California Regulations 30 19

(b) In the event a request form is incomplete, or improperly completed so that a QME panel selectioncannot properly be made, the request form shall be returned to the employee with an explanation whythe selection could not be made.

(c) The Request for Qualified Medical Evaluator Form along with the instruction form in Section 105 entitled How toRequest a Qualified Medical Evaluator shall be provided by the claims administrator (or, if there is noclaims administrator, the employer) to the unrepresented employee by personal delivery to theemployee or by first class or certified mailing.

(d)(1) For admitted injuries between January 1, 1991 and December 31, 1993, a panel request formand notice in a form prescribed by the Administrative Director pursuant to Article 8 of Chapter 4.5 of this Title shall beprovided to an unrepresented employee where the employee, the claims administrator or, if none, theemployer alleges a medical conclusion that the employee is no longer entitled to temporary disabilityindemnity and permanent disability cannot be determined or is or is not payable. The QME shalladdress all medical issues raised by the parties, including but not limited to the employees permanentand stationary status, the extent and scope of medical treatment, the employee's status as a QualifiedInjured Worker or the existence of new and further disability in order to produce a completecomprehensive medical-legal evaluation. (2) For admitted injuries occurring on or after January 1, 1994 a panel request form and theAdministrative Directors notice pursuant to Article 8 of Chapter 4.5 of this Title shall be provided to anunrepresented employee where a party disputes a medical conclusion by the primary treatingphysician. If the issues are other than the level of permanent impairment and limitations or the need formedical care, the objecting party shall, absent good cause as determined by the Appeals Board, notifythe other party of the nature of the objection within 30 days of receipt of the report from the primarytreating physician. The objecting party shall submit a written copy of the objection to the QME alongwith any medical records submitted pursuant to the requirements of Section 35. After the QMEevaluation is complete, either the employee or the employer may object to any new or unresolvedissue. The parties shall utilize the same QME to the extent possible. Where the issue is outside theQMEs scope of practice pursuant to the QMEs licensing authority, the parties may select anotherQME pursuant to subdivision (a) of Section 4064 of the Labor Code.

(e) If the request form is submitted by an unrepresented employee who no longer resides within the state of California, the geographic area of the QME panel selection within the state shall be determined by agreement between the claims administrator or, if none, the employer, and the employee. If noagreement can be reached, the geographic area of the QME panel selection shall be determined bythe employees former residence within the state.

History: Amendment of subsections (a), (c), and (d)(1) effective 5/14/00.