Chapter 1. Industrial Medical Council
Article 3. Assignment of Qualified Medical Evaluators, Evaluation Procedure

§30. QME Panel Requests.

(a) Requests for a QME panel made by an unrepresented employee pursuant to Labor Code Sections 4061 and 4062 shall be submitted on the form in Section 106.

(b) In the event a request form is incomplete, or improperly completed so that a QME panel selection cannot properly be made, the request form shall be returned to the employee with an explanation why the selection could not be made.

(c) The Request for Qualified Medical Evaluator Form along with the instruction form in Section 105 entitled “How to Request a Qualified Medical Evaluator” shall be provided by the claims administrator (or, if there is no claims administrator, the employer) to the unrepresented employee by personal delivery to the employee or by first class or certified mailing.

(d)(1) For admitted injuries between January 1, 1991 and December 31, 1993, a panel request form and notice in a form prescribed by the Administrative Director pursuant to Article 8 of Chapter 4.5 of this Title shall be provided to an unrepresented employee where the employee, the claims administrator or, if none, the employer alleges a medical conclusion that the employee is no longer entitled to temporary disability indemnity and permanent disability cannot be determined or is or is not payable. The QME shall address all medical issues raised by the parties, including but not limited to the employee's permanent and stationary status, the extent and scope of medical treatment, the employee's status as a Qualified Injured Worker or the existence of new and further disability in order to produce a complete comprehensive medical-legal evaluation.

(2) For admitted injuries occurring on or after January 1, 1994 a panel request form and the Administrative Director's notice pursuant to Article 8 of Chapter 4.5 of this Title shall be provided to an unrepresented employee where a party disputes a medical conclusion by the primary treating physician. If the issues are other than the level of permanent impairment and limitations or the need for medical care, the objecting party shall, absent good cause as determined by the Appeals Board, notify the other party of the nature of the objection within 30 days of receipt of the report from the primary treating physician. The objecting party shall submit a written copy of the objection to the QME along with any medical records submitted pursuant to the requirements of Section 35. After the QME evaluation is complete, either the employee or the employer may object to any new or unresolved issue. The parties shall utilize the same QME to the extent possible. Where the issue is outside the QME's scope of practice pursuant to the QMEs licensing authority, the parties may select another QME pursuant to subdivision (a) of Section 4064 of the Labor Code.

(e) If the request form is submitted by an unrepresented employee who no longer resides within the state of California, the geographic area of the QME panel selection within the state shall be determined by agreement between the claims administrator or, if none, the employer, and the employee. If no agreement can be reached, the geographic area of the QME panel selection shall be determined by the employee's former residence within the state.

NOTE: Authority cited: Sections 139, 139.2, 4061 and 4062, Labor Code. Reference: Sections 139.2, 4061 and 4062, Labor Code.

HISTORY

1. New article 3 and section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).

2. Amendment of subsection (b) and new subsections (d)-(e) filed 8-23-96; operative 9-22-96 (Register 96, No. 34).

3. Amendment of subsections (a), (c) and (d)(1) filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).