California Regulations 11 3

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§ Eligibility Requirements for QMEs



The Council shall appoint as QMEs all applicants who meet the requirements set forth in Labor Code Section 139.2(b) and all applicants shall:

(a) Submit the required supporting documentation which shall be as follows:

(1) Copy of current license to practice in California; (2) Copy of Board certification by a specialty board recognized by the Council or documentation of one of the following: (A) For Medical Doctors, or Doctors of Osteopathy, a copy of his or her certificate of completion in a postgraduate training in his or her specialty at an institution recognized by the Accreditation Council for Graduate Medical Education or the osteopathic equivalent. Physicians who completed the minimum postgraduate training requirements as of January 1, 1995, shall have seven years from the date of completion to become board certified or otherwise eligible under Section 139.2 of the Labor Code. Physicians who completed the minimum post graduate training requirements prior to January 1, 1995, shall have until January 1, 2003 to become board certified or otherwise eligible under Section one under 139.2 of the Labor Code. (B) For MDs or DOs, 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. (C) 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 post doctoral experience in the treatment of emotional and mental disorders or (ii) served as an AME on a or more occasions prior to January 1, 1990 has not less than five years post doctoral experience in the diagnosis and treatment of emotional and mental disorders. (D) 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 post graduate 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. (E) Or, for other physicians, a copy of his or her professional diploma. (3) No MD or DO who failed a specialty certifying examination after 1985 may be certified as a qualified medical evaluator in that specialty, until the physicians subsequently passes the certifying examination. Especially of such physician shall be medicine-otherwise qualified.

(b) In lieu of the requirements of (a)(2), a physician may submit a declaration under penalty of perjury stating that he or she has served as an agreed medical evaluator on eight or more occasions prior to January 1, 1970 or a declaration under penalty of perjury that the physician has written 100 or more ratable comprehensive-medical legal reports and served as an Agreed Medical Evaluator on 25 or more occasions annually between January 1, 1990 and December 31, 1994.

(c) (1) All applicants shall provide supplemental information and/or documentation to the Council after an application form is submitted if necessary to verify an applicant's eligibility for QME appointment. All applicants shall notify the council upon any change of applicant's address(es). (2) Each applicant 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 his or her appointment.

(d) Each applicant 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 and 4601 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 650.

(e) Each applicant shall declare under penalty of perjury on the QME application whether or not he or she: (1) has an unrestricted license or is currently on probation from his or her state licensing board and; (2) Devotes at least 1/3 of his or her 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 eight or more occasions in the year prior to application and each year of the applicant's term; or the applicant meets the requirements of Section 15.

(f) All applicants 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 Section 139 (b) (1), shall be considered to have applied to take the QME competency examination when he or she submits the properly-completed Application for Appointment as a QME Form in Section 100, and the Registration Form for the QME Competency Examination in Section 102 along with the appropriate fee as specified in Section 11 (f) (2). (2) The fee for applying to 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) A physician 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 could cause to grant an extension to the physician(s). (5) The Medical Director shall inform the physician in writing whether he or she shall be allowed to take the examination within 45 calendar days from the date the Council receives the properly-completed forms and appropriate fee. (6) The Medical Director shall inform the physician 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) A physician given notice in writing that he or she has passed the QME competency examination shall file the QME Fee Assessment Form in Section 103 including the appropriate fee within 30 days of the notice. The physician shall not be appointed to the official QME list until the appropriate fee is paid. Appointments shall be for two year terms from the date of the examination. (8) Any physician 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 his/her exam shall be nullified. (9) If a physician fails the competency examination or fails to appear for a noticed QME examination for which he or she has submitted a QME Examine Registration Form 102, he or she may apply to take a subsequent examinations, provided he or she submits a new application form and a fee of $125.00. A physician 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) A physician 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 appeals 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 decisions 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 submit, prior to his or her term of appointment, the payment of the annual fee required by section 17 of this Article.

History: amendment effective 5/14/00.