Chapter 1. Industrial Medical Council
Article 1. General

§1. 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.

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. 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.