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California > Regulations

§ 1 Chap 1 - Industrial Medical Council; Article 1 - General Definitions

As used in these regulations:




(a) Accreditation. 'Accreditation' means the conferring of recognized status as a provider of physician education by the Industrial Medical Council.



(b) Administrative Director. 'Administrative Director' means the administrative director of the Division of Workers' Compensation of the State of California Department of Industrial Relations.




(c) AME. '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. 'Appeals Board' means the Workers' Compensation Appeals Board within the State of

California Department of Industrial Relations.




(e) Audit. '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. '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. '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. '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. 'Council' means the Industrial Medical Council as defined in Labor Code Section 139.





(j) Course. '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. '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. 'Direct medical treatment' is 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. '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) Disability Evaluation Unit (DEU). 'DEU' is the unit under the Administrative Director

responsible for issuing summary disability ratings.




(o) Employer. 'Employer' mean 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. 'Evaluator' means 'Qualified Medical Evaluator' or 'Agreed Medical Evaluator.'




(q) Medical Director. '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. 'Provider' means the individual or organization which has been accredited by the

Council to offer physician education programs. There are two categories of providers that may grant

credit for continuing education programs and give courses in disability evaluation report writing:

(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. 'Qualified Injured Worker' means a employee defined pursuant to

subdivision (c) of Section 10003 of this Title.




(t) Qualified Medical Evaluator. '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. '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. A 'physician's office' is 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. A 'rebuttal examination' is 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. '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. A 'treating physician' is 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. 'Unrepresented employee' means an employee not represented by an

attorney.


History:


1. Repealer and new section filed 8-1-94; operative 8-31-94 (Register 94, No. 31). For prior

history, see Register 93, No. 38.



2. Change without regulatory effect amending subsections (c), (g), (h), (k) and (p) filed 9-19-94

pursuant to section 100, title 1, California Code of Regulations (Register 94, No. 38).



3. Amendment of subsections (d) and (f), repealer and new subsection (m), amendment of subsections

(n) and (o), new subsections (p) and (q) and subsection relettering, and amendment of newly

designated subsection (r) filed 8-23-96; operative 9-22-96 (Register 96, No. 34).



4. New subsection (s) and subsection relettering filed 6-3-97; 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 former subsection (f), new subsections (h), (j), (k),

(m), (r) and (x) and subsection relettering filed 10-16-2000 as an emergency; operative 1-1-2001

(Register 2000, No. 42). A Certificate of Compliance must be transmitted to OAL by 5-1-2001 or

emergency language will be repealed by operation of law on the following day.