Section 55.1 - Reappointment: Continuing Education ProgramsA QME shall complete within the previous 24 months of his, her or their term of appointment 16 hours of continuing education in disability evaluation, or workers' compensation related medical dispute evaluation, or other workers' compensation related topics approved by the Administrative Director, given by a provider accredited by the Administrative Director. This section shall apply to applications for reappointment received on or after April 1, 2026.
(a) There are two types of continuing education programs:(1) On-site programs, in which the instructor and QME are in the same location. On site programs can also be accomplished electronically where the instructor and the QME are in the same virtual location as long as the virtual location provides a means for the instructor to continuously track who is attending the class virtually to ensure that attendees remain in the virtual location for the entirety of the actual instruction. In order to provide accreditation for virtual in person instruction, the provider and the QME must satisfy all of the requirements for distance learning as contained in subsection (a)(2) of this regulation; and(2) Distance learning programs.(A) Providers of distance learning programs shall give either a pre- or post-course self-examination based on the program material. The provider shall grade the QME's test. Credit for the course can be given only for a passing rate of no lower than 70 percent correct responses. The Administrative Director may audit physicians' examinations and scores.(B) Credit for distance learning courses shall be granted for the actual time spent viewing, listening to or participating in the program and for the reasonable and necessary time to take the examinations for up to eight hours per program. Credit for the same distance learning program may be taken only once.(C) All distance learning materials shall bear a date of release and shall be updated every three years. The provider shall notify the Administrative Director in writing of the revision.(b) The 16 hours of continuing education shall be in disability evaluation, workers' compensation related medical dispute evaluation, or other workers' compensation related topics approved by the Administrative Director. The 16 hours of instruction in continuing education shall include,(1) A minimum of 4 hours of instruction in disability impairment rating;(2) A minimum of 3 hours of instruction in medical-legal report writing;(3) A minimum of 2 hour of instruction in anti-bias training which meets the qualifications outlined in Section 11(h);(4) A minimum of 2 hours in of instruction consisting of a review of workers' compensation case law;(5) A minimum of 1 hour of instruction in proper application of the medical-legal fee schedule or in QME adherence to regulatory clerical requirements;(6) The remaining 4 hours may include credit earned as follows:(A) A physician may earn a maximum of 2 hours of credit for having their reports reviewed by an approved educational provider. The review shall consist of actual discussion between the physician and the educational provider involving critical review of a report or reports authored by the physician and submitted to the educational provider for critique involving assessment of the report quality in relation to assessment of factors outlined in Title 8, California Code of Regulations § 10682. The educational provider shall produce a written checklist as part of the report review indicating their assessment of the individual report. The checklist shall include the factors outlined in Title 8, California Code of Regulations § 10682. The educational provider shall give a copy of the completed checklist to the physician along with any certification of completion of the report review.(B) The DWC may provide on its website annually a list of recommended educational topics for QME certification based on review of medical-legal reports in the previous year.(C) Credit may be received for physician time spent in activities enumerated in section (c).(c) In addition to granting credit for attending a course or program which it gives, the Administrative Director may grant credit for: (1) Participating in a panel on the development or review of the QME competency examination. A physician may receive one hour credit for each hour of participation on a panel. The QME shall obtain documentation of participation from the test administrator for submission to the Administrative Director.(2) Instructing in a program given for QME credit by a provider accredited by the Administrative Director. The instructor may receive two hours of credit for each hour of instruction in an accredited provider's program or one hour of credit for each hour of participation on a panel. Credit for the same presentation may be taken only once during each calendar year. The QME shall submit documentation of participation from the program provider to the Administrative Director.(3) Attending a program which is accepted by the QME's licensing board for renewal of his or her professional license, provided the subject matter is directly related to California impairment evaluation or workers' compensation medical dispute evaluation. To request credit for this type of course, the QME must submit:
(B) written material which describes the program content and program faculty; and(C) documentation that the program is for continuing education credit by the physician's licensing board.(4) Passing the QME competency examination. A QME may be granted six hours of continuing education credit for passing this examination for the purpose of receiving an initial appointment as a QME.(5) Participating in a panel created by the DWC Medical Director to review medical-legal reports for quality. A physician may receive one hour credit for each hour of participation on a panel not to exceed 4 hours in a calendar year. The QME shall obtain documentation of participation from the Medical Director or their designee for submission to the Administrative Director.(d) To apply to the Administrative Director for accreditation, a provider shall submit to the Administrative Director, at least 60 calendar days before any public advertisement of the applicant's program or course is made:(1) a completed form 118, in section 118 of these regulations.(2) A curriculum vitae for each proposed instructor or author (for paper-based programs). A proposed instructor or author shall have education and/or training and recent work experience relevant to the subject of his/her presentation.(3) The proposed promotional material for the program.(4) An outline of course content, or actual course content, consistent with the topics in section of Title 855(b) or 11.5(a) and (i) of Title 8 of the California Code of Regulations.(e) The Administrative Director shall accredit an applicant who meets the definition of an education provider in Section 1(p); submits a completed, signed and dated application which demonstrates past experience in providing continuing education programs; and proposes a program which meets the requirements of section 55(b) or a course which meets the requirements of section 11.5(a) and (i). Proposed content for continuing education program credit must relate directly to disability evaluation or California workers' compensation-related medical dispute evaluation, or other workers' compensation related topics approved by the Administrative Director. No credit shall be recognized by the Administrative Director for material solely discussing the business aspects of workers' compensation medical practice such as billing, coding and marketing that is not regulated or described in a regulation related to practice as a QME that is promulgated by the Administrative Director.(f) The Administrative Director shall notify the applicant within 30 calendar days after receipt of the application containing all the information listed in section 55(d) whether that provider has been accredited for a two year period. Incomplete applications will be returned to the applicant.(g) A provider that has been accredited by the Administrative Director will be given a number which must be displayed on any public advertisements of QME continuing education programs for that provider with the statement "Accredited by the Administrative Director of the California Division of Workers' Compensation for Qualified Medical Evaluator continuing education. Physicians may report up to _____ hours of credit for QME reappointment."(h) On or before the date the program is first presented or distributed, the provider shall submit the program syllabus (all program handouts) to the Administrative Director. Each distance learning program shall also submit one copy of the examinations and one copy of the audio/video tapes, computer program or each issue of the journal or newsletter for which credit is to be granted.(i) A provider may offer different QME continuing education programs during the two-year accreditation period provided the subject matter is in disability evaluation or workers' compensation related medical dispute resolution. The provider shall send the Administrative Director the program outlined and faculty for each new program at least forty-five (45) days prior to the date of presentation of the new program. The Administrative Director may require submission of program syllabi. The Administrative Director may require changes in the program based on its review of the program outline, program syllabi, promotional material or faculty if the Administrative Director finds that any aspect of the program is not in compliance with these regulations.(j) Promotional materials for a program must state the educational objectives; the professional qualifications of program faculty (at least all relevant professional degrees); the content of program activities; the maximum number of credit hours to be granted; and the intended audience.(k) Joint sponsorship of education programs (as between an accredited and an unaccredited provider) must be approved by the Administrative Director prior to presentation of the program.(l) Accredited providers that cease to offer education programs shall notify the Administrative Director in writing.(m) Instructors shall not recruit members or promote commercial products or services immediately before, during or after a course. Providers or vendors may display/sell educational related to workers' compensation or applications for membership in an area adjoining a course. A course provider or faculty member shall disclose on QME Form 119 (Faculty Disclosure of Commercial Interest), located in section of Title 8119 of Title 8 of the California Code of Regulations, any significant financial interest in or affiliation with any commercial product or service held by faculty and discussed in a course and that interest or affiliation must be disclosed to all attendees. A provider shall file every Form 119 in its possession or in its control with the Administrative Director.(n) The provider shall issue a certificate of completion to each QME who successfully completes a continuing education program. The certificate must list the provider; provider number; date(s); location and title of the continuing education program; and the number of hours in attendance for which credit is to be granted. Credit shall be granted only for the actual time of attendance at or participation in a program. Each accredited provider may in its sole discretion limit the amount of credit hours that a course will be granted to less than the amount of time actually spent in attendance in the course.(o) To apply for re-accreditation, a provider must submit a completed QME Form 118 (Application for Accreditation or Re-Accreditation as Education Provider) (See, 8 Cal. Code Regs. § 118). The provider may complete section 2 of the form using a new program or course or one which was given by the provider during the recent accreditation period. The Administrative Director shall give the provider ninety (90) days' notice of the need to seek re-accreditation.(p) The provider shall maintain attendance records for each continuing education program for a period of no less than three (3) years after the program is given. A physician attending the program must be identified by signature. The provider must submit a copy of the signature list to the Administrative Director within sixty (60) days of completion of the program.(q) The provider is required to give the QME's Evaluation Form 117 (Qualified Medical Evaluator Continuing Education Response Form) (See, 8 Cal. Code Regs. § 117) to program attendees and request they submit the form to the Administrative Director. This information shall not be used in lieu of a certification of completion given by the provider, as specified pursuant to section (m). Destruction by a provider or its employee of a QME's Evaluation Form or failure by such provider or its employee to distribute Form 117 as part of its program shall constitute grounds for revocation of a provider's accredited status. The Administrative Director shall tabulate the responses and return a summary to the provider within ninety (90) days of completion of the program.(r) The Administrative Director may audit a provider's program(s) at the request of the medical director to determine if the provider meets the criteria for accreditation. The Administrative Director may audit programs randomly, when a complaint is received, or on the basis of responses on QME Form 117 (Qualified Medical Evaluator Continuing Education Response Form) (See, 8 Cal. Code Regs. § 117). An auditor shall not receive QME credit for an audited program. The Administrative Director shall make written results of the audit available to the provider no more than thirty (30) days after the audit is complete.(s) The Administrative Director may withdraw accreditation of a provider or deny such a provider's application for accreditation on the following grounds (in addition to failure to meet the relevant requirements of subdivision of Title 811.5(a) or 55(d) of Title 8 of the California Code of Regulations):(1) Conviction of a felony or any offense substantially related to the activities of the provider.(2) Any material misrepresentation of fact made by the provider.(3) Failure to comply with Administrative Director regulations.(4) False or misleading advertising.(5) Failure to comply with Administrative Director recommendations following an audit.(6) Failure to distribute QME Form 117 (Qualified Medical Evaluator Continuing Education Response Form) (See, 8 Cal. Code Regs. § 117) cards to program attendees. Note: Forms referred to above are 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, § 55.1
Note: Authority cited: Sections 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, 4060, 4061, 4062, 4062.1, 4062.2, 4062.3, 4067 and 4628, Labor Code.
1. New section filed 2-26-2024; operative 2/26/2024 pursuant to Government Code section 11343.4(b)(3) (Register 2024, No. 9).