CCR 31.5

(a) A replacement QME to a panel shall be provided to an unrepresented worker upon the employee's request if any of the following occurs:

(1) A QME on the panel issued does not practice in the specialty requested by the employee.

(2) A QME on the panel issued cannot schedule an examination for the employee within 60 days of the employee's request.

(3) The employee has changed his or her residence address since the QME panel was issued.

(4) A physician on the QME panel is a member of the same group practice as defined by Labor Code section 139.3 as another QME on the panel.

(5) The QME is unavailable pursuant to section 33.

(b) Any party may request a replacement QME if any of the following occurs:

(1) The employee's primary treating physician in accordance with Section 9785 of this Title is on the panel.

(2) The claims administrator or, if none, the employer and the unrepresented employee agree that a new panel may be issued in the geographic area of the employee's work place.

(3) The Medical Director, upon written request, finds good cause that a replacement QME is appropriate for reasons related to the medical nature of the injury. For purposes of this subsection, “good cause” is defined as a documented medical or psychological impairment.

(4) The Medical Director, upon written request, determines after a review of all appropriate records that the specialty chosen by the injured worker is medically or otherwise inappropriate for the injury to be evaluated.

(5) Any violation of Section 34.

(c) The Medical Director shall select replacement QME(s) at random.

NOTE

Authority cited: Sections 139, 139.2, 4061 and 4062, Labor Code. Reference: Sections 139.2, 4061 and 4062, Labor Code.