Where this sits
- TITLE 8. INDUSTRIAL RELATIONS DIVISION 1. DEPARTMENT OF INDUSTRIAL RELATIONS CHAPTER 1. DIVISION OF WORKERS' COMPENSATION-QUALIFIED MEDICAL EVALUATOR
- Article 10.5. QME Process Forms
The regulation, as printed
Any physician who files a QME Form 100 (Application for Appointment), 103 (QME Fee Assessment Form) or 104 (Reappointment Application) with the Administrative Director also shall complete the QME SFI Form 124, in order to disclose specified financial interests that may affect the fairness of QME panels, and append it to the form 100, 103 or 104 being submitted when the form is filed. NOTE: Form 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.
Authority and history
Note: Authority cited: Sections 53, 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, Labor Code.
1. New section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
No released decision named this rule
Not a comment on the rule — most of Title 8 never reaches a published panel decision, because most of it is followed without argument. The text above is the state's own.
Rules beside this one
Article 10.5. QME Process Forms — regulations rarely stand alone, and the answer is often two sections away.
- § 118Application for Accreditation or Re-Accreditation As Education Provider.
- § 119Faculty Disclosure of Commercial Interest.
- § 120Voluntary Directive for Alternate Service of Medical-Legal Evaluation Report on Disputed Injury to Psyche.
- § 121Declaration Regarding Protection of Mental Health Record.
- § 122AME or QME Declaration of Service of Medical-Legal Report.
- § 125[Reserved]