workers’Compensation Judge or the Appeals Board.


History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§57. Reappointment: ProfessionalStandard—Violation of Business andProfessions Code Section 730.

The Administrative Director may deny ap-pointment or reappointment to any physicianwho has performed a QME evaluation or exam-ination without valid QME certification at the

time of examining the injured worker or the timeof signing the initial or follow-up evaluationreport.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code; and Section 730, Business andProfessions Code. Reference: Sections 139.2(d) and139.2(j)(6), Labor Code; and Section 730, Businessand Professions Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

ARTICLE 6

QME Discipline

§60. Discipline.(a) The Administrative Director may, in his

or her discretion, suspend or terminate anyphysician from the QME list without hearing:

(1) whose license has been revoked;(2) whose license has been suspended or

terminated by the relevant licensing board so asto preclude practice;

(3) who has been convicted of a misde-meanor or felony related to the conduct of his orher practice or who has been suspended orplaced on probation by his or her licensingboard;

(4) based on a stipulation or a decision bythe physician’s licensing board that the physi-cian has been placed on probation;

(5) who has failed to pay timely the appro-priate fee as required under section 17 of Title 8of the California Code of Regulations.

(b) The Administrative Director may, basedon a complaint by the Medical Director, andfollowing a hearing pursuant to section 61 ofTitle 8 of the California Code of Regulations,suspend, terminate or place on probation a QMEfound in violation of a statutory or administra-tive duty as described in the AdministrativeDirector Sanction Guidelines for QMEs undersection 65 of Title 8 of the California Code ofRegulations. Such violations include, but are notlimited to:

(1) one violation of Labor Code section139.3 or 4628;

(2) failure to follow the medical proceduresestablished by the Administrative Director pur-suant to Labor Code section139.2(j)(1)(2)(3)(4)(5) or (6);


(3) failure to comply with the requirementsof Labor Code section 139.2(b) or (c) and/orsection 10, 10.5, 11 or 12 of Title 8 of theCalifornia Code of Regulations;

(4) failure to comply with the unavailabil-ity notification requirements pursuant to section33 of Title 8 of the California Code of Regula-tions.

(5) failure to comply with the disclosure,ethical or conflict of interest requirements pur-suant to sections 40, 41 or 41.5, respectively, ofTitle 8 of the California Code of Regulations;

(6) failure to complete accurate and com-plete reports pursuant to Labor Code section139.2(i) or to comply with section 39.5 of Title8 of the California Code of Regulations.

(7) one finding by the Appeals Board of exparte contact by the QME prohibited by LaborCode section 4062.3.

(8) one finding by the Administrative Di-rector that the QME solicited an injured workerto take over that worker’s treatment for his orher workers compensation claim.

(9) failure to disclose a disqualifying con-flict of interest as required by section 41.5 ofTitle 8 of the California Code of Regulations;

(10) failure to disclose a significant finan-cial interest, as defined in sections 1(cc) and 29of Title 8 of the California Code of Regulations.

(c) The Medical Director may file a com-plaint with the Administrative Director against aQME on any of the grounds listed in subsection(b) based on a complaint from a member of thepublic and/or the Medical Director’s own initia-tive. The Medical Director may assign legalcounsel and investigators to conduct all mattersrelated to this Article.

(d) The powers and discretion of the Ad-ministrative Director are hereby delegated to theMedical Director of the Division, or his or herdesignee Associate Medical Director, with re-spect to:

(1) Conducting investigations and assign-ing investigators;

(2) Issuing subpoenas for testimony and/orproduction of documents;

(3) Propounding interrogatories;(4) Receiving and filing requests for hear-

ing and notices of defense;(5) Setting and calendaring cases for hear-

ing;(6) Issuing notices of hearing;

(7) Assigning counsel; and(8) Performing all other functions related to

QME discipline under this Article, except forissuing statements of issues, issuing accusationsand issuing disciplinary orders after hearing.

(e) A report prepared by a QME which hasnot been completed and served on one or moreparties prior to the date of the final decisiontaken by the licensing board or the date of theconviction, whichever is earlier, shall be inad-missible before the Appeals Board and no partyshall have liability for payment for the report.

Note: Authority cited: Sections 11180-11191, Gov-ernment Code; Sections 111, 133, 139.2 and 5307.3,Labor Code. Reference: Sections 139.2 and 4062.3,Labor Code.

History: 1. New article 6 (sections 60-62), renum-bering of former section 51 to new section 60, repealerand new subsection (a), amendment of subsection (b),new subsection (b)(6) and subsection renumbering,and new subsections (b)(8) and (d) filed 8-23-96;operative 9-22-96 (Register 96, No. 34).2. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§61. Hearing Procedure.(a) Where the Medical Director determines

that there is prima facie evidence of any viola-tion of section 60 of Title 8 of the CaliforniaCode of Regulations, he or she shall make andsubmit a prima facie case of the violation to theAdministrative Director.

(b) If the Administrative Director sustainsthe Medical Director’s prima facie case, theQME shall be notified in writing of the deter-mination and shall also be notified of his or herright to a hearing in accordance with Chapter 4(commencing with Section 11370) and Chapter5 (commencing with section 11500) and Part 1of Division 3 of the Government Code.

(1) The Administrative Director may, not-withstanding Government Code section 11502,assign the hearing to a hearing officer designatedby the Medical Director who shall act as anAdministrative Law Judge for the purposes ofGovernment Code sections 11370 et seq. and11500 et seq., or may delegate in whole or inpart to an Administrative Law Judge the author-ity to conduct the hearing and decide the case. Inthe event of a hearing, the hearing officer orAdministrative Law Judge shall fix the time andplace of the hearing and notify interested parties


in writing no fewer than 10 days in advance ofthe hearing and in accordance with Code ofCivil Procedure sections 1013(a) and 2015.5specifying the time and place of the hearing.

(2) If an Administrative Law Judge con-ducts a hearing, the Administrative Law Judgeselected to preside over the hearing shall hearthe case alone, and exercise all powers related tothe conduct of the hearing.

(3) At the conclusion of the hearing, theAdministrative Law Judge or hearing officershall file a written statement of findings andproposed decision with the Administrative Di-rector. The decision made pursuant to this actionshall include specific findings in accordancewith section 60(b) of Title 8 of the CaliforniaCode of Regulations, and under section 65 ofTitle 8 of the California Code of Regulationsshall recommend, but defer to the Administra-tive Director the final decision with respect tosanctions.

(4) The Administrative Director’s decisionon which sanction(s) to impose on a QME,pursuant to Labor Code section 139.2(k) or anyother statute giving the Administrative Directordisciplinary authority, shall be in accordancewith the Sanction Guidelines for Qualified Med-ical Evaluators under section 65 of Title 8 of theCalifornia Code of Regulations.

(5) In accordance with Government Codesection 11517(c), if the proposed decision is notadopted by the Administrative Director, theAdministrative Director shall determine whetheror not to decide the case, based on the recordand transcript, and/or whether or not to takeadditional evidence or to refer the case back tothe Administrative Law Judge to take additionalevidence on any issue or issues requested by theAdministrative Director.

(6) Within thirty (30) days of the date thewritten decision is served upon the QME, theQME may file a petition for reconsiderationwith the Administrative Director. The petitionshall be governed by Government Code section11521 and shall set forth any legal or factualbasis as to why the decision should not beconfirmed.

(c) Judicial Review of the AdministrativeDirector’s decision may be had by the filing of apetition for writ of mandate pursuant to Govern-ment Code Section 11523 no later than thirty(30) days after the last day on which the

Administrative Director can order reconsider-ation in accordance with (b)(6) of this section.

Note: Authority cited: Sections 133, 139.2, 5307.3and 5307.4, Labor Code; and Sections 11370 et seq.and 11500 et seq., Government Code. Reference:Section 139.2, Labor Code; and Sections 11502 etseq., Government Code.

History: 1. Renumbering of former section 52 tonew section 61, and amendment of subsections (c) and(d) filed 8-23-96; operative 9-22-96 (Register 96, No.34).2. Repealer and new section and amendment of Notefiled 4-14-2000; operative 5-14-2000 (Register 2000,No. 15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§62. Probation.(a) A physician on probationary status from

his or her licensing authority may be placed onprobationary status by the Administrative Direc-tor in its discretion in accordance with SanctionGuidelines for Qualified Medical Evaluatorsunder section 65 of Title 8 of the CaliforniaCode of Regulations.

(b) A QME on probationary status may berequired to report periodically to the MedicalDirector to ensure compliance with any condi-tions of probation that have been imposed by theAdministrative Director. These conditions mayinclude the completion of specific courses andtraining.

(c) A QME shall be deemed to have passedprobation and be eligible for reappointment if heor she has complied with the conditions imposedby the Administrative Director during the pro-bation period, and meets the requirements forreappointment in accordance with Article 5.

(d) A QME shall be deemed to have failedprobation if upon completion of the probationperiod it is determined that he or she has notcomplied with the conditions imposed by theAdministrative Director during the probationperiod, and/or has failed to meet the require-ments for reappointment in accordance withArticle 5.

(e) The Administrative Director shall ter-minate probation, which shall be equivalent to afailure to pass probation, before completion ofthe probation period if during the probationperiod it is determined that a QME has notcomplied with the conditions of probation.

Note: Authority cited: Sections 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,


4061, 4062, 4062.1, 4062.2, 4067 and 4628, LaborCode.

History: 1. Renumbering of former section 53 tonew section 62, new subsection (a) and subsectionrelettering, and amendment of subsections (c) and (d)filed 8-23-96; operative 9-22-96 (Register 96, No. 34).2. Amendment of subsections (a), (c) and (d) filed4-14-2000; operative 5-14-2000 (Register 2000, No.15).3. Amendment of section and Note filed 1-13-2009;operative 2-17-2009 (Register 2009, No. 3).

§63. Denial of Appointment orReappointment.

(a) Whenever the Administrative Directordetermines that an application for appointmentor reappointment as a Qualified Medical Evalu-ator will be denied, the Administrative Directorshall:

(1) Notify the applicant in writing of thedecision to deny the application and the reasonsfor the denial; and

(2) Provide notice that if the applicant sub-mits a specific, written response to the notice ofdenial within thirty (30) days, the Administra-tive Director will review the decision to denythe application, and within sixty (60) days ofreceipt of the response notify the applicant ofthe Administrative Director’s final decision.

(b) If the applicant fails to submit a spe-cific, written response to the notice of denialwithin thirty (30) days, the decision to denyshall become final without any further notice.

(c) If the applicant submits a specific, writ-ten response, and the Administrative Director’sfinal decision is that the application should bedenied, notice of the final decision shall beprovided to the applicant by means of a state-ment of issues and notice of right to hearingunder Chapter 5 (commencing with section11500) of Title 2 of the Government Code.

(d) All notices and response under thissection shall be made by certified mail.

Note: Authority cited: Sections 133, 139.2(f) and5307.3, Labor Code; Section 11500 et seq., Govern-ment Code. Reference: Section 139.2, Labor Code.


§65. Sanction Guidelines for QualifiedMedical Evaluators.

The guidelines for determining appropriatesanctions for physicians licensed as QualifiedMedical Evaluators shall be set forth in the

Sanction Guidelines for Qualified MedicalEvaluators as adopted by the Industrial MedicalCouncil on October 21, 1999, and re-adoptedand enforced by the Administrative Director.

[Sanction Guidelines for Qualified MedicalEvaluators Not Reproduced]


History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Change without regulatory effect amending sectionfiled 10-29-2001 pursuant to section 100, title 1,California Code of Regulations (Register 2001, No.44). Pursuant to this filing, material adopted pursuantto the Administrative Procedure Act that had previ-ously been incorporated by reference in the CaliforniaCode of Regulations was instead printed in full in theCalifornia Code of Regulations.3. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

ARTICLE 7

Practice Parameters for the

Treatment of Common Industrial

Injuries

[Repealed]

§70. Treatment Guideline for LowBack Problems. [Repealed]

Note: Authority cited: Section 139(e)(8), LaborCode. Reference: Section 139(e)(8) Labor Code.

History: 1. Editorial correction changing place-ment of article 7 heading (Register 97, No. 23).2. New section filed 6-3-97; operative 7-3-97 (Regis-ter 97, No. 23).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.5. Repealer of article 7 (sections 70-77) and sectionfiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).


§71. Treatment Guideline forIndustrial Neck Injuries. [Repealed]

Note: Authority cited: Section 139(e)(8), LaborCode. Reference: Section 139(e)(8), Labor Code.

History: 1. New section filed 7-18-97; operative8-17-97 (Register 97, No. 29).2. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).3. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.4. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§72. Treatment Guideline forOccupational Asthma. [Repealed]


History: 1. New section filed 9-18-95; operative10-18-95 (Register 95, No. 38).2. Change without regulatory effect amending sectionheading and section filed 9-25-95 pursuant to section100, title 1, California Code of Regulations (Register95, No. 39).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.5. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§73. Treatment Guideline for ContactDermatitis. [Repealed]


History: 1. New section filed 9-18-95; operative10-18-95 (Register 95, No. 38).2. Change without regulatory effect amending sectionheading and section filed 9-25-95 pursuant to section100, title 1, California Code of Regulations (Register95, No. 39).3. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).4. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-

fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.5. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§74. Treatment Guideline for Post–Traumatic Stress Disorder. [Repealed]

Note: Authority cited: Section 139(e)(8), LaborCode. Reference: Section 139 and 139.2, Labor Code.

History: 1. New section filed 1-24-97; operative2-23-97 (Register 97, No. 4).2. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.3. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§75. Treatment Guidelines forShoulder Problems. [Repealed]



§76. Treatment Guideline for KneeProblems. [Repealed]


History: 1. New article 7 (section 76) and sectionfiled 5-13-97; operative 6-12-97 (Register 97, No. 20).2. Amendment filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15).3. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).


Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.4. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§76.5. Treatment Guideline for ElbowProblems. [Repealed]



§77. Treatment Guideline forProblems of the Hand and Wrist.[Repealed]


History: 1. New section filed 7-18-97; operative8-17-97 (Register 97, No. 29).2. Change without regulatory effect amending sectionfiled 7-12-2001 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2001, No. 28).Pursuant to this filing, material adopted pursuant to theAdministrative Procedure Act that had previouslybeen incorporated by reference in the California Codeof Regulations was instead printed in full in theCalifornia Code of Regulations.3. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

ARTICLE 10

QME Application Forms

§100. The Application forAppointment as Qualified MedicalEvaluator Form.

[QME Form 100 (Rev. 2/2009) NotReproduced]

NOTE: Form is available at no charge bydownloading from the web at www.dir.ca.gov/

dwc/forms.html or by requesting at 1-800-794-6900.

Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1 and 4062.2, Labor Code; Sections1798 et seq., Civil Code, and Sections 6250 et seq.,Government Code.

History: 1. Renumbering of former article 10 tonew article 15, new article 10 (sections 100-104) andnew section filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15). For prior history see Register94, No. 31.2. Amendment filed 8-23-2001; operative 8-23-2001pursuant to Government Code section 11343.4 (Reg-ister 2001, No. 34).3. Change without regulatory effect amending sectionfiled 5-2-2002 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2002, No. 18).4. Change without regulatory effect amending sectionfiled 1-27-2006 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2006, No. 4).5. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§101. The Alien Application Form.[Repealed]

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§102. The Application for QMECompetency Examination Form.


NOTE: Form is available at no charge bydownloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.

Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Section 139.2, LaborCode.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Change without regulatory effect amending sectionfiled 1-27-2006 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2006, No. 4).3. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).


§103. The QME Fee AssessmentForm.




History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Change without regulatory effect amending sectionfiled 6-27-2000 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2000, No. 26).3. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§104. The Reappointment Applicationas Qualified Medical Evaluator Form.



Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4061.5, 4062, 4062.1 and 4062.2, Labor Code;Sections 1798 et seq., Civil Code; and Sections 6250et seq., Government Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Amendment filed 9-6-2001; operative 10-6-2001(Register 2001, No. 36).3. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

ARTICLE 10.5QME Process Forms

§105. The Request for QualifiedMedical Evaluator Panel —Unrepresented Form and Attachmentto Form 105 (How to Request a QMEIf You Do Not Have an Attorney).


[Attachment to QME Form 105 (Rev. 2/2009)Not Reproduced]



Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4061.5, 4062, 4062.1, 4062.2, 4064 and 4067,Labor Code.

History: 1. New article 10.5 (sections 105-117)and new section filed 4-14-2000; operative 5-14-2000(Register 2000, No. 15). For prior history see Register94, No. 31.2. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§106. The Request for QualifiedMedical Evaluator Panel —Represented Form and Attachment toForm 106 (How to Request a QME in aRepresented Case).


[Attachment to QME Form 106 (Rev. 2/2009)Not Reproduced]


Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4064 and 4067, LaborCode.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Change without regulatory effect amending sectionfiled 5-2-2002 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2002, No. 18).3. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§107. The Qualified MedicalEvaluator Panel Selection Form.





History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§108. The Qualified MedicalEvaluator Panel Selection InstructionForm.




History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§109. The Qualified MedicalEvaluator Notice of UnavailabilityForm.




History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§110. The Appointment NotificationForm.





History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15). For prior historysee Register 94, No. 31.2. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§111. The Qualified MedicalEvaluator’s Findings Summary Form.



Note: Authority cited: Sections 53, 133, 139.2 and5307.3, Labor Code. Reference: Sections 139.2, 4060,4061, 4062, 4062.1, 4062.2, 4064, 4067 and 4660-4664, Labor Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§112. The QME/AME Time FrameExtension Request Form.





§113. Notice of Denial of Request forTime Extension Form.







§114. The Denial of Time ExtensionForm. [Repealed]

Note: Authority cited: Sections 139 and 139.2,Labor Code. Reference: Sections 139.2, 4060, 4061,4062 and 4062.5, Labor Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§115. The Notice of Late QualifiedMedical Evaluator Report Form.[Repealed]

Note: Authority cited: Sections 139 and 139.2,Labor Code. Reference: Sections 139.2, 4060, 4061,4062 and 4062.5, Labor Code.

History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Repealer filed 1-13-2009; operative 2-17-2009(Register 2009, No. 3).

§116. Notice of Late QME/AMEReport — No Extension RequestedForm.





§117. Qualified Medical EvaluatorCourse Evaluation Form.




History: 1. New section filed 4-14-2000; operative5-14-2000 (Register 2000, No. 15).2. Change without regulatory effect amending sectionfiled 5-2-2002 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2002, No. 18).3. Amendment of section heading, repealer and newsection and new Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§118. Application for Accreditation orRe–Accreditation As EducationProvider.




History: 1. New section filed 10-16-2000 as anemergency; operative 1-1-2001 (Register 2000, No.42). A Certificate of Compliance must be transmittedto OAL by 5-1-2001 or emergency language will berepealed by operation of law on the following day.2. New section refiled 5-2-2001 as an emergency;operative 5-2-2001 (Register 2001, No. 18). A Certif-icate of Compliance must be transmitted to OAL by8-30-2001 or emergency language will be repealed byoperation of law on the following day.3. Certificate of Compliance as to 5-2-2001 order,including further amendment of section, transmitted toOAL 7-12-2001 and filed 8-23-2001 (Register 2001,No. 34).4. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).


§119. Faculty Disclosure ofCommercial Interest.




History: 1. New section filed 10-16-2000 as anemergency; operative 1-1-2001 (Register 2000, No.42). A Certificate of Compliance must be transmittedto OAL by 5-1-2001 or emergency language will berepealed by operation of law on the following day.2. New section refiled 5-2-2001 as an emergency;operative 5-2-2001 (Register 2001, No. 18). A Certif-icate of Compliance must be transmitted to OAL by8-30-2001 or emergency language will be repealed byoperation of law on the following day.3. Certificate of Compliance as to 5-2-2001 order,including further amendment of section, transmitted toOAL 7-12-2001 and filed 8-23-2001 (Register 2001,No. 34).4. Repealer and new section and new Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§120. Voluntary Directive forAlternate Service of Medical–LegalEvaluation Report on Disputed Injuryto Psyche.





§121. Declaration RegardingProtection of Mental Health Record.






§122. AME or QME Declaration ofService of Medical–Legal Report.





§123. QME/AME Conflict of InterestDisclosure and Objection or Waiver byRepresented–Parties Form.





§124. Specified Financial InterestAttachment to QME Forms 100, 103 or104 (“SFI Form 124”).

Any physician who files a QME Form 100(Application for Appointment), 103 (QME FeeAssessment Form) or 104 (Reappointment Ap-plication) with the Administrative Director alsoshall complete the QME SFI Form 124, in orderto disclose specified financial interests that mayaffect the fairness of QME panels, and append itto the form 100, 103 or 104 being submittedwhen the form is filed.


[QME SFI Form 124 (Rev. 2/2009) NotReproduced]




§125. [Reserved]

ARTICLE 15

Fraudulent or Misleading

Advertising

§150. Definitions.As used in this Article:(a) Administrative Director — means the

Administrative Director of the Division ofWorkers’ Compensation of the State of Califor-nia, Department of Industrial Relations, andincludes his or her designee.

(b) Advertising copy — includes any “pub-lic communication” as defined in Business andProfessions Code Section 651, or any othercommunication of any message in any form ormedium regarding the availability for profes-sional employment of any physician, which ismade by or on behalf of any physician to thegeneral public or any substantial portion thereof.

Advertising concerning medical services re-garding industrial injuries or illnesses whichbenefits any physician, and which is placed byany medical clinic, medical service organizationor other non-physician third party shall bedeemed advertising copy subject to these regu-lations.

(c) Medical Board — means the MedicalBoard of California as established in Businessand Professions Code Section 2001.

(d) Medical Director — means the physi-cian appointed pursuant to Labor Code Section122 or such person as he or she may designate.

(e) Physician — has the meaning defined inLabor Code Section 3209.3.

(f) QME — means a Qualified MedicalEvaluator as defined in Labor Code Section139.2.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 139.2,139.4 and 139.45, Labor Code.

History: 1. New article 10 and section filed 3-31-93; operative 4-30-93 (Register 93, No. 14).2. Renumbering of article 10 to article 15 filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).3. New subsection (a), repealer of subsection (b),subsection relettering and amendment of Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§151. Filing of Documents.Any document filed under these regulations

shall be deemed filed on the date when it isreceived by the Administrative Director.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 133,139.4 and 139.45, Labor Code.


§152. Statement of Intent.Nothing in these regulations is intended to

alter the interpretation or application of Busi-ness and Professions Code section 651. Theseregulations are promulgated under the authorityof Labor Code sections 139.4 and 139.45 andare intended to reflect the Administrative Direc-tor’s understanding of the Legislature’s intentthat the Administrative Director apply a higherand independent standard, pursuant to thoseSections, to physician advertising which relatesto industrial injuries or illnesses.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 28,139.4 and 139.45, Labor Code.


§153. False or Misleading AdvertisingCopy Prohibited.

No physician subject to these regulations, orany person acting on his or her behalf or for hisor her benefit, shall use, cause to be used, orallow to be used:

(a) Any advertising copy which, throughendorsements, testimonials or other representa-tions, makes or implies any guarantee, warranty,or prediction that is intended, or is likely, to


create a false or unjustified expectation of favor-able results concerning the outcome of theemployment of the physician.

(b) Any advertising copy which by use of afirm name, trade name, fictitious business name,or other professional designation states or im-plies a relationship between any physician inprivate practice and any governmental agency orentity, with the exception that, as provided insection 154 below, a physician currently orpreviously certified by the Administrative Direc-tor as a Qualified Medical Evaluator may statethis fact in advertising copy, a curriculum vitaeor in descriptive text, only for the period of timethat is true and correct.

(c) Any advertising copy which states orimplies that a medical-legal report written byany physician, or group or association of physi-cians enjoys any special degree of credibility byany workers’ compensation judge or judges.

(d) Any advertising copy which advises orrecommends the securing of any medical-legalexamination, or which suggests that a tacticaladvantage may be secured by obtaining anymedical-legal evaluation.

(e) Any advertising copy which containsthe phrase “Qualified Medical Evaluator” or thedesignation “QME” unless such phrase is usedto identify individual physicians who are cur-rently certified as QMEs by the AdministrativeDirector in accordance with Labor Code section139.2.

(f) Any advertising copy which contains afirm name, trade name, or fictitious businessname which contains the phrases “QualifiedMedical Evaluator,” “Qualified Medical Exam-iner”, “Agreed Medical Evaluator”, “AgreedMedical Examiner”, “Independent Medical Ex-aminer”, “Independent Medical Evaluator” orthe designations “QME”, “AME” or “IME.”

(g) Any advertising copy which states orimplies that any physician has an ongoing ap-pointment, title or professional status as an“Agreed Medical Examiner,” “Agreed MedicalEvaluator”, “Independent Medical Examiner,”“AME,” or “IME.”

(h) Any advertising copy which states orimplies that the physician is currently an“Agreed Medical Examiner” or “IndependentMedical Examiner” in the California Workers’Compensation system.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 28,139.2, 139.4 and 139.45, Labor Code.

History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of subsections (b), (e) and (f), newsubsection (h) and amendment of Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).

§154. Permissible AdvertisingContent.

(a) A physician subject to these regulations,or any person acting on his or her behalf, mayuse, disseminate, or cause to be disseminated tothe public, or any portion of the public, adver-tising copy which relates to any industrial injuryor illness which accurately states:

(1) The name of each physician affiliatedwith or participating in the physician’s practice.

(2) The address, telephone number andbusiness hours of the office or offices.

(3) The areas of practice each physicianengages in.

(4) An individual physician’s appointmentas a QME. A physician who is not currentlycertified by the Administrative Director as aQualified Medical Evaluator may, in a curricu-lum vitae or descriptive text, state any periods inthe past during which the physician was certifiedas a Qualified Medical Evaluator.

(5) A statement that the physician is BoardCertified or limits his or her practice to specificfields as authorized by Business and ProfessionsCode Section 651. Any statement of BoardCertification shall include the name of the cer-tifying board.

(6) Any languages spoken fluently by thephysician or his or her staff.

(7) A description of any diagnostic or ther-apeutic facilities available.

(8) The availability of surgery or hospital-ization on a lien basis.

(9) The usual time frame for schedulingappointments or producing medical reports.

(10) That all billings are made in compli-ance with the Official Medical Fee Schedulepromulgated by the Administrative Director.

(11) Biographic information concerningthe physician’s educational background, intern-ships and residencies, hospital affiliations, pro-fessional affiliations and professional publica-tions.


(b) Any physician who wishes to use, dis-seminate, or cause to be disseminated to thepublic, or any portion of the public, any adver-tising copy which relates to any industrial injuryor illness which contains any material not spec-ified in subsection (a) above, shall apply inwriting to the Administrative Director for ap-proval before using such material. The Admin-istrative Director shall approve all requestswhich do not contain material which is false orlikely to mislead the public with respect toworkers’ compensation. No advertising copysubmitted to the Council pursuant to this sub-section shall be used until the AdministrativeDirector has given his/her written approval.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 139.2,139.4 and 139.45, Labor Code.

History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of subsections (a)(4), (a)(10) and (b)and amendment of Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§155. Filing of Complaints.(a) Any person may file a complaint with

the Medical Director, alleging that any physi-cian is using advertising copy which violates theprovisions of Business and Professions CodeSection 651, or the provisions of these regula-tions.

(b) Complaints filed with the Medical Di-rector shall be in writing and contain the follow-ing:

(1) The full name and address of the partyfiling the complaint.

(2) The full name and address of the phy-sician against whom the complaint is made, or ifthe complainant is unable to identify the physi-cian using the advertising, as much informationas the complainant can provide to assist theAdministrative Director in identifying the phy-sician who used the advertisement.

(3) A copy, if available to the complainingparty, of the advertising copy against which thecomplaint is made, or a description of themedium in which the advertising copy appeared.Such description should contain sufficient de-tails regarding the manner and form in which theadvertising copy was published to allow a copyof the advertising copy to be obtained by theAdministrative Director.

(4) A detailed statement of the grounds onwhich the advertising copy is alleged to violate

Business and Professions Code Section 651 orthese regulations.

(5) All complaints filed under this sectionshall be filed with the Medical Director, atDivision of Workers’ Compensation, P.O. Box71010, Attention: Medical Unit, Oakland, CA94612.

(6) Nothing in these regulations shall pre-vent the Administrative Director or MedicalDirector from acting independently, and withoutreceipt of a complaint, to initiate an investiga-tion and issue a complaint on the AdministrativeDirector’s own motion whenever the Adminis-trative Director or Medical Director has reasonto believe that there has been a violation ofBusiness and Professions Code section 651 orthese regulations.

Note: Authority cited: Sections 133, 139.4, 139.45and 5307.3, Labor Code. Reference: Sections 139.4and 139.45, Labor Code.

History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of subsections (b)(2)-(3) and (b)(5)-(6) and amendment of Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

§156. Requests to Review AdvertisingCopy.

(a) Upon receipt of a complaint under Sec-tion 155 of these regulations, the AdministrativeDirector shall serve a written notice of com-plaint on the physician against whom the com-plaint was filed. Such notice shall direct thephysician to file a copy of his or her advertisingwith the Medical Director within 15 workingdays of the date on which the notice was served.

(b) The Medical Director may take suchsteps as he or she deems necessary to determinewhether the complaint has merit.

(1) The Medical Director shall respond tothe complaint within fifteen (15) working daysof the Administrative Director’s receipt of thephysician’s response and notify the complainantthat the Administrative Director:

(A) will investigate the complaint; or(B) will require additional time to ascertain

whether the complaint has merit; or(C) will refer a copy of the complaint to

another agency which also has jurisdiction overthe subject matter of the complaint; or

(D) will take no further action on the com-plaint because the Administrative Director lacks


jurisdiction over the person or conduct com-plained of; or

(E) will take no further action on the com-plaint because the allegations of the complaintdo not warrant further action by the Administra-tive Director for the reasons stated in the re-sponse.

(c) At the time of filing the advertisingcopy with the Medical Director, the physicianshall also file an answer to the complaint, brieflysetting forth the grounds on which the physicianbelieves the copy to be in compliance withBusiness and Professions Code Section 651, andthe provisions of these regulations. Nothingcontained in the answer shall preclude the rightof the physician to present further or differentgrounds of defense before the AdministrativeDirector or appropriate licensing board. Uponreviewing the physician’s answer, the MedicalDirector may dismiss or informally resolve thecomplaint where he or she deems such actionappropriate.

(d) The Administrative Director may, with-out receipt of a complaint, request a physician toprovide a copy of any advertising used by thatphysician for review. Such a request shall bemade in writing, and shall be personally servedon the physician.

(e) If a physician who has been appointedas a QME fails to deliver a copy of the adver-tising used to the Administrative Director withinfifteen (15) working days of receipt of thenotice, the Administrative Director may inferfrom the failure to comply that the advertisingmaterial used by the QME is in violation ofBusiness and Professions Code Section 651, orthese regulations. The maximum penalty that theAdministrative Director may impose for a find-ing of violation based solely on the negativeinference created by this provision shall besuspension of the physician’s appointment as aQualified Medical Evaluator for a period of sixmonths followed by a period of probation not toexceed one year.

(f) If a non-QME physician fails to delivera copy of the advertising used to the Adminis-trative Director within fifteen (15) working daysof receipt of the request, the AdministrativeDirector shall refer the matter to that physician’slicensing board for such proceedings as thatboard may deem proper.


History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of section heading, section and Notefiled 1-13-2009; operative 2-17-2009 (Register 2009,No. 3).

§157. Determinations.(a) If, after reviewing the physician’s ad-

vertising copy and the physician’s answer to thecomplaint, the Medical Director determines thatthe advertising copy violates Business and Pro-fessions Code section 651, or these regulationsand that the physician is currently a QualifiedMedical Evaluator, the disciplinary and hearingprocedures set forth in sections 60 through 65 ofTitle 8 of the California Code of Regulationsshall apply. The Medical Director shall forwarda copy of any final decision of such violations tothe physician’s licensing board for such pro-ceedings as that board may deem proper.

(b) If the Medical Director determines thatthe physician subject to the investigation cur-rently is not a QME, the Medical Director shallforward a copy of the preliminary determina-tion, the complaint, and all supporting documen-tation to the appropriate physician’s licensingboard for such proceedings as that board maydeem proper.


History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of subsections (a) and (b), repealer ofsubsections (c)-(d)(6) and amendment of Note filed1-13-2009; operative 2-17-2009 (Register 2009, No.3).

§158. Penalties.(a) A QME who is found to have violated

any provision of Business and Professions Codesection 651, or these regulations may have his orher QME status terminated, suspended, orplaced on probation by the Administrative Di-rector. Any probation imposed may have suchconditions as the Administrative Director deemsreasonable, including, but not limited to thepublication of corrective advertising and thesubmission of future advertising copy for theAdministrative Director’s approval before itsuse.


(b) The Administrative Director shall con-sider the following factors in determining theappropriate penalty for a violation of Businessand Professions Code section 651, or theseregulations:

1. the seriousness or materiality of the mis-representation,

2. whether the physician cooperated withthe investigation,

3. whether the violation was a single event,or appeared to be part of a pattern sufficient todemonstrate a business practice,

4. whether the violator has a record of priordiscipline by the Administrative Director, Med-ical Board, or other appropriate licensing boardor authority,

5. whether the violator has a record ofcontempt reprimands or adjudications issued bythe Workers’ Compensation Appeals Board.


History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of subsections (a), (b) and (b)4. andamendment of Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).

§159. Severability.If any portion of this chapter or the applica-

tion of any part thereof to any person, individ-ual, party, entity, or circumstance is held invalid,the remainder of the chapter and its applicationto any other person, individual, party, entity, orcircumstance, shall not be affected thereby.


History: 1. New section filed 3-31-93; operative4-30-93 (Register 93, No. 14).2. Amendment of Note filed 1-13-2009; operative2-17-2009 (Register 2009, No. 3).

CHAPTER 4.5DIVISION OF WORKERS’

COMPENSATION

SUBCHAPTER 1ADMINISTRATIVE DIRECTOR—

ADMINISTRATIVE RULES

ARTICLE 12Return to Work

§10001. Definitions. [Renumbered]Note: Authority cited: Sections 133, 139.48 and

5307.3, Labor Code. Reference: Sections 139.48 and4658.1, Labor Code; Henry v. WCAB (1998) 68Cal.App.4th 981.

History: 1. New section filed 6-30-2006; operative7-1-2006. Submitted to OAL for filing with theSecretary of State and printing only pursuant toGovernment Code section 11340.9(g) (Register 2006,No. 38). For prior history, see Register 96, No. 52.2. Renumbering of former section 10001 to section10116.9 filed 11-17-2008; operative 11-17-2008 pur-suant to Government Code section 11343.4 (Register2008, No. 47).

§10002. Offer of Work; Adjustment ofPermanent Disability Payments.[Renumbered]

Note: Authority cited: Sections 133, 139.48 and5307.3, Labor Code. Reference: Sections 139.48 and4658, Labor Code; Del Taco v. WCAB (2000) 79Cal.App.4th 1437; Anzelde v. WCAB (1996) 61 Cal.Comp. Cases 1458 (Writ denied); and Henry v. WCAB(1998) 68 Cal.App.4th 981.

History: 1. New section filed 6-30-2006; operative7-1-2006. Submitted to OAL for filing with theSecretary of State and printing only pursuant toGovernment Code section 11340.9(g) (Register 2006,No. 38). For prior history, see Register 96, No. 52.2. Renumbering of former section 10002 to section10117 filed 11-17-2008; operative 11-17-2008 pursu-ant to Government Code section 11343.4 (Register2008, No. 47).

§10003. Form [DWC AD 10003 Noticeof Offer of Work]. [Renumbered]

Note: Authority cited: Sections 133, 139.48 and5307.3, Labor Code. Reference: Sections 139.48 and4658, Labor Code.

History: 1. New section filed 6-30-2006; operative7-1-2006. Submitted to OAL for filing with theSecretary of State and printing only pursuant toGovernment Code section 11340.9(g) (Register 2006,No. 38). For prior history, see Register 96, No. 52.2. Renumbering of former section 10003 to section10118 filed 11-17-2008; operative 11-17-2008 pursu-ant to Government Code section 11343.4 (Register2008, No. 47).

§10004. Return to Work Program.[Renumbered]

Note: Authority cited: Sections 133, 139.48 and5307.3, Labor Code. Reference: Sections 62.5, 139.48and 5814.6, Labor Code.

History: 1. New article 12 (sections 10004-10005)and section filed 7-19-2006; operative 8-18-2006(Register 2006, No. 29). For prior history of article 12


(sections 10001-10021), see Register 88, No. 21;Register 95, No. 7 and Register 96, No. 52.2. Renumbering of former section 10004 to section10119 filed 11-17-2008; operative 11-17-2008 pursu-ant to Government Code section 11343.4 (Register2008, No. 47).

§10005. Form [DWC AD 10005Request for Reimbursement ofAccommodation Expenses].[Renumbered]


History: 1. New section filed 7-19-2006; operative8-18-2006 (Register 2006, No. 29). For prior history,see Register 96, No. 52.2. Renumbering of former section 10005 to section10120 filed 11-17-2008; operative 11-17-2008 pursu-ant to Government Code section 11343.4 (Register2008, No. 47).

SUBCHAPTER 1.5

INJURIES ON OR AFTER JANUARY

1, 1990

ARTICLE 6

Retraining and Return to Work—

Definitions and General Provisions

[Second Enacted Version]

Another Article 6, Civil Penalty, precedes Section10113.

§10116. Applicability of Article.The provisions of this article are applicable to

Articles 6.5, 7, and 7.5 of these regulations,except for the definitions in section 10116.9.The definitions in section 10116.9 only apply tothe provisions of Articles 6.5 and 7.5.

Note: Authority cited: Sections 111, 133, 5307.3and 5307.4, Labor Code. Reference: Sections 139.5,4658, 4658.1, 4658.5 and 4658.6, Labor Code.

History: 1. New article 6 (sections 10116-10116.9)and section filed 11-17-2008; operative 11-17-2008pursuant to Government Code section 11343.4 (Reg-ister 2008, No. 47). For prior history of article 6, seeRegister 2008, No. 15, renumbering article 6, sections10116-10121 to article 9, sections 10136-10142.

§10116.1. Filing and ReportingRequirements.

(a) “Electronic Adjudication ManagementSystem” or “EAMS” means the computer case

management system used by the Division ofWorkers’ Compensation to electronically storeand maintain the Division of Workers’ Compen-sation or appeals board’s case files and toperform other case management functions.

(b) All forms, documents or correspon-dence submitted to the Retraining and Return toWork Unit shall be signed by the filing party andstored in the EAMS:

(1) Except for documents or forms whichopen a Retraining and Return to Work Unit file,all documents and forms shall contain a casenumber assigned by the Division of Workers’Compensation.

(2) Case opening documents shall be as-signed a case number by the Division of Work-ers’ Compensation after filing where no casenumber has been previously assigned for thedate of injury alleged by the injured worker. Thecase number shall be preceded by the prefix“VOC” for cases governed by Article 7 of theserules and “RSU” for cases governed by Article6.5 and 7.5 of these rules. If a case number hasbeen previously assigned by the Division ofWorkers’ Compensation, the prefix “VOC” or“RSU” shall precede the assigned case numberon a form or document filed with the Retrainingand Return to Work Unit. Documents or formsfiled in existing cases without a case numberwill be returned to the sender with instructionsfor proper filing.

(3) All documents presented for filing shallconform to the requirements of sections 10217,10228 and 10232 of title 8 of the CaliforniaCode of Regulations.

(4) The Division of Workers’ Compensa-tion shall scan all documents and forms filedinto the EAMS case file and then the paperdocument or form will be destroyed not lessthan 30 business days after filing. A properlyfiled form or document shall be deemed a legalfiling for all purposes.

(5) The service of all documents and formsshall conform to the methods of service de-scribed in section of 10218 of title 8 of theCalifornia Code of Regulation.

(c) All required notices, any documents orforms shall be sent to the employee and his orher attorney, if any, on a timely basis by theclaims administrator in the form and mannerprescribed in section 10218 of title 8 of theCalifornia Code of Regulation. Failure to pro-vide notices timely shall subject the insurer,

63 DIVISION OF WORKERS’ COMPENSATION 8 CCR §10116.1

third party administrator or self-insured em-ployer to administrative or civil penalties. Thenotices are timely when sent according to therequirements of sections 9813, 9813.1 and9813.2 of title 8 of the California Code ofRegulation.

Note: Authority cited: Sections 133, 139.48, 139.5,4658, 4658.5 and 5307.3, Labor Code. Reference:Section 139.5, Labor Code; Godinez v. Buffets, Inc.(2004, Significant Panel Decision) 69 Cal. Comp.Cases 1311; and Vulean Materials Co. v. WCAB(2006, Writ Denied) 71 Cal. Comp. Cases 1346.

History: 1. New section filed 11-17-2008; opera-tive 11-17-2008 pursuant to Government Code section11343.4 (Register 2008, No. 47).

§10116.2. Electronic Filing Exemption.If a document is filed with EAMS as part of

the electronic filing trial, that document does notneed to be filed in compliance with sections10228 and 10232 of title 8 of the CaliforniaCode of Regulation.

Note: Authority cited: Sections 111, 133, 5307.3and 5307.4, Labor Code. Reference: Sections 124 and126, Labor Code.


§10116.3. Incomplete Filings.(a) A form filed without the attachments or

enclosures required by these rules is deemedincomplete and shall not be deemed filed for anypurpose. All incomplete requests will be datestamped by the Division of Workers’ Compen-sation.

(b) The Retraining and Return to WorkUnit shall notify the filer and the other partieswhen a form or document is deemed not filed.

(c) Forms including filing instructions andvenue lists shall be provided upon request by theRetraining and Return to Work Unit. Requestsshall be submitted to:

Retraining and Return to Work Unit HeadquartersP.O. Box 420603San Francisco, CA 94142

Or may be found at http://www.dir.ca.gov/dwc/forms.html



§10116.4. Reproduction of Forms,Notices. [Repealed]

Note: Authority cited: Sections 133, 139.5 and5307.3, Labor Code. Reference: Section 139.5, LaborCode; Godinez v. Buffets, Inc. (2004, Significant PanelDecision) 69 Cal. Comp. Cases 1311; and VuleanMaterials Co. v. WCAB (2006, Writ Denied) 71 Cal.Comp. Cases 1346.

History: 1. Renumbering of former section10123.1 to new section 10116.4, including amendmentof section and new Note, filed 11-17-2008; operative11-17-2008 pursuant to Government Code section11343.4 (Register 2008, No. 47).2. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10116.5. Technical Problems andUnavailability of EAMS.

Technical problems with filing documentsshall be governed by sections 10223 and 10225of title 8 of the California Code of Regulation.



§10116.6. Retraining and Return toWork File Retention.

(a) Following a period of fifty (50) yearsafter the filing of a document used to open a caseor file, the Division of Workers’ Compensationmay destroy the electronic and/or paper file ineach case maintained by the Retraining andReturn to Work Unit.

(b) The Division of Workers’ Compensa-tion, at any time, may convert a paper file to anelectronic file. The Division of Workers’ Com-pensation shall inform the parties when a paperfile is converted. If a paper case file has beenconverted to electronic form, the paper case filemay be destroyed no less than 30 business daysafter the parties have been informed of theconversion.


Note: Authority cited: Sections 133, 138.4, 139.5and 5307.3, Labor Code. Reference: Section 139.5,Labor Code.


§10116.7. Misfiled or MisdirectedDocuments.

(a) A request to move, substitute, or correcta document shall be made in conformity withsection 10223 of title 8 of the California Code ofRegulation, except that a request to substituteshall be made in lieu of a petition to substitute asallowed under section 10223(b). The authorityto approve moving a document from one file toanother file shall reside with the Manager of theRetraining and Return to Work Unit or his or herdesignee.

(b) If a document is not filed in compliancewith sections 10217, 10228 and 10232 of title 8of the California Code of Regulations and theseregulations, the administrative director may inhis or her discretion take the actions set forth insection 10222 of title 8 of the California Code ofRegulations.

Note: Authority cited: Sections 133, 138.4, 139.5and 5307.3, Labor Code. Reference: Section 139.5,Labor Code.


§10116.8. Jurisdiction Where theIssue of Injury Has Not Been Resolved.

(a) No forms, notices or reports shall befiled with the Retraining and Return to WorkUnit until the claims administrator has acceptedliability for the injury or there has been a findingof compensable injury by the appeals board.

(b) Any requests for provision of retrainingor return to work services and for intervention/dispute resolution require confirmation on theappropriate form by the employee or his/herrepresentative that liability for the injury hasbeen accepted.

(c) Forms sent to the Retraining and Returnto Work Unit when a good faith issue of injuryexists or where there has been no confirmationof acceptance of liability for the injury shall bereturned to the sender.

Note: Authority cited: Sections 133, 139.48, 139.5,4658, 4658.5 and 5307.3, Labor Code. Reference:Section 139.5, Labor Code; Godinez v. Buffets, Inc.

(2004, Significant Panel Decision) 69 Cal. Comp.Cases 1311; and Vulean Materials Co. v. WCAB(2006, Writ Denied) 71 Cal. Comp. Cases 1346.


§10116.9. Definitions for Article 6.5and 7.5.

The following definitions apply to the provi-sions of Article 6.5 and 7.5 governing injuriesoccurring on or after January 1, 2004:

(a) “Alternative work” means work (1) of-fered either by the employer who employed theinjured worker at the time of injury, or byanother employer where the previous employ-ment was seasonal work, (2) that the employeehas the ability to perform, (3) that offers wagesand compensation that are at least 85 percent ofthose paid to the employee at the time of injury,and (4) that is located within a reasonablecommuting distance of the employee’s resi-dence at the time of injury.

(b) “Approved training facility” means atraining or skills enhancement facility or insti-tution that meets the requirements of section10133.58.

(c) “Claims administrator” means a self-administered insurer providing security for thepayment of compensation required by Divisions4 and 4.5 of the Labor Code, a self-administeredself-insured employer, a self-administered jointpowers authority, a self-administered legallyuninsured, or a third-party claims administratorfor a self-insured employer, insurer, legallyuninsured employer, or joint powers authority.

(d) “Employer” means the person or entitythat employed the injured employee at the timeof injury.

(e) “Essential functions” means job dutiesconsidered crucial to the employment positionheld or desired by the employee. Functions maybe considered essential because the positionexists to perform the function, the functionrequires specialized expertise, serious resultsmay occur if the function is not performed, otheremployees are not available to perform thefunction or the function occurs at peak periodsand the employer cannot reorganize the workflow.

(f) “Insurer” has the same meaning as inLabor Code section 3211.


(g) “Modified work” means regular workmodified so that the employee has the ability toperform all the functions of the job and thatoffers wages and compensation that are at least85 percent of those paid to the employee at thetime of injury, and located within a reasonablecommuting distance of the employee’s resi-dence at the time of injury.

(h) “Nontransferable training voucher”means a document provided to an employee thatallows the employee to enroll in education-related training or skills enhancement. The doc-ument shall include identifying information forthe employee and claims administrator, andspecific information regarding the value of thevoucher pursuant to Labor Code section 4658.5.

(i) “Notice” means a required letter or formgenerated by the claims administrator and di-rected to the injured employee.

(j) “Offer of modified or alternative work”means an offer to the injured employee ofmedically appropriate employment with thedate-of-injury employer through the use of FormDWC-AD 10133.53, Notice of Offer of Modi-fied or Alternative Work.

(k) “Parties” means the employee, theclaims administrator and their designated repre-sentatives, if any.

(l ) “Permanent and stationary” means thepoint in time when the employee has reachedmaximal medical improvement, meaning his orher condition is well stabilized, and unlikely tochange substantially in the next year with orwithout medical treatment, based on (1) anopinion from a treating physician, AME, orQME; (2) a judicial finding by a Workers’Compensation Administrative Law Judge, theWorkers’ Compensation Appeals Board, or acourt; or (3) a stipulation that is approved by aWorkers’ Compensation Administrative LawJudge or the Workers’ Compensation AppealsBoard.

(m) “Permanent partial disability award”means a final award of permanent partial dis-ability determined by a workers’ compensationadministrative law judge or the appeals board.

(n) “Regular work” means the employee’susual occupation or the position in which theemployee was engaged at the time of injury andthat offers wages and compensation equivalentto those paid to the employee at the time ofinjury, and located within a reasonable commut-ing distance of the employee’s residence at thetime of injury.

(o) “Seasonal work” means employment asa daily hire, a project hire, or an annual seasonhire.

(p) “Supplemental job displacement bene-fit” means an educational retraining or skillsenhancement allowance for injured employeeswhose employers are unable to provide workconsistent with the requirements of Labor Codesection 4658.6.

(q) “Vocational & return to work counselor(VRTWC)” means a person or entity capable ofassisting a person with a disability with devel-opment of a return to work strategy and whoseregular duties involve the evaluation, counselingand placement of disabled persons. A VRTWCmust have at least an undergraduate degree inany field and three or more years full timeexperience in conducting vocational evalua-tions, counseling and placement of disabledadults.

(r) “Work restrictions” means permanentmedical limitations on employment activity es-tablished by the treating physician, qualifiedmedical examiner or agreed medical examiner.

Note: Authority cited: Sections 133, 139.48, 4658.5and 5307.3, Labor Code. Reference: Sections 124,139.48, 4658.1, 4658.5 and 4658.6, Labor Code; andHenry v. WCAB (1998) 68 Cal.App.4th 981.

History: 1. Renumbering of former section 10001to new section 10116.9, including amendment ofsection heading, section and Note, filed 11-17-2008;operative 11-17-2008 pursuant to Government Codesection 11343.4 (Register 2008, No. 47).

ARTICLE 6.5

Return to Work

§10117. Offer of Work; Adjustment ofPermanent Disability Payments.

(a) This section shall apply to all injuriesoccurring on or after January 1, 2005, and to thefollowing employers:

(1) Insured employers who employed 50 ormore employees at the time of the most recentpolicy inception or renewal date for the insur-ance policy that was in effect at the time of theemployee’s injury;

(2) Self-insured employers who employed50 or more employees at the time of the mostrecent filing by the employer of the Self-Insur-er’s Annual Report that was in effect at the timeof the employee’s injury; and


(3) Legally uninsured employers who em-ployed 50 or more employees at the time ofinjury.

(b) Within 60 calendar days from the datethat the condition of an injured employee withpermanent partial disability becomes permanentand stationary:

(1) If an employer does not serve the em-ployee with a notice of offer of regular work,modified work or alternative work for a periodof at least 12 months, each payment of perma-nent partial disability remaining to be paid to theemployee from the date of the end of the 60 dayperiod shall be paid in accordance with LaborCode section 4658(d)(1) and increased by 15percent.

(2) If an employer serves the employeewith a notice of offer of regular work, modifiedwork or alternative work for a period of at least12 months, and in accordance with the require-ments set forth in paragraphs (3) and (4), eachpayment of permanent partial disability remain-ing to be paid from the date the offer was servedon the employee shall be paid in accordancewith Labor Code section 4658(d)(1) and de-creased by 15 percent, regardless of whether theemployee accepts or rejects the offer.

(3) The employer shall use form DWC-AD10133.53 (Section 10133.53) to offer modifiedor alternative work, or form DWC-AD 10118(Section 10118) to offer regular work. Theclaims administrator may serve the offer of workon behalf of the employer.

(4) The regular, alternative, or modifiedwork that is offered by the employer pursuant toparagraph (2) shall be located within a reason-able commuting distance of the employee’sresidence at the time of the injury, unless theemployee waives this condition. This conditionshall be deemed to be waived if the employeeaccepts the regular, modified, or alternativework, and does not object to the location within20 calendar days of being informed of the rightto object. The condition shall be conclusivelydeemed to be satisfied if the offered work is atthe same location and the same shift as theemployment at the time of injury.

(c) If the claims administrator relies upon apermanent and stationary date contained in amedical report prepared by the employee’s treat-ing physician, QME, or AME, but there issubsequently a dispute as to an employee’spermanent and stationary status, and there has

been a notice of offer of work served on theemployee in accordance with subdivision (b),the claims administrator may withhold 15%from each payment of permanent partial disabil-ity remaining to be paid from the date the noticeof offer was served on the employee until therehas been a final judicial determination of thedate that the employee is permanent and station-ary pursuant to Labor Code section 4062.

(1) Where there is a final judicial determi-nation that the employee is permanent andstationary on a date later than the date relied onby the employer in making its offer of work, theemployee shall be reimbursed any amount with-held up to the date a new notice of offer of workis served on the employee pursuant to subdivi-sion (b).

(2) Where there is a final judicial determi-nation that the employee is not permanent andstationary, the employee shall be reimbursed anyamount withheld up to the date of the determi-nation.

(3) The claims administrator is not requiredto reimburse permanent partial disability benefitpayments that have been withheld pursuant tothis subdivision during any period for which theemployee is entitled to temporary disabilitybenefit payments.

(d) If the employee’s regular work, modi-fied work, or alternative work that has beenoffered by the employer pursuant to paragraph(1) of subdivision (b) and has been accepted bythe employee, is terminated prior to the end ofthe period for which permanent partial disabilitybenefits are due, the amount of each remainingpermanent partial disability payment from thedate of the termination shall be paid in accor-dance with Labor Code section 4658(d)(1), asthough no decrease in payments had been im-posed, and increased by 15 percent. An em-ployee who voluntarily terminates his or herregular work, modified work, or alternativework shall not be eligible for the 15 percentincrease in permanent partial disability pay-ments pursuant to this subdivision.

(e) Nothing in this section shall prevent theparties from settling or agreeing to commute thepermanent disability benefits to which an em-ployee may be entitled. However, if the perma-nent disability benefits are commuted by aworkers’ compensation administrative lawjudge or the appeals board pursuant to LaborCode section 5100, the commuted sum shall

67 DIVISION OF WORKERS’ COMPENSATION 8 CCR §10117

account for any adjustment that would havebeen required by this section if payment hadbeen made pursuant to Labor Code section4658.

(f) When the employer offers regular, mod-ified or alternative work to the employee thatmeets the conditions of this section and subse-quently learns that the employee cannot lawfullyperform regular, modified or alternative work,the employer is not required to provide theregular, modified or alternative work.

(g) If the employer offers regular, modified,or alternative seasonal work to the employee,the offer shall meet the following requirements:

(1) the employee was hired for seasonalwork prior to injury;

(2) the offer of regular, modified or alterna-tive seasonal work is of reasonably similar hoursand working conditions to the employee’s pre-

vious employment, and the one year require-ment may be satisfied by cumulative periods ofseasonal work;

(3) the work must commence within 12months of the date of the offer; and

(4) The offer meets the conditions set forthin this section.

Note: Authority cited: Sections 133, 139.48 and5307.3, Labor Code. Reference: Sections 139.48 and4658, Labor Code; Del Taco v. WCAB (2000) 79Cal.App.4th 1437; Anzelde v. WCAB (1996) 61 Cal.Comp. Cases 1458 (writ denied); and Henry v. WCAB(1998) 68 Cal.App.4th 981.

History: 1. New article 6.5 (sections 10117-10120)and renumbering of former section 10002 to newsection 10117, including amendment of section, filed11-17-2008; operative 11-17-2008 pursuant to Gov-ernment Code section 11343.4 (Register 2008, No.47).


§10118. Form [DWC AD 10118 Noticeof Offer of Work].



History: 1. Renumbering of former section 10003to new section 10118, including amendment of sectionheading and repealer and new form, filed 11-17-2008;

operative 11-17-2008 pursuant to Government Codesection 11343.4 (Register 2008, No. 47).

§10119. Return to Work Program.(a) This section shall apply to injuries oc-

curring on or after July 1, 2004;


(b) An “Eligible Employer” means any em-ployer, except the state or an employer eligibleto secure the payment of compensation pursuantto subdivision (c) of Section 3700, who, basedon the employer’s payroll records or otherequivalent documentation or evidence, em-ployed 50 or fewer full-time employees on thedate of injury.

(c) “Full-time employee” means an em-ployee who, during the period of his or heremployment within the year preceding the in-jury, worked an average of 32 or more hours perweek.

(d) The Return to Work Program is admin-istered by the administrative director for thepurpose of promoting the employee’s early andsustained return to work following a work-related injury or illness.

(e) This program shall be funded by theReturn to Work Fund, which shall consist of allpenalties collected pursuant to Labor Code sec-tion 5814.6 and transfers made to this fund bythe administrative director from the Workers’Compensation Administrative Revolving Fundestablished pursuant to Labor Code section 62.5.The reimbursements offered to eligible employ-ees as set forth in this section shall be availableonly to the extent funds are available.

(f) An eligible employer shall be entitled toreimbursement through this program for ex-penses incurred to make workplace modifica-tions to accommodate an employee’s return tomodified or alternative work, up to the follow-ing maximum amounts:

(1) $1,250 to accommodate each temporar-ily disabled employee, for expenses incurred inallowing such employee to perform modified oralternative work within physician-imposed tem-porary work restrictions; and

(2) $2,500 to accommodate each perma-nently disabled employee, for expenses incurredin returning such employee to sustained modi-fied or alternative work within physician-im-posed permanent work restrictions; however, ifan employer who has received reimbursementfor a temporarily disabled employee under para-graph (1) is also requesting reimbursement forthe same employee for accommodation of per-manent disability, the maximum available reim-bursement is $2,500. For the purpose of thissubdivision, “sustained modified or alternativework” is work anticipated to last at least 12months.

(g) Reimbursement shall be provided forany of the following expenses, provided they arespecifically prescribed by a physician or arereasonably required by restrictions set forth in amedical report:

(1) modification to worksite;(2) equipment;(3) furniture;(4) tools; or(5) any other necessary costs reasonably

required to accommodate the employee’s re-strictions.

(h) An eligible employer seeking reim-bursement pursuant to subdivision (d) shallsubmit a “Request for Reimbursement of Ac-commodation Expenses” (Form DWC AD10120, section 10120) to the Division of Work-ers’ Compensation Return to Work Programwithin ninety (90) calendar days from the dateof the expenditure for which the employer isseeking reimbursement. As a condition to reim-bursement, the expenditure shall not have beenpaid or covered by the employer’s insurer or anysource of funding other than the employer. Thefiling date may be extended upon a showing ofgood cause for such extension. The employershall attach to its request copies of all pertinentmedical reports that contain the work restric-tions being accommodated, any other documen-tation supporting the request, and all receipts foraccommodation expenses. Requests should besent to the mailing address for the Division ofWorkers’ Compensation Return to Work Pro-gram that is listed in the web site of the Divisionof Workers’ Compensation, at: http://www.dir.ca.gov/dwc/dwc_home_page.htm

(i) The administrative director or his or herdesignee shall review each “Request for Reim-bursement of Accommodation Expenses,” andwithin sixty (60) business days of receipt shallprovide the employer with notice of one of thefollowing:

(1) that the request has been approved,together with a check for the reimbursementallowed, and an explanation of the allowance, ifless than the maximum amounts set forth insubdivision (d); or

(2) that the request has been denied, withan explanation of the basis for denial; or

(3) that the request is deficient or incom-plete and indicating what clarification or addi-tional information is necessary.

(j) In the event there are insufficient fundsin the Return to Work Fund to fully reimburse an


employer or employers for workplace modifica-tion expenses as required by this section, theadministrative director shall utilize the follow-ing priority list in establishing the amount ofreimbursement or whether reimbursement isallowed, in order of decreasing priority as fol-lows:

(1) Employers who have not previouslyreceived any reimbursement under this program;

(2) Employers who have not previouslyreceived any reimbursement under this programfor the employee who is the subject of therequest;

(3) Employers who are seeking reimburse-ment for accommodation required in returning apermanently disabled employee to sustainedmodified or alternative work; and,

(4) Employers who are requesting reim-bursement for accommodation required by atemporarily disabled employee.

(k) An eligible employer may appeal theadministrative director’s notice under subdivi-sion (i) by filing a declaration of readiness toproceed within twenty calendar days of theissuance of the notice, together with a petitionentitled “Petition Appealing Administrative Di-rector’s Reimbursement Allowance,” settingforth the basis of the appeal pursuant to section10294 of title 8 of the California Code ofRegulations.


History: 1. Renumbering of former section 10004to new section 10119, including amendment of sec-tion, filed 11-17-2008; operative 11-17-2008 pursuantto Government Code section 11343.4 (Register 2008,No. 47).


§10120. Form [DWC AD 10120Request for Reimbursement ofAccommodation Expenses].



History: 1. Renumbering of former section 10005

to new section 10120, including amendment of sectionheading and repealer and new form, filed 11-17-2008;operative 11-17-2008 pursuant to Government Codesection 11343.4 (Register 2008, No. 47).


ARTICLE 7

Vocational Rehabilitation

[Second Enacted Version]

[Repealed]

§10122. Definitions. [Repealed]Note: Authority cited: Sections 133, 139.5 and

5307.3, Labor Code. Reference: Sections 124, 139.5,4635 and 4644, Labor Code.

History: 1. New section filed 1-18-90; operative1-18-90 (Register 90, No. 4). New section is exemptfrom review by OAL pursuant to Government Codesection 11351.2. Change without regulatory effect amending sectionfiled 1-22-91 pursuant to section 100, title 1, Califor-nia Code of Regulations (Register 91, No. 10).3. Amendment filed 12-31-93; operative 1-1-94. Sub-mitted to OAL for printing only pursuant to Govern-ment Code section 11351 (Register 93, No. 53).4. Amendment of subsections (d), (e), (g) and (l ),new subsections (m) and (n), and amendment of Notefiled 8-26-98; operative 9-25-98 (Register 98, No. 35).5. Amendment alphabetizing definitions and reletter-ing subsections filed 1-29-2003; operative 1-29-2003pursuant to Government Code section 11343.4 (Reg-ister 2003, No. 5).6. Change without regulatory effect repealing subsec-tion (b) and relettering subsections filed 5-1-2003pursuant to section 100, title 1, California Code ofRegulations (Register 2003, No. 18).7. Change without regulatory effect repealing article 7(sections 10122-10133.22) and section filed 2-25-2009 pursuant to section 100, title 1, California Codeof Regulations (Register 2009, No. 9).

§10122.1. Weekend or HolidayDeadlines. [Repealed]

Note: Authority cited: Sections 133, 138.4, 139.5and 5307.3, Labor Code. Reference: Sections 133,139.5 and 4637, Labor Code.

History: 1. New section filed 1-29-2003; operative1-29-2003 pursuant to Government Code section11343.4 (Register 2003, No. 5).2. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10123. Vocational RehabilitationReporting Requirements. [Repealed]

Note: Authority cited: Sections 133, 139.5, 4658,4658.5 and 5307.3, Labor Code. Reference: Section139.5, Labor Code; Godinez v. Buffets, Inc. (2004,Significant Panel Decision) 69 Cal. Comp. Cases1311; and Vulean Materials Co. v. WCAB (2006, WritDenied) 71 Cal. Comp. Cases 1346.

History: 1. New section filed 1-18-90; operative1-18-90 (Register 90, No. 4). New section is exemptfrom review by OAL pursuant to Government CodeSection 11351.2. Change without regulatory effect amending sectionfiled 1-22-91 pursuant to section 100, title 1, Califor-nia Code of Regulations (Register 91, No. 10).3. Amendment of subsections (a)(2), (c)(2), (d), (e),(e)(1) and (f), repealer of subsections (f)(1)-(g)(2) andsubsection relettering, and amendment of newly des-ignated subsections (g)-(i) filed 12-31-93; operative1-1-94. Submitted to OAL for printing only pursuantto Government Code section 11351 (Register 93, No.53).4. Change without regulatory effect amending subsec-tion (f) and Note filed 3-14-94 pursuant to title 1,section 100, California Code of Regulations (Register94, No. 11).5. Amendment of subsection (g) filed 2-21-95; oper-ative 2-21-95. Submitted to OAL for printing onlypursuant to Government Code section 11351 (Register95, No. 8).6. Amendment of section heading, section and Note,filed 11-17-2008; operative 11-17-2008 pursuant toGovernment Code section 11343.4 (Register 2008,No. 47).7. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10123.1. Reproduction of Forms,Notices. [Renumbered]

Note: Authority cited: Sections 133, 139.5 and5307.3, Labor Code. Reference: Sections 139.5, 4636,4637, 4638 and 4645, Labor Code.

History: 1. Change without regulatory effect add-ing new section filed 1-22-91 pursuant to section 100,title 1, California Code of Regulations (Register 91,No. 10).2. Editorial correction of printing error restoring sec-tion 10123.2 (Register 91, No. 31).3. Renumbering and amendment of former section10123.2 to section 10123.1 filed 12-31-93; operative1-1-94. Submitted to OAL for printing only pursuantto Government Code section 11351 (Register 93, No.53).4. Amendment filed 2-21-95; operative 2-21-95. Sub-mitted to OAL for printing only pursuant to Govern-ment Code section 11351 (Register 95, No. 8).5. Amendment of first paragraph filed 8-7-95; opera-tive 8-7-95. Submitted to OAL for printing onlypursuant to Government Code section 11351 (Register95, No. 32).6. Amendment of first paragraph filed 9-11-95; oper-ative 9-11-95. Submitted to OAL for printing onlypursuant to Government Code section 11351 (Register95, No. 37).


7. Renumbering of former section 10123.1 to section10116.4 filed 11-17-2008; operative 11-17-2008 pur-suant to Government Code section 11343.4 (Register2008, No. 47).

§10123.2. Unrepresented Employees.[Repealed]

Note: Authority cited: Sections 133, 139.5, 139.6and 5307.3, Labor Code. Reference: Sections 139.5,4636, 4637, 4638 and 4645, Labor Code.

History: 1. Change without regulatory effect add-ing new section filed 1-22-91 pursuant to section 100,title 1, California Code of Regulations (Register 91,No. 10).2. Editorial correction of printing error restoring sec-tion 10123.1 (Register 91, No. 31).3. Renumbering of former section 10123.1 to section10123.2 filed 12-31-93; operative 1-1-94. Submittedto OAL for printing only pursuant to GovernmentCode section 11351 (Register 93, No. 53).4. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10123.3. Referral to RehabilitationProviders; Facilities. [Repealed]

Note: Authority cited: Sections 133, 139.5, 139.6and 5307.3, Labor Code. Reference: Section 139.5(h),Labor Code.

History: 1. New section filed 12-31-93; operative1-1-94. Submitted to OAL for printing only pursuantto Government Code section 11351 (Register 93, No.53).2. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10124. Identification of MedicalEligibility. [Repealed]


History: 1. Change without regulatory effect re-numbering and amending former section 10124 tosection 10127.1 and former section 10124.1 to section10124 filed 1-22-91 pursuant to section 100, title 1,California Code of Regulations (Register 91, No. 10).For prior history, see Register 90, No. 4.2. Editorial correction of printing error restoring sec-tion 10124 (Register 91, No. 31).3. Amendment of section heading and section filed12-31-93; operative 1-1-94. Submitted to OAL forprinting only pursuant to Government Code section11351 (Register 93, No. 53).

4. Change without regulatory effect amending subsec-tion (b) filed 3-14-94 pursuant to title 1, section 100,California Code of Regulations (Register 94, No. 11).5. Amendment of subsections (b)-(b)(1) filed 2-21-95; operative 2-21-95. Submitted to OAL for printingonly pursuant to Government Code section 11351(Register 95, No. 8).6. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10124.1. Identification of VocationalFeasibility. [Repealed]

Note: Authority cited: Sections 133, 138.4, 139.5and 5307.3, Labor Code. Reference: Sections 4635and 4637, Labor Code.

History: 1. New section filed 5-30-2001; operative6-29-2001 (Register 2001, No. 22). For prior history,see Register 91, No. 46.2. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10125. Maximum VocationalRehabilitation Expenditures forInjuries Occurring On or After 1/1/94.[Repealed]

Note: Authority cited: Sections 133, 139.5 and5307.3, Labor Code. Reference: Sections 139.5, 4636,4638 and 4642, Labor Code.

History: 1. Renumbering of former section 10125to section 10127.2 and new section filed 12-31-93;operative 1-1-94. Submitted to OAL for printing onlypursuant to Government Code section 11351 (Register93, No. 53).2. Change without regulatory effect repealing sectionfiled 2-25-2009 pursuant to section 100, title 1, Cali-fornia Code of Regulations (Register 2009, No. 9).

§10125.1. Vocational RehabilitationMaintenance Allowance. [Repealed]

Note: Authority cited: Sections 133, 139.5 and5307.3, Labor Code. Reference: Sections 139.5, 4636,4638 and 4642, Labor Code.

History: 1. New section filed 12-31-93; operative1-1-94. Submitted to OAL for printing only pursuantto Government Code section 11351 (Register 93, No.53).2. Change without regulatory effect amending subsec-tion (a) filed 3-14-94 pursuant to title 1, section 100,California Code of Regulations (Register 94, No. 11).3. Amendment of subsection (c) filed 2-21-95; oper-ative 2-21-95. Submitted to OAL for printing onlypursuant to Government Code section 11351 (Register95, No. 8).


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