Chapter 1. Industrial Medical Council
Article 4. Evaluation Procedures

§41. Ethical Requirements.

a) All QMEs, regardless of whether the injured worker is represented by an attorney, shall:

(1) Maintain a clean, professional medical office (as defined in Section 1(m)) at all times including functioning evaluating medical instruments and equipment appropriate to conducting the evaluation within the physician's scope of practice.

(2) Schedule all appointments for comprehensive medical-legal evaluations without regard to whether a worker is unrepresented or represented by an attorney. A QME shall not refuse to schedule an appointment with an injured worker solely because the worker is not represented by an attorney or because a promise to reimburse or reimbursement is not made prior to the evaluation.

(3) Not request the employee to submit to an unnecessary exam or procedure.

(b) QMEs selected by an unrepresented injured worker from a three-member panel provided by the Council shall not engage in ex parte communication in violation of Labor Code Section4062.2.

(c) All QMEs, regardless of whether the injured worker is represented by an attorney, shall with respect to his or her comprehensive medical-legal evaluation:

(1) Refuse any compensation from any source contingent upon writing an opinion that in any way could be construed as unfavorable to a party to the case.

(2) Review all available relevant medical and non-medical records and/or facts necessary for an accurate and objective assessment of the injured workers' case before generating a written report.

(3) Render expert opinions or conclusions without regard to an injured workers' race, sex, national origin, religion or sexual preference.

(4) Render expert opinions or conclusions only on issues with regard to which the QME has adequate qualifications, education, and training. All conclusions shall be based on the facts and on the QME's training and specialty-based knowledge and shall be without bias either for or against the injured worker or the employer.

(5) Present a report that addresses all relevant issues, is ratable by the DEU, if applicable, and complies with all relevant guidelines of the Industrial Medical Council.

(d) All aspects of all physical and/or psychological comprehensive medical-legal evaluations, including history taking, shall be directly related to medical issues as presented by any party or addressed in the reports of treating physician(s).

(e) No physician certified by the IMC as a QME, or his or her agent, shall contact a QME for the purpose of influencing that QME's opinions or conclusions in any QME evaluation.

(f) No QME shall schedule appointments to the extent that any injured worker will be required to wait for more than one hour at a QME's office prior to being seen for the previously agreed upon appointment time for an evaluation. If the injured worker is unrepresented and is not seen by the QME within one hour, he or she may terminate the exam and request a replacement evaluator from the Council. No party shall be liable for the terminated exam. The QME may explain any reasons for the delay to the injured worker and, provided both parties agree, the evaluation may proceed or be rescheduled at a later date. If the evaluation is rescheduled, the QME shall provide notice to the claims administrator or, if none, the employer within 5 working days after rescheduling the appointment.

(g) If the injured worker terminates the examination process based on an alleged violation of either Section 40 or Section 41(a) and the Appeals Board later determines that good cause did not exist for the termination, the cost of the evaluation shall be deducted from the injured worker's award. A violation of Section 40 or of any part of section 41(a) shall constitute good cause for purposes of an Appeals Board determination. No party shall be liable for any cost for medical reports or medical services delivered as a result of an exam terminated for good cause.

(h) Nothing in this section shall require a QME to undertake or continue a comprehensive medical-legal evaluation where the injured worker or his/her representative uses abusive language towards the QME or the QME's staff or deliberately attempts to disrupt the operation of the QME's office in any way. The QME shall state under penalty of perjury, the facts supporting the termination of the evaluation process. Upon request, the Medical Director shall investigate the facts and make a final determination of the issue(s).

(i) Nothing in this section shall require a QME to undertake or continue a comprehensive medical-legal evaluation where the injured worker is intoxicated or under the influence of any medication which impairs the injured worker's ability to participate in the evaluation process. The QME shall state under penalty of perjury, the facts supporting the termination of the evaluation process. Upon request, the Medical Director shall investigate the facts and make a final determination of the issue(s).

NOTE: Authority cited: Sections 139.2, 5307.3 and 5307.6, Labor Code. Reference: Sections 139, 139.2, 4060, 4061, 4062 and 4062.2, Labor Code

HISTORY

1. New section filed 4-11-95; operative 5-11-95 (Register 95, No. 15).

2. New subsection (b), subsection relettering, and amendment of redesignated subsection (b)(1) filed 7-18-95 as an emergency; operative 7-18-95 (Register 95, No. 29). A Certificate of Compliance must be transmitted to OAL by 11-15-95 or emergency language will be repealed by operation of law on the following day.

3. Certificate of Compliance as to 7-18-95 order including amendment of subsection (b), deletion of subsection (b)(1) designator, and amendment of Note transmitted to OAL 11-14-95 and filed 12-21-95 (Register 95, No. 51).

4. Amendment filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15).