Cal. Code Regs. tit. 8 § 16

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 16 - Determination of Fees for QME Eligibility

(a) For purposes of establishing the annual fee for any qualified medical evaluator pursuant to Article 2, physicians (as defined under Section 3209.3 of the Labor Code) shall be classified into one of three categories:

(1) QMEs who meet all applicable requirements under Article 2 and 5 and who have conducted 0-10 comprehensive medical-legal evaluations in the twelve months prior to the assessment of the fee. Comprehensive medical-legal evaluations are evaluations as defined under Section (1)(i) of this Chapter performed by a physician.

(2) QMEs who meet all applicable requirements under Article 2 and 5 and who have conducted 11-24 comprehensive medical-legal evaluations in the twelve months prior to assessment of the fee. Comprehensive medical-legal evaluations are evaluations as defined under Section (1)(i) of this Chapter performed by a physician.

(3) QMEs who meet all applicable requirements under Article 2 and 5 and who have conducted 25 or more comprehensive medical-legal evaluations in the twelve months prior to assessment of the fee. Comprehensive medical-legal evaluations are evaluations as defined under Section (1)(i) of this Chapter performed by a physician.

(b) The evaluations shall be conducted in compliance with all applicable statutes and regulations.

(c) Verification of the number of examinations shall be made by the Administrative Director using The Qualified or Agreed Medical Evaluator Findings Summary Form in section 111 (See, 8 Cal. Code Regs. § 111), as well as any other relevant records or sources of information. Misrepresentation of the number of evaluations performed for purposes of establishing a physician's QME fee shall constitute grounds for disciplinary proceedings under section 60 of this chapter.

NOTE: Form referred to above is available at no charge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.

Cal. Code Regs. Tit. 8, § 16

1. New section filed 4-9-93 as an emergency; operative 4-9-93 (Register 93, No. 15). A Certificate of Compliance must be transmitted to OAL 8-9-93 or emergency language will be repealed by operation of law on the following day.
2. Editorial correction amending NOTE (Register 93, No. 17).
3. New section refiled 9-16-93 with amendment of subsection (a) as an emergency; operative 9-16-93 (Register 93, No. 38). A Certificate of Compliance must be transmitted to OAL by 1-14-94 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-16-93 order including amendments transmitted to OAL 10-28-93 and filed 12-14-93 (Register 93, No. 51).
5. Amendment of section filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
6. Amendment filed 6-7-99 as an emergency; operative 6-7-99 (Register 99, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-5-99 or emergency language will be repealed by operation of law on the following day.
7. Reinstatement of section as it existed prior to 6-7-99 emergency amendment by operation of Government Code section 11346.1(f) (Register 2000, No. 3).
8. Amendment filed 1-19-2000; operative 1-19-2000 pursuant to Government Code section 11343.4(d) (Register 2000, No. 3).
9. Renumbering of former section 16 to section 18 and renumbering of former section 14 to number 16 filed 4-14-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 15).
10. Amendment of subsection (c) and NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).

Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code.

1. New section filed 4-9-93 as an emergency; operative 4-9-93 (Register 93, No. 15). A Certificate of Compliance must be transmitted to OAL 8-9-93 or emergency language will be repealed by operation of law on the following day.
2. Editorial correction amending Note(Register 93, No. 17).
3. New section refiled 9-16-93 with amendment of subsection (a) as an emergency; operative 9-16-93 (Register 93, No. 38). A Certificate of Compliance must be transmitted to OAL by 1-14-94 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-16-93 order including amendments transmitted to OAL 10-28-93 and filed 12-14-93 (Register 93, No. 51).
5. Amendment of section filed 8-23-96; operative 9-22-96 (Register 96, No. 34).
6. Amendment filed 6-7-99 as an emergency; operative 6-7-99 (Register 99, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-5-99 or emergency language will be repealed by operation of law on the following day.
7. Reinstatement of section as it existed prior to 6-7-99 emergency amendment by operation of Government Code section 11346.1(f) (Register 2000, No. 3).
8. Amendment filed 1-19-2000; operative 1-19-2000 pursuant to Government Code section 11343.4(d) (Register 2000, No. 3).
9. Renumbering of former section 16 to section 18 and renumbering of former section 14 to number 16 filed 4-14-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 15).
10. Amendment of subsection (c) and Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).