Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.1. Provider Suspension Procedure

§ 9788.1. Notice of Provider Suspension.

(a) The Administrative Director shall issue a notice of suspension to a physician, practitioner, or provider who has met one of the criteria set forth under Labor Code section 139.21(a)(1).

(b) The term “suspension from participation” means the physician, practitioner, or provider is prohibited from providing any goods or services related to an occupational injury or illness that is either for pay or required by Labor Code sections 4060, 4061, 4062, 4062.1, 4062.2, 4600, 4600.3, 4610, 4610.5, 4610.6, 4616, and 4620. The term “suspension from participation” also precludes a physician's continued certification as a qualified medical evaluator pursuant to Labor Code section 139.2.

(c) The physician, practitioner, or provider is prohibited from seeking payment or reimbursement, either directly or indirectly, for any goods or services related to an occupational injury or illness that is provided on or after the date of their suspension.

(d) The notice required under subdivision (a) shall be in writing and shall include all of the following:

(1) Notice that the physician, practitioner, or provider is subject to suspension from participating in the workers' compensation system;

(2) The basis for the suspension under Labor Code section 139.21(a)(1);

(3) A statement that the suspension is effective 30 days from the date the notice is mailed, unless the physician, practitioner, or provider requests a hearing and, in that hearing, provides proof that Labor Code section 139.21(a)(1) is not applicable;

(4) A statement that the physician, practitioner, or provider may request a hearing within 10 days from the date the notice is served, which will stay the suspension pending the outcome of the hearing, and that the failure to request a hearing will result in suspension pursuant to section 9788.2(b); and

(5) A description of the method for requesting the hearing, including instructions on how the request should be filed and served.

(e) The notice shall be served by registered or certified mail.

Note: Authority: Sections 133 and 139.21, Labor Code. Reference: Section 139.21, Labor Code.

HISTORY

1. Amendment of article heading, new article 5.1 (sections 9788.1-9788.4) and new section filed 1-6-2017 as an emergency; operative 1-6-2017 (Register 2017, No. 1). A Certificate of Compliance must be transmitted to OAL by 7-5-2017 or emergency language will be repealed by operation of law on the following day. For prior history of article 5.1 (sections 9788.01-9788.91), see Register 2014, No. 16.

2. Amendment of article heading, new article 5.1 (sections 9788.1-9788.4) and new section refiled 6-29-2017 as an emergency; operative 7-6-2017 pursuant to Government Code section 11346.1(d) (Register 2017, No. 26). A Certificate of Compliance must be transmitted to OAL by 10-4-2017 or emergency language will be repealed by operation of law on the following day.

3. Amendment of article heading, new article 5.1 (sections 9788.1-9788.4) and new section refiled 9-28-2017 as an emergency; operative 10-5-2017 pursuant to Government Code section 11346.1(d) (Register 2017, No. 39). A Certificate of Compliance must be transmitted to OAL by 1-3-2018 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 9-28-2017 order, including amendment of subsections (d)(4) and (e), transmitted to OAL 12-29-2017 and filed 2-7-2018; amendments operative 2-7-2018 pursuant to Government Code section 11343.4(b)(3) (Register 2018, No. 6).