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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 3.6. Independent Medical Review

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§9768.8. Removal of Physicians from Independent Medical Reviewer List

(a) The Administrative Director may cancel the IMR contract and remove a physician from the Independent Medical Reviewer list if the Administrative Director determines based upon the Administrative Director's monitoring of reports:

(1) That the physician, having been notified by the Administrative Director of the physician's selection to render an Independent Medical Review, has not issued the Independent Medical Review report in a case within the time limits prescribed in these regulations on more than one occasion; or

(2) That the physician has not met the reporting requirements on more than one occasion; or

(3) That the physician has at any time failed to disclose to the Administrative Director that the physician had a conflict of interest pursuant to section 9768.2; or

(4) That the physician has failed to schedule appointments within the time frame required by these regulations on more than one occasion; or

(5) That the physician has failed to maintain the confidentiality of medical records and the review materials consistent with the applicable state and federal law.

(b) The Administrative Director shall cancel the IMR contract and remove a physician from the Independent Medical Reviewer list if the Administrative Director determines:

(1) That the physician no longer meets the qualifications to be on the list; or

(2) That the physician's contract application to be on the list contained material statements which were not true.

(c) The Administrative Director shall place a physician on an inactive list for up to the end of the two year contract term whenever the Administrative Director determines that the appropriate licensing Board from whom the physician is licensed has filed an accusation for a quality of care violation, fraud related to medical practice, or conviction of a felony crime or a crime related to the conduct of his or her practice of medicine against the physician or taken other action restricting the physician's medical license. If the accusation or action is later withdrawn, dismissed or determined to be without merit during the two year contract term, the physician shall advise the Administrative Director who will then remove the physician's name from the inactive list. If the accusation or action is withdrawn, dismissed or determined to be without merit after the expiration of the two year contract term, the physician may reapply to serve as an Independent Medical Reviewer pursuant to section 9768.4.

(d) Upon removal of a physician from the Independent Medical Reviewer list or placement on the inactive list, the Administrative Director shall advise the physician by mail of the removal or placement on the inactive list, the Administrative Director's reasons for such action, and the right to request a hearing on the removal from the IMR list or placement on the inactive list.

(e) A physician who has been mailed a notice of removal from the list or placement on the inactive list, may, within 30 calendar days of the mailing of the notice, request a hearing by filing a written request for hearing with the Administrative Director. If a written request for hearing is not received by the Administrative Director within 30 calendar days of the mailing of the notice, the physician shall be deemed to have waived any appeal or request for hearing.

(f) Upon receipt of a written request for hearing, the Administrative Director shall prepare an accusation and serve the applicant physician with the accusation, as provided in Government Code section 11503.

(g) Hearings shall be held by the Administrative Director or his or her designee under the procedures of Chapter 5 of Part 1 of Division 3 of Title 2 of the Government Code (commencing with section 11500) and the regulations of the Office of Administrative Hearings (Title 1, California Code of Regulations, section 1000 et seq.).

(h) Failure to timely file a notice of defense or failure to appear at a noticed hearing or conference shall constitute a waiver of a right to a hearing.

(i) A physician who has been removed from the list may petition for reinstatement after one year has elapsed since the effective date of the Administrative Director's decision on the physician's removal. The provisions of Government Code section 11522 shall apply to such petition.

NOTE

Authority cited: Sections 133 and 4616, Labor Code; and Section 11400.20, Government Code. Reference: Section 4616.4, Labor Code; and Sections 11415.10, 11503 and 11522, Government Code.

HISTORY

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 section, transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register 2005, No. 23).

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