DWC Posts Proposed QME Rules to Forum

Wednesday, May 6, 2026 | 0

The California Division of Workers' Compensation proposed an informal draft of rules that would clarify eligibility requirements for qualified medical evaluators and establish parameters for listing offices as remote-only office locations.

Other provisions in the regulations that the division posted to its online forum for a 10-day comment period would revise timelines relating to how the agency responds to applications and administers QME placement exams.

The proposed rules would require providers applying to serve as QMEs to declare under penalty of perjury that they have not previously been terminated from the program, either as a result of having their authorization revoked or by resigning while disciplinary actions were pending.

The rules would also expand on the requirement for providers to disclose their license status.

The law requires providers to state that they have an unrestricted license to practice in California and are not on probation. Providers who have restrictions or are on probation are required to disclose those restrictions and the terms of probation.

The rules would add a requirement for providers to also report the details of any pending disciplinary action.

Another provision would declare that the certificate of completion for the disability evaluation report writing course is valid for only three years for the purposes of QME certification or appointment. Though the certificate is required for appointment as a QME, there is no explicit expiration date in the rules. 

In the case of providers who have retired from active practice due to disability, the proposed rules would require documentation of the disability in the form of medical records from the treating physician or a licensed provider.

Beyond who can qualify, the proposal would also limit how certain evaluators conduct medical-legal reviews and limit referrals when an acupuncturist is selected as the QME. 

When the QME is an acupuncturist and the issue of disability is disputed, the rules require the provider to notify the parties that another specialty is necessary to determine disability and refer the parties to request an additional panel.

That provision would remain under the proposal. However, the division is proposing a new provision that would prohibit both QMEs and agreed medical evaluators who are certified in acupuncture from obtaining a consultation "for the purpose of resolving a medical issue that is outside of the evaluator's scope of practice and area of clinical competency." Except in cases when a referral is needed to determine disability, the rules would explicitly prohibit acupuncturists from obtaining a consultation from another physician for the purposes of preparing a medical-legal report.

Separate provisions would address where and how QMEs can perform evaluations.

The rules would allow QMEs to designate up to three offices that would be listed on panel selection forms as remote-only locations. While offices can be designated as remote, the rules would require that they have an actual physical address and be available to the provider to perform in-person evaluations as needed.

Providers designating remote locations must also have at least one office where they provide in-person exams.

When a QME panel list is issued with a physician who provides only remote evaluations or a remote-only office, the rules would allow the division to replace that QME or replace the entire panel if one party to the action doesn't consent to a remote exam, under the proposed rules.

The rules would also allow the division to replace a provider in represented cases where both parties struck the same QME name from a panel. Alternatively, the division could replace the entire panel in such a situation.

Other changes would revise timelines surrounding both QME exams and application processes.

Under current rules, the DWC provides notice at least 60 days before holding the QME exam. Applications are due at least 45 days before the test, and the division informs applicants of their eligibility to sit for the exam within 15 days of receiving an application.

The division would provide notice at least 120 days before holding the exam, under the proposed rules. Applications would be due 60 days before the test, and the DWC would have 45 days from receiving applications to inform providers whether they can take it.

The rules would add a new section declaring that anyone who has failed the QME exam three times is not eligible to sit for a subsequent test for a period of two years from the date of the last failed test. 

Time periods for the DWC to process and respond to QME applications would be extended to 60 days from 45 days, under the rules.

The DWC is accepting comments on the proposed rules through 5 p.m. on May 15. The agency would have to initiate a formal rulemaking process to adopt the proposed regulations, which would require another comment period and a public hearing.

The proposed rules are available here.