(1) Apply to the Administrative Director on the Physician Contract Application set forth in section 9768.5.
(2) Furnish a certified copy of his or her board certification, a copy of his or her current license to practice medicine, and submit other documentation of his or her qualifications as the Administrative Director may require.
(3) Designate specialties based on each of his or her board certifications.
(4) Designate the address(es) of the physician's office with necessary medical equipment where in-person examinations will be held.
(5) Agree to see any injured worker assigned to him or her within 30 days unless there is a conflict of interest as defined in section 9768.2.
(6) During the application process and after being notified by the Administrative Director that the contract application has been accepted, the physician shall keep the Administrative Director informed of any change of address, telephone, email address or fax number, and of any disciplinary action taken by a licensing board.
(b) The contract application, completed by the physician, and any supporting documentation included with the contract application, shall be filed at the Administrative Director's office listed on the form. The contract application submitted by the physician may be rejected if it is incomplete, contains false information or does not contain the required supporting documentation listed in this section.
(c) The Administrative Director shall maintain a list of physicians who have applied, and whom the Administrative Director has contracted with to conduct Independent Medical Reviews under Labor Code section 4616.4.
(d) The IMR contract term is two years. A physician may apply to serve for subsequent two year terms by following the procedure set forth in subdivision (a).
Authority cited: Sections 133 and 4616, Labor Code. Reference: Section 4616.4, Labor Code.
1. New section filed 12-31-2004 as an emergency; operative 1-1-2005 (Register 2004, No. 53). A Certificate of Compliance must be transmitted to OAL by 5-2-2005 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-31-2004 order, including amendment of
subsections (a) and (c), transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register
2005, No. 23).