§ 11. Eligibility Requirements for Initial Appointment as a QME.
8 CA ADC § 11Barclays Official California Code of RegulationsEffective: February 26, 2024
Effective: February 26, 2024
8 CCR § 11
§ 11. Eligibility Requirements for Initial Appointment as a QME.
The Administrative Director shall appoint as QMEs all applicants who meet the requirements set forth in Labor Code Section 139.2(b) and all applicants:
(C) A declaration under penalty of perjury accompanied by supporting documentation that the physician has qualifications that the Administrative Director and the Medical Board of California or the Osteopathic Medical Board of California both deem to be equivalent to board certification in a specialty.
(3) If a psychologist, (i) a copy of a doctoral degree in psychology or a doctoral degree deemed equivalent for licensure by the Board of Psychology pursuant to Section 2914 of the Business and Professions Code, and has not had less than five years postdoctoral experience in the treatment of emotional and mental disorders or (ii) served as an AME on eight or more occasions prior to January 1, 1990 and has not less than five years postdoctoral experience in the diagnosis and treatment of emotional and mental disorders.
(4) For Doctors of Chiropractic, the physician shall provide a copy of a current or otherwise valid certificate in California Workers Compensation Evaluation by either a California professional chiropractic association or an accredited California college recognized by the Administrative Director (i.e. Workers' Compensation Evaluation Certificate with a minimum 25 hours completed). For purposes of this subsection, a current or otherwise valid certificate in California Workers Compensation Evaluation is one that has been obtained within the three years prior to the current application to become certified as a QME.
(b)(1) Shall, prior to appointment as a QME, complete a course of at least sixteen (16) hours in disability evaluation report writing pursuant to section 11.5 of this Article. Doctors of Chiropractic who submit documentation showing compliance with section 11(a)(4) are exempt from this requirement; and
(d) Shall agree that during a QME evaluation exam he, she or they will not treat or offer or solicit to provide medical treatment for that injury for which he, she or they have done a QME evaluation for an injured worker unless a medical emergency arises as defined under subdivision (a) or (b) of section 1317.1 of the Health and Safety Code. A QME may also provide treatment if requested by the employee pursuant to section 4600 of the Labor Code, but he, she or they shall not offer or solicit to provide it. A QME who solicits an injured worker to receive direct medical treatment or to become the primary treating physician of that employee shall be subject to disciplinary action pursuant to section 60.
(2) Devotes at least one-third of his, her or their total practice time to providing direct medical treatment during each year of the applicant's term of appointment. This requirement shall not apply if the applicant qualifies for appointment because the applicant served as an AME on 8 or more occasions in the year prior to application and in each year of the applicant's term; or if the applicant meets the requirements of section 15; and
(1) In order to take this examination, a physician who is not currently appointed as a QME and not exempt pursuant to Labor Code section 139(b)(1), shall be considered to have applied to take the QME competency examination upon submitting the properly-completed Application for Appointment Form in Section 100 (see, 8 Cal. Code Regs. section 100), and the Registration Form for the QME Competency Examination in section 102 (see, 8 Cal. Code Regs. § 102) and the appropriate fee as specified in section 11(f)(2).
(4) An applicant must submit the properly completed forms as required in section 11(f)(1) to the Administrative Director at least forty-five (45) calendar days prior to the date of the next scheduled competency examination unless the Administrative Director finds good cause to grant an extension to the physician(s).
(7) An applicant who passes the QME competency examination shall file the QME Fee Assessment Form in Section 103 (see, 8 Cal. Code Regs. section 103) including the appropriate fee within thirty (30) days of the date of the notice. The physician shall not be appointed to the official QME list until the appropriate fee is paid and has completed a disability evaluation report writing course pursuant to section 11.5. Appointments shall be for two-year terms beginning with the date of appointment by the Administrative Director.
(8) Any applicant, who upon good cause shown by the test administrator, is suspected of cheating may be disqualified from the examination and, upon a finding that the applicant did cheat in that exam, the applicant will be denied further admittance to any QME examination for a period of at least five years thereafter. Any applicant who fails to follow test instructions and/or proctor instructions either before or during or at the conclusion of an examination shall be disqualified from the examination procedure and the applicant's exam shall be nullified.
(9) If an applicant fails the competency examination or fails to appear for a noticed QME examination for which the applicant has submitted a QME Exam Registration Form 102 (see, 8 Cal. Code Regs. § 102), the applicant may apply to take any subsequent examinations, upon submission of a new test application form and a fee of $125. An applicant who fails the exam three times shall show proof of having completed six (6) hours continuing education from a course approved by the Administrative Director prior to taking the examination again.
(10) Any applicant who receives a failing grade on a competency exam may appeal the failing grade to the Administrative Director. Appeals shall be considered on a case by case basis. Appeals will be accepted immediately after a candidate has completed the examination and until ten (10) days after the date of the examination results letter. The appeal shall state specific facts as to why the failing grade should be overturned. Pursuant to Section 6254(g) of the Government Code, the Administrative Director will consider appeals of test questions and will base his, her or their decision solely on the written appeal including any supporting documentation submitted by the physician. Appeals will only be accepted for the current examination period. Grounds for appeal are:
(1) Instruction designed to increase awareness and understanding of differences in human experience, as well as awareness of implicit or unconscious bias, stereotyping, and discrimination, and the ways in which unconscious bias can unintentionally impact perceptions and decision-making, including in medical evaluations and reporting, and lead to disparities in health care strategies, to help eliminate or reduce implicit bias in medical evaluations and reporting.
Note: Forms referred to above are available at no charge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.
Credits
Note: Authority cited: Sections 133, 139.2, 4060, 4062 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code; and Section 6254, Government Code.
History
1. New section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2. New subsections (a)-(c) and subsection relettering, amendment of newly designated subsections (d)-(f)(6), new subsections (f)(7) and (f)(8) and subsection renumbering, amendment of newly designated subsections (f)(9) and (f)(10), and new subsection (g) filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
3. Change without regulatory effect amending section (f)(5) filed 6-20-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 25).
4. Amendment filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).
5. Amendment of section heading and section filed 8-23-2001; operative 8-23-2001 pursuant to Government Code section 11343.4 (Register 2001, No. 34).
6. Amendment of section and Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
7. Amendment of subsection (a)(4) and Note filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day.
8. Amendment of subsection (a)(4) and Note refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 7-1-2013 order transmitted to OAL 8-2-2013 and filed 9-16-2013 (Register 2013, No. 38).
10. Amendment of subsections (a)(4), (b)(1), (d), (e), (e)(2), (f)(2), (f)(4)-(6) and (f)(10) and new subsections (h)-(h)(4) filed 2-26-2024; operative 2-26-2024 pursuant to Government Code section 11343.4(b)(3) (Register 2024, No. 9).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 8, § 11, 8 CA ADC § 11
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