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State
California Regulations
TITLE 8 INDUSTRIAL RELATIONS DIVISION 1 DEPARTMENT OF INDUSTRIAL RELATIONS


database is current through 09/29/06, Register 2006, No. 39
s 1. Definitions.
As used in these regulations:
(a) "Accreditation" means the conferring of recognized status as a provider of physician education by the Industrial Medical Council.
(b) "Administrative Director" means the administrative director of the Division of Workers' Compensation of the State of California Department of Industrial Relations.
(c) "AME" means Agreed Medical Examiner or Agreed Medical Evaluator, a physician selected by agreement between the employer and the employees to resolve disputed medical issues referred by the parties in a workers' compensation proceeding.
(d) "Appeals Board" means the Workers' Compensation Appeals Board within the State of California Department of Industrial Relations.
(e) "Audit" means a formal evaluation of a continuing education program, disability evaluation report writing course, or an accredited provider which is conducted at the request of the Medical Director.
(f) "Comprehensive Medical-Legal Evaluation" means a medical evaluation performed pursuant to Labor Code Sections 4060, 4061, or 4062 and meeting the requirements of Section 9793 of this Title.
(g) "Claims Administrator" means a self-administered insurer providing security for the payment of compensation required by Divisions 4 and 4.5 of the Labor Code, a self-administered self-insured employer, a group self-insurer, or a third-party claims administrator for a self-insured employer, insurer, legally uninsured employer, group self-insurer, or joint powers authority.
(h) "Continuing Education Program" means a systematic learning experience (such as a course, seminar, or audiovisual or computer learning program) which serves to develop, maintain, or increase the knowledge, skills and professional performance of physicians who serve as Qualified Medical Evaluators in the California workers' compensation system.
(i) "Council" means the Industrial Medical Council as defined in Labor Code Section 139.
(j) "Course" means the 12 hours of instruction in disability evaluation report writing which is required of a Qualified Medical Evaluator prior to appointment. A course must be approved by the Council.
(k) "Credit Hour" means a sixty minute hour. A credit hour may include time for questions and answers related to the presentation.
( l) "Direct medical treatment" means that special phase of the health care provider-patient relationship which-(1) attempts to clinically diagnose and alter or modify the expression of a non-industrial illness, injury or pathological condition; or (2) attempts to cure or relieve the effects of an industrial injury.
(m) "Distance Learning" means an education program in which the instructor and student are in different locations, as in programs based on audio or video tapes, computer programs, or printed educational material.
(n) "DEU" is the Disability Evaluation Unit under the Administrative Director responsible for issuing summary disability ratings.
(o) "Employer" means an uninsured employer and the Uninsured Employers Fund pursuant to Labor Code Section 3716. The UEF shall only be subject to these regulations after proper service has been made on the uninsured employer and the Appeals Board has obtained jurisdiction over the UEF by joinder as a party.
(p) "Evaluator" means "Qualified Medical Evaluator" or "Agreed Medical Evaluator."
(q) "Medical Director" means the Executive Medical Director appointed by the Industrial Medical Council pursuant to Labor Code Section 122, who is Executive Secretary of the Council.
(r) "Provider" means the individual or organization which has been accredited by the Council to offer physician education programs. There are two categories of providers: (1) the Council and (2) individuals, partnerships, or corporations; hospitals; clinics or other patient care facilities; educational institutions; medical or health-related organizations whose membership includes L.C. 3209.3 physicians; organizations of non-medical participants in the California workers' compensation system; and governmental agencies. In the case of a national organization seeking accreditation, the California Chapter or organization affiliated with the national organization shall be accredited by the Council in lieu of the national organization.
(s) "Qualified Injured Worker" means a employee defined pursuant to subdivision (c) of Section 10003 of this Title.
(t) "Qualified Medical Evaluator" (QME) means a physician licensed by the appropriate licensing body for the state of California and appointed by the Council pursuant to Labor Code Section 139.2, provided however, that acupuncturist QMEs shall not perform comprehensive medical-legal evaluations to determine disability.
(u) "QME competency examination" means an examination administered by the Industrial Medical Council for the purpose of demonstrating competence in evaluating medical-legal issues in the workers' compensation system. This examination shall be given at least as often as twice annually.
(v) "Physician's office" means a bona fide office facility which is identified by a street address and any other more specific designation such as a suite or room number and which contains the usual and customary equipment for the evaluation and treatment appropriate to the physician's medical specialty or practice.
(w) "Rebuttal examination" means a comprehensive medical-legal evaluation performed at the request of a party concerning a disputed medical finding or conclusion by a QME concerning an unrepresented employee.
(x) "Significant Financial Interest or Affiliation" means grant or research support; status as a consultant, member of a speakers' bureau, or major stock shareholder; or other financial or material interest for the program faculty member or his or her family.
(y) "Treating physician" means a physician who has provided direct medical treatment to an employee which is reasonably required to cure or relieve the effects of an industrial injury pursuant to section 4600 of the Labor Code.
(z) "Treatment Guideline" means the advisory guideline issued by the Industrial Medical Council which sets out a systematic statement intended to assist health care providers in the California workers' compensation community in making decisions about appropriate medical treatment for specific industrial injuries.
(aa) "Unrepresented employee" means an employee not represented by an attorney.


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.






s 10. Appointment of QMEs.
Applications for appointment as a QME shall be submitted on the form in Section 100. The completed application form, and any supporting documentation as required by the application, shall be filed at the Council's headquarters office. Upon its approval of each application form and supporting documentation, the Council shall certify as eligible to sit for the QME competency examination those applicants who meet all of the statutory and regulatory eligibility requirements. Any application for appointment may be rejected if it is incompletely filled out, contains false information or does not contain the required supporting documentation listed in Section 11.


Note: Authority cited: Sections 133, 139 and 139.2, Labor Code. Reference: Sections 139.2, 4060, 4061 and 4062, Labor Code.






s 10.1. The Application for Appointment as Qualified Medical Evaluator Form.


Note: Authority cited: Sections 133, 139 and 139.2, Labor Code. Reference: Sections 139.2, 4060, 4061 and 4062, Labor Code.






s 10.1A. Reappointment Application as Qualified Medical Evaluator Form.







s 10.2. The QME Fee Assessment Notice Form.

STATE OF CALIFORNIA GRAY DAVIS, GOVERNOR
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DEPARTMENT OF INDUSTRIAL RELATIONS
INDUSTRIAL MEDICAL COUNCIL ADDRESS REPLY TO:
395 Oyster Point Blvd., Ste. 102 P.O. Box 8888
South San Francisco, CA 94080 San Francisco, CA 94128-8888
Tel: (650) 737-2700 Fax: (650) 737-2989


Fee Period: -
License Number:


Dear Dr.:
Pursuant to Labor Codes 139.2(n) and 8 CCR,s 16, the Industrial Medical Council requires all physicians appointed or reappointed as QualifiedMedical Evaluators (QMEs) to pay an annual fee. The QME fee is non-refundable.
$250 FEE

QMEs who have conducted 25 or more comprehensive medical - legal evaluations in the twelve months prior to assessment of the fee. All evaluationsperformed as a Qualified Medical Evaluator, Agreed Medical Evaluator, and Independent Medical Evaluator must be counted for the purpose of feeassessment (8 CCRss 14, 15).
$125 FEE

QMEs who have conducted 11-24 comprehensive medical legal evaluations in the twelve months prior to assessment of the fee. All evaluationsperformed as a Qualified Medical Evaluator, Agreed Medical Evaluator, and Independent Medical Evaluator must be counted for the purpose of feeassessment (8 CCRss 14, 15).
$110 FEE

QMEs who have conducted 0-10 comprehensive medical legal evaluations in the twelve months prior to assessment of the fee. All evaluations performed as a Qualified Medical Evaluator, Agreed Medical Evaluator, and Independent Medical Evaluator must be counted for the purpose of feeassessment (8 CCRss 14, 15).
ADDITIONAL LOCATIONS
QMEs who perform evaluations at more than one medical office location are required to pay an additional $100 per location (8 CCRs 15).
Misrepresentation of the number of evaluations performed or the number of additional locations shall constitute grounds for disciplinary proceedings(8 CCRs 60).
Department of Industrial Relations

Industrial Medical Council

Location Fee Calculation Worksheet


License Number:
Street, City, State, Zip Code, Phone No.
[ ]
Enter total Number of All location boxes checked - -> __________
THIS SECTION MUST BE COMPLETED BY THE PHYSICIAN.

______ $250 Primary fee for those physicians who have done 25 or more medical/legal evaluations.
______ $125 Primary fee for those physicians who have done 11-24 medical/legalevaluations.
______ $110 Primary fee for those physicians who have done 0-10 medical/legalevaluations.
Based on the amount of primary fee I have paid, I hereby declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Physician's Signature
__________________________ Date __________
For DIR Use Only:
( ) $250 Fee ( ) $125 Fee ( ) $110 Fee
___________ Fee for Additional Locations ($100 per location)
Total Paid $ ____________
Total Locations __________
IMC Form 5 (4/99)




Note: Authority cited: Sections 133, 139 and 139.2, Labor Code. Reference: Sections 139.2, 4060, 4061 and 4062, Labor Code.






s 10.5. Limitations on Certification as Qualified Medical Evaluators.
(a) All eligibility requirements contained herein shall be applied without regard to the race, creed, color, gender, religion, or national origin of the individual applying for the public benefit.
(b) Pursuant to Section 411 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, (Pub. L. No. 104-193 (PRWORA)), (8 U.S.C. s 1621), and notwithstanding any other provision of this division, aliens who are not qualified aliens, nonimmigrant aliens under the Immigration and Nationality Act (INA) (8 U.S.C. s 1101 et seq.), or aliens paroled into the United States under Section 212(d)(5) of the INA (8 U.S.C. s 1182(d)(5)), for less than one year, are not eligible to receive QME certification as set forth in Labor Code Section 139.2.
(c) A qualified alien is an alien who, at the time he or she applies for, receives, or attempts to receive QME certification is, under Section 431(b) of the PRWORA (8 U.S.C. s 1641(b)), any of the following:
(1) An alien who is lawfully admitted for permanent residence under the INA (8 U.S.C. s 1101 et seq.).
(2) An alien who is granted asylum under Section 208 of the INA (8 U.S.C. s 1158).
(3) A refugee who is admitted to the United States under Section 207 of the INA (8 U.S.C. s 1157).
(4) An alien who is paroled into the United States under Section 212(d)(5) of the INA (8 U.S.C. s 1182(d)(5)) for a period of at least one year.
(5) An alien whose deportation is being withheld under Section 243(h) of the INA (8 U.S.C. s 1253(h)) (as in effect immediately before the effective date of Section 307 of division C of Public Law 104-208) or Section 241(b)(3) of such Act (8 U.S.C. s 1251(b)(3)) (as amended by Section 305(a) of division C of Public Law 104-208).
(6) An alien who is granted conditional entry pursuant to Section 203(a)(7) of the INA as in effect prior to April 1, 1980. (8 U.S.C. s 1153(a)(7)) (See editorial note under 8 U.S.C. s 1101, "Effective Date of 1980 Amendment").
(7) An alien who is a Cuban or Haitian entrant (as defined in Section 501(e) of the Refugee Education Assistance Act of 1980 (8 U.S.C. s 1522 note)).
(8) An alien who meets all of the conditions of subparagraphs (A), (B), (C), and (D) below:
(A) The alien has been battered or subjected to extreme cruelty in the United States by a spouse or parent, or by a member of the spouse's or parent's family residing in the same household as the alien, and the spouse or parent of the alien consented to, or acquiesced in, such battery or cruelty. For purpose of this subsection, the term "battered or subjected to extreme cruelty" includes, but is not limited to being the victim of any act or threatened act of violence including any forceful detention, which results or threatens to result in physical or mental injury. Rape, molestation, incest (if the victim is a minor), or forced prostitution shall be considered as acts of violence.
(B) There is a substantial connection between such battery or cruelty and the need for QME certification in the opinion of the IMC. For purposes of this subsection, the following circumstances demonstrate a substantial connection between the battery or cruelty and the need for QME certification:
(1) QME certification is needed to enable the alien to become self-sufficient following separation from the abuser.
(2) QME certification is needed to enable the alien to escape the abuser and/or the community in which the abuser lives, or to ensure the safety of the alien from the abuser.
(3) QME certification is needed due to a loss of financial support resulting from the alien's separation from the abuser.
(4) QME certification is needed because the battery or cruelty, separation from the abuser, or work absences or lower job performance resulting from the battery or extreme cruelty or from legal proceedings relating thereto (including resulting child support, child custody, and divorce actions) cause the alien to lose his or her job or to earn less or to require the alien to leave his or her job for safety reasons.
(5) QME certification is needed because the alien requires medical attention, health counseling, or has become disabled, as a result of the battery or extreme cruelty.
(6) QME certification is needed because the loss of a dwelling or source of income or fear of the abuser following separation from the abuser jeopardizes the alien's ability to care for his or her children (e.g., inability to house, feed, or clothe children or to put children into daycare for fear of being found by the abuser).
(7) QME certification is needed to alleviate nutritional risk or need resulting from the abuse or following separation from the abuser.
(8) QME certification is needed to provide medical care during a pregnancy resulting from the abuser's sexual assault or abuse of, or relationship with, the alien and/or to care for any resulting children.

(9) Where medical coverage and/or health care services are needed to replace medical coverage or health care services the alien had when living with the abuser.
(C) The alien has a petition that has been approved or has a petition pending which sets forth a prima facie case for:
(1) status as a spouse or child of a United States citizen or legal permanent resident pursuant to clause (ii), (iii), or (iv) of Section 204 (a)(1)(A) of the INA (8 U.S.C. s 1154(a)(1)(A)(ii), (iii) or (iv) and (B)(i)),
(2) classification pursuant to (ii) or (iii) of Section 204(a)(1)(B) of the INA (8 U.S.C. s 1154(a)(1)(B)(ii) or (iii)),
(3) suspension of deportation and adjustment of status pursuant to Section 244(a)(3) of the INA (8 U.S.C. s 1254) as in effect prior to April 1, 1997 [Pub.L. 104-208, s 501 (effective September 30, 1996, pursuant to s 591); Pub.L. 104-208, s 304 (effective April 1, 1997, pursuant to s 309; Pub.L. 105- 33, s 5581 (effective pursuant to s 5582)] (incorrectly codified as "cancellation of removal under Section 240A of such Act [8 U.S.C. s 1229b] (as in effect prior to April 1, 1997)."
(4) status as a spouse or child of a United States citizen pursuant to clause (i) or Section 204(a)(1)(A) of the INA (8 U.S.C. s 1157(a)(1)(A)(i)) or classification pursuant to clause (i) of Section 204(a)(1)(B) of the INA (8 U.S.C. s 1154(a)(1)(B)(i)), or
(5) cancellation of removal pursuant to section 240(b)(2) of the INA (8 U.S.C. s 1229b(b)(2)).
(D) For the period for which QME certification is sought, the individual responsible for the battery or cruelty does not reside in the same household or family eligibility unit as the individual subjected to the battery or cruelty.
(9) An alien who, under Section 431(c)(2) of the PRWORA (8 U.S.C. s 1641(c)(2)), meets all of the conditions of subparagraphs (A), (B), (C), (D), and (E) below:
(A) The alien has a child who has been battered or subjected to extreme cruelty in the United States by a spouse or a parent of the alien (without the active participation of the alien in the battery or cruelty), or by a member of the spouse's or parent's family residing in the same household as the alien, and the spouse or parent consented or acquiesced to such battery or cruelty. For purposes of this subsection, the term "battered or subjected to extreme cruelty: includes but is not limited to being the victim o any act or threatened act of violence including any forceful detention, which results or threatens to result in physical or mental injury. Rape. molestation, incest (if the victim is a minor), or forced prostitution shall be considered as acts of violence.
(B) The alien did not actively participate in such battery or cruelty.
(C) There is a substantial connection between such battery or cruelty and the need for QME certification to be provided in the opinion IMC. For purposes of this subsection, the following circumstances demonstrate a substantial connection between the battery or cruelty and the need for the benefits to be provided:
(1) QME certification is needed to enable the alien's child to become self-sufficient following separation from the abuser.
(2) QME certification is needed to enable the alien's child to escape the abuser and/or the community in which the abuser lives, or to ensure the safety of the alien's child from the abuser.
(3) QME certification is needed due to a loss of financial support resulting from the alien's child's separation from the abuser.
(4) QME certification is needed because the battery or cruelty, separation from the abuser, or work absences are lower job performance resulting from the battery or extreme cruelty or from legal proceedings relating thereto (including resulting child support, child support, child custody, and divorce actions) cause the alien's child to lose his or her job or to earn less or to require the alien's child to leave his or her job for safety reasons.
(5) QME certification is needed because the alien's child requires medical attention or mental health counseling, or has become disabled, as a result of the battery or extreme cruelty.
(6) QME certification is needed because the loss of a dwelling or source of income or fear of the abuser following separation from the abuser jeopardizes the alien's child's ability to care for his or her children (e.g., inability to house, feed, or clothe children or to put children into day care for fear of being found by the abuser).
(7) QME certification is needed to alleviate nutritional risk or need resulting from the abuse or following separation from the abuser.
(8) QME certification is needed to provide medical care during a pregnancy resulting from the abuser's sexual assault or abuse of, or relationship with, the alien's child and/or care for any resulting children.
(9) Where medical coverage and/or health care services are needed to replace medical coverage or health care services the alien's child had when living with the abuser.
(D) The alien meets the requirements of subsection (c)(8)(C) above.
(E) For the period for which benefits are sought, the individual responsible for the battery or cruelty does not reside in the same household or family eligibility unit as the individual subjected to the battery or cruelty.
(10) An alien child who meets all of the conditions of subparagraphs (A), (B), and (C) below:

(A) The alien child resides in the same household as a parent who has been battered or subjected to extreme cruelty in the United States by that parent's spouse or by a member of the spouse's family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty. For purposes of this subsection, the term "battered or subjected to extreme cruelty: includes but is not limited to being the victim of any act or threatened act of violence including any forceful detention, which results or threatens to result in physical or mental injury. Rape, molestation, incest (if the victim is a minor), or forced prostitution shall be considered as acts of violence.
(B) There is a substantial connection between such battery or cruelty and the need for QME certification in the opinion of IMC. For purposes of this subsection, the following circumstances demonstrate a substantial connection between the battery or cruelty and the need for the benefits to be provided:
(1) QME certification is needed to enable the alien child's parent to become self-sufficient following separation from the abuser.
(2) QME certification is needed to enable the alien child's parent to escape the abuser and/or the community in which the abuser lives, or to ensure the safety of the alien child's parent from the abuser.
(3) QME certification is needed due to a loss of financial support resulting from the alien child's parent's separation from the abuser.
(4) QME certification is needed because the battery or cruelty, separation from the abuser, or work absences or lower job performance resulting from the battery or extreme cruelty or from legal proceedings relating thereto (including resulting child support, child custody, and divorce actions) cause the alien child's parent to lose his or her job or to earn less or to require the alien child's parent to leave his her job for safety reasons.
(5) QME certification is needed because the alien child's parent requires medical attention or mental health counseling, or has become disabled, as a result or the battery or extreme cruelty.
(6) QME certification is needed because the loss of a dwelling or source of income or fear of the abuser following separation from the abuser jeopardizes the alien child's parent's ability to care for his or her children (e.g., inability to house, feed, or clothe children or to put children into day care for fear of being found by the abuser).
(7) QME certification is needed to alleviate nutritional risk or need resulting from the abuse or following separation from the abuser.
(8) QME certification is needed to provide medical care during a pregnancy resulting from the abuser's sexual assault or abuse of, or relationship with, the alien child's parent and/or to care for any resulting children.
(9) Where medical coverage and/or health care services are needed to replace medical coverage or health care services the alien child's parent had when living with the abuser.
(C) The alien child meets the requirements of subsection (c)(8)(C) above.
(d) For purposes of this section, "nonimmigrant" is defined the same as in Section 101(a)(15 ) of the INA (8 U.S.C. s 1101(a)(15)).
(e) For purposes of establishing eligibility for certification as a QME pursuant to Labor Code Section 139.2, all of the following must be met:

(1) The applicant must declare himself or herself to be a citizen of the United States or a qualified alien under subsection (c), a nonimmigrant alien under subsection (d), or an alien paroled into the United States for less than one year under Section 212(d)(5) of the INA (8 U.S.C. s 1182(d)(5)). The applicant shall declare that status through use of the "Statement of Citizenship, Alienage, and Immigration Status for QME Certification," Form 101.
(2) The applicant must present documents of a type acceptable to the Immigration and Naturalization Service (INS) which serve as reasonable evidence of the applicant's declared status. A fee receipt from the INS for replacement of a lost, stolen, or unreadable INS document is reasonable evidence of the alien's declared status.
(3) The applicant must complete and sign Form 101 and submit the from to the IMC with any other required information under Article 2 and Article 5 of this division.
(4) Where the documents presented do not on their face appear to be genuine or to relate to the individual presenting them, the government entity that originally issued the documents shall be contacted for verification. With regard to naturalized citizens and derivative citizens presenting certificates of citizenship and aliens, the INS is the appropriate government entity to contact for verification. The IMC shall request verification from the INS by filing INS Form G-845 with copies of the pertinent documents provided by the applicant with the local INS office. If the applicant has lost his or her original documents or presents expired documents or is unable to present any documentation evidencing his or her immigration status, the applicant shall be referred to the local INS office to obtain documentation.
(5) The type of documentation referred to the INS for verification pursuant to INS Form G-845 shall include the following:
(A) The document presented indicates immigration status but does not include an alien registration or alien admission number.
(B) The document is suspected to be counterfeit or to have been altered.
(C) The document includes an alien registration number in the A60 000 000 (not yet issued) or A80 000 000 (illegal border crossing) series.
(D) The document is one of the following: an INS Form, I-181b notification letter issued in connection with an INS Form I-181 Memorandum of Creation of Records of Permanent Residence, and Arrival-Departure Record (INS Form I-94) or an foreign passport stamped "PROCESSED FOR I-551, TEMPORARY EVIDENCE OF LAWFUL PERMANENT RESIDENCE" that INS issued more than one year before the date of application for QME certification.
(6) If the INS advises that the applicant has citizenship status or immigration status which makes him or her a qualified alien, a nonimmigrant or alien paroled for less than one year under Section 212(d)(5) of the INA, the INS verification shall be accepted. If the INS advises that it cannot verify that the applicant has citizenship status or an immigration status that makes him or her a qualified alien, a nonimmigrant or an alien paroled for less than one year under Section 212(d)(5) of the INA, QME certification shall be denied and the applicant notified pursuant to the Administrative Procedure Act (Gov't Code s 11370 et seq. of his or her right to appeal the denial of his or her certification.
(f) Pursuant to Section 434 of PRWORA (8 U.S.C. s 1644), where the Industrial Medical Council reasonably believes that an alien is unlawfully in the State based on the failure of the alien to provide reasonable evidence of the alien's declared status, after an opportunity to do so, said alien shall be reported to the Immigration and Naturalization Service.

(g) Eligibility for QME certification is established where subsections (e)(1)- (3) are satisfied. Any alien who provides documentation specified under subsection (e)(5) shall be eligible for QME certification until and unless the Industrial Medical Council receives written confirmation from the Immigration and Naturalization Service that the alien is not eligible for QME certification.
(h) Nothing in this section shall be construed to withdraw eligibility for QME certification if any of the conditions in U.S.C. s 1621(b) are present.
(i) Any applicant who was made eligible for QME certification whose services are terminated, suspended, or reduced pursuant to subsections (b) and (e), is entitled to a hearing under Section 61 of these regulations.


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; and Section 11507 et seq., Government Code.






s 11. Eligibility Requirements for Initial Appointment as a QME.
The Council shall appoint as QMEs all applicants who meet the requirements set forth in Labor Code Section 139.2(b) and all applicants:
(a) Shall submit the required supporting documentation:
(1) Copy of current license to practice in California;
(2) For Medical Doctors, or Doctors of Osteopathy:
(A) A copy of the applicant's certificate of completion of postgraduate specialty training at an institution recognized by the Accreditation Council for Graduate Medical Education or the osteopathic equivalent as defined pursuant to Section 12, or;
(B) A copy of the applicant's Board certification by a specialty board recognized by the Council or as defined pursuant to Section 12, or;
(C) A declaration under penalty of perjury accompanied by supporting documentation that the physician has qualifications that the Council 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 (1) 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 Council (i.e. Workers' Compensation Evaluation Certificate with a minimum 44 hours completed or; (2) a certificate of completion of a chiropractic postgraduate specialty program of at least 300 hours taught by a school or college recognized by the Council, the Board of Chiropractic Examiners and the Council on Chiropractic Education.
(5) Or, for other physicians, a copy of the physician's professional diploma.
(b) Prior to appointment as a QME, each applicant shall complete a course of at least 12 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.
(c)(1) Shall provide supplemental information and/or documentation to the Council after an application form is submitted if requested to verify an applicant's eligibility for appointment.
(2) Shall declare that he or she has not performed a QME Evaluation without QME Certification. The Council, after hearing pursuant to Section 61 may deny appointment to any applicant who has performed a QME Evaluation without QME Certification prior to appointment.
(d) Shall agree that during a QME exam he or she will not treat or offer or solicit to provide medical treatment for that injury for which he or she has 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 or she shall not offer or solicit to provide it. A QME who solicits an injured employee 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.
(e) Shall declare under penalty of perjury on the QME application he or she:
(1) has an unrestricted license or is currently on probation from the state licensing board and;
(2) devotes at least one-third of 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 has served as an AME on 8 or more occasions in the year prior to application and each year of the applicant's term; or if the applicant meets the requirements of section 15.
(f) Shall pass the QME Competency Examination.
(1) In order to take this examination, a physician who is not currently appointed as a QME and not exempt pursuant to Labor Code s139(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, and the Registration Form for the QME Competency Examination in Section 102 and the appropriate fee as specified in Section 11(f)(2).
(2) The fee for applying to take or retake the QME competency examination is $125.00 and may be waived by the Council at its discretion for first time applicants.
(3) The Medical Director shall give appropriate public notice of the date, time and location of the examination no fewer than 60 calendar days before a competency examination is to be given.
(4) An applicant must submit the properly completed forms as required in Section 11(f)(1) to the Medical Director at least 30 calendar days prior to the date of the next scheduled competency examination unless the Medical Director finds good cause to grant an extension to the physician(s).
(5) The Medical Director shall inform the applicant in writing whether he or she shall be allowed to take the examination within 15 calendar days from the date the Council receives the properly-completed forms and appropriate fee.
(6) The Medical Director shall inform the applicant in writing whether or not he or she passed the examination within 60 calendar days from the date the applicant takes the competency examination.
(7) An applicant who passes the QME competency examination shall file the QME Fee Assessment Form in Section 103 including the appropriate fee within 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 Council.
(8) 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, 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 Council 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 Council. Appeals shall be considered on a case by case basis. Appeals will be accepted immediately after a candidate has completed the examination and until 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 Council will consider appeals of test questions in closed session with counsel and will base its 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:

(A) Significant procedural error in the examination process;
(B) Unfair Discrimination;
(C) Bias or fraud.
(g) Each applicant shall pay the annual fee required by section 17 of this Article prior to appointment.


Note: Authority cited: Section 139.2, Labor Code. Reference: Section 139.2, Labor Code; and Section 6254, Government Code..






s 11.1. Application for QME Competency Examination Form.


Note: Authority cited: Section 139.2, Labor Code. Reference: Section 139.2, Labor Code.






s 11.5. Disability Evaluation Report Writing Course.
Prior to appointment as a QME, a physician shall complete a course of at least twelve hours of instruction in disability evaluation report writing. The course curriculum shall be specified by the Council.
(a) To apply to the Council for accreditation, a provider shall submit:
(1) a completed IMC Form 118 which contains
(A) the applicant's name; address; director of education with contact information; type of organization; length of time in business; nature of business; and past experience providing continuing education courses (including a list of other accrediting agencies that have approved such courses);
(B) a description of the proposed education program or course which includes the title; type (continuing education program or disability evaluation report writing course); location(s); date(s); length of training in clock hours; educational objectives; a complete description of the program or course content; faculty; and the names of other accrediting agencies that have approved the program.
(2) A curriculum vitae for each proposed instructor. A proposed instructor shall have education and/or training and recent work experience relevant to the subject of his/her presentation.
(3) To apply to the Council for accreditation, an applicant shall submit the application to the Council, at least 60 calendar days before any public advertisement of the applicant's course.
(b) The Council shall accredit an applicant that meets the definition of provider in Section 1(r); submits a completed, signed and dated application which demonstrates past experience in providing continuing education programs; and proposes a program which meets the requirements of 55(c) or a course which meets the requirements of 11.5(a) and (i). The applicant must demonstrate that adequate time is allocated to the curriculum set forth in section 11(5)(i) for the course to be approved by the Council. Proposed content for continuing education program credit must relate directly to disability evaluation or California workers' compensation-related medical dispute evaluation. No credit shall be recognized by the IMC for material primarily discussing the business aspects of workers' compensation medical practice, including but not limited to billing, coding and marketing.
(c) The Council shall notify the applicant within 20 calendar days following the next scheduled Council meeting after receipt of the application containing all the information listed in Section 11.5(a) whether that provider has been accredited for a two year period and the proposed course has been approved. Incomplete applications will be returned to the provider.
(d) A provider that has been accredited by the Council will be given a number which must be displayed on course promotional material.
(e) On or before the date the course is first presented, the provider shall submit the program syllabus (all program handouts) to the Council.
(f) An approved course may be offered for two (2) years. A provider shall notify the Council in writing of any change to the faculty in an approved course. The provider shall send the Council the program outline, promotional material and faculty for each offering of the program at least 45 days prior to the date of the presentation of the program. The Council may require submission of the program syllabi. The Council may require changes in the program based on its review of the program outline, program syllabi, promotional material or faculty if the IMC finds that any aspect of the program is not in compliance with these regulations.
(g) To apply for re-accreditation, a provider must submit a completed IMC Form 118, using the application process in 11.5(a). The provider may complete section 2 of the form using a new program or course or one which was given by the provider during the recent accreditation period. The Council shall give the provider 90 days' notice of the need to seek re-accreditation.
(h) Promotional materials for a course must state the provider's educational objectives; the professional qualifications of course faculty (at the least, all relevant professional degrees); the content of course activities; and the intended audience.
(i) The minimum of 12 hours of instruction in disability evaluation report writing shall include:
(1) The Qualified Medical Evaluator's Role in the Disability Evaluation Process (minimum recommended 1 hour)
How disability evaluation reports are used
The reasons why reports must be clear, complete and timely
The QME's role as an expert witness
Impact of the QME's report on the injured worker
QME ethics and the Confidentiality of Medical 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 (impairment and disability)
The occupational history
The physician examination and the role of testing
Labor Code requirements to use Packard Thurber's Evaluation of Industrial Disability Factors of disability
Subjective
Objective
Work restrictions
Loss of pre-injury capacity
Causation

Determination of permanent and stationary status
Vocational rehabilitation
Apportionment
Future medical treatment
Review of records
Providing sufficient support for conclusions
(4) The Council's Disability Evaluation Protocols (minimum recommended 1 hour)
An overview of the protocols and an in-depth discussion of one or more of the Neuromusculoskeletal, Pulmonary, Cardiac, Immunologic, or Psychiatric protocols.
(5) The Third Party Perspective (minimum recommended 1 hour)
The report from the perspective of those who read it:

Judge(s), attorney(ies), insurer(s), rater(s), employer(s), qualified rehabilitation representative(s).
(6) Anatomy of a Good Report (small group or other interactive sessions - minimum recommended 3 hours)
Discussion of examples of good reports and identification of weaknesses in reports
Opportunities for the practitioner to critique and/or correct reports.
If feasible, physician should have the opportunity to write a sample report.
Review of results of IMC annual report review and identification of common problems with reports
(7) Mechanics of Report Writing (minimum recommended 1 hour)
The QME Process

Face to face time
Timelines for submission of report
Completion of required forms
Service of reports
Final questions and answers
(j) No more than four hours of the required twelve hours of instruction may be taken by distance learning. All audio or video tapes, computer programs and printed educational material used in the course must be submitted to the Council on or before the date the course is first given. All distance learning materials shall bear a date of release and shall be updated yearly. The provider shall notify the Council in writing of the revision.
(k) No one shall recruit members or promote commercial products or services in the instruction room immediately before, during, or immediately after the presentation of a course. Providers or vendors may display/sell educational materials related to workers' compensation or applications for membership in an area adjoining a course. A course provider or faculty member shall disclose on IMC form 119 any significant financial interest in or affiliation with any commercial product or service which is discussed in a course and that interest or affiliation must be disclosed to all attendees. A provider shall file every form 119 in its possession with the Council.
( l) The provider shall maintain attendance records for each disability evaluation report writing course for a period of no less than three years after the course is given. A physician attending the course must be identified by signature. The provider must submit a copy of the signature list to the Council within 60 days of completion of the course.
(m) The provider is required to give the IMC's Evaluation Form 117) to course attendees and request they submit the form to the IMC. This information shall not be used in lieu of a certification of completion given by the provider, as specified pursuant to section (n). Destruction by a provider or its employee of a QME's Evaluation Form or failure by such provider or its employee to distribute Form 117 as part of its course shall constitute grounds for revocation of a provider's accredited status. The Council shall tabulate the responses and return a summary to the provider within 90 days of completion of the course.
(n) The provider shall issue a certificate of completion to the physician which states the name of the provider, the provider's number, the date(s) and location and title of the course. To be eligible for appointment as a QME, a physician must complete no less than 12 hours of the curriculum specified in Section 11.5(i) and must submit a copy of that certificate to the Council.
(o) Joint sponsorship of courses (as between an accredited and an unaccredited provider) must be approved by the Council prior to presentation of the course.
(p) The Council may audit a provider's course(s) at the request of the medical director to determine if the provider meets the criteria for accreditation. The Council may audit courses given by providers randomly, when a complaint is received, or on the basis of responses on IMC Form 117. An auditor shall not receive QME credit for auditing a course. The Council shall make written results of the audit available to the provider no more than 30 days after the audit is completed.
(q) Accredited providers that cease to offer disability evaluation report writing courses shall notify the Council in writing no later than 60 days prior to the discontinuing an approved course.
(r) The Council may withdraw accreditation of a provider or deny such a provider's application for accreditation on the following grounds (in addition to failure to meet the relevant requirements of subsections 11.5(a):
(1) Conviction of a felony or any offense substantially related to the activities of the provider.
(2) Any material misrepresentation of fact made by the provider.
(3) Failure to comply with Council regulations
(4) False or misleading advertising
(5) Failure to comply with Council recommendations following an audit
(6) Failure to distribute Council form 117 cards to course attendees.


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.






s 12. Recognition of Specialty Boards.
The Council shall recognize all specialty boards accredited by the American Board of Medical Specialties (ABMS), the American Osteopathic Association, the American Board of Professional Psychology, Inc. and those boards either accredited or considered equivalent to ABMS recognized boards by the Medical Board, the Osteopathic Medical Board and the Board of Psychology of State of California. The Council shall recognize chiropractic diplomate boards whose programs are taught by the Council on Chiropractic Education accredited colleges.


Note: Authority cited: Sections 139 and 139.2, Labor Code. Reference: Sections 139.2(b)(2)(A), 4060, 4061 and 4062, Labor Code.






s 13. Physician's Specialty.
A physician's specialty(ies) is one for which the physician is board certified or, has completed a postgraduate specialty training as defined in Section 11(a)(2)(A), or held an appointment as a QME in that specialty on June 30, 2000, pursuant to Labor Code Section 139.2, having provided to the Council documentation from the relevant board of certification or qualification or has provided documentation which meets the requirements of Section 11.


Note: Authority cited: Sections 139 and 139.2, Labor Code. Reference: Sections 139.2(b)(2)(A), 4060, 4061 and 4062, Labor Code.






s 13.5. Chiropractic Certification in Workers' Compensation Evaluation.
Note: The "Physicians Guide" does not appear as a part of this regulation. Copies are available through the Executive Medical Director of the Industrial Medical Council; P.O. Box 8888 San Francisco, CA 94128-8888.


Note: Authority cited: Sections 139, 139.2 and 139.3, Labor Code. Reference: Sections 139.2, 4060, 4061 and 4062, Labor Code.s 13.7. Appointment of Retired or Teaching Physicians. (continued)