Title 8. Industrial Relations

Division 1. Department of Industrial Relations

Chapter 1. Division of Workers' Compensation-Qualified Medical Evaluator Regulations

Article 4. Evaluation Procedures

§41.7. Gifts to Medical Evaluators.

(a) No physician reporting as an Agreed Medical Evaluator or a Qualified Medical Evaluator shall accept gifts that have a total fair market value in the aggregate of three hundred sixty dollars ($ 360) or more, from any single source that handles California workers' compensation matters, in the course of any consecutive twelve months. The sources include, but are not limited to, one or more attorneys, physicians, employers, claims administrators, medical or health care or insurance or utilization review business entities. This prohibition shall not include reasonable and appropriate income earned from a Medical Provider Network as defined in Labor Code sections 4616 et seq, from a Health Care Organization as defined in Labor Code sections 4600.3 et seq, from a Preferred Provider Organization or managed care organization as defined in Health and Safety Code sections 1340 et seq for services performed as a treating physician nor for reasonable and appropriate income paid for services performed as reviewing physician or medical director pursuant to Labor Code section 4610, or for services performed as an Agreed Medical Evaluator or Qualified Medical Evaluator.

(b) For the purposes of this section, “Gift” means any payment to the extent that consideration of equal or greater value is not received. It includes any rebate or discount in the price of anything of value, unless the rebate or discount is also made in the regular course of business to members of the public, and any loan, forgiveness or other thing of value having a fair market value in excess of $ 360 in the aggregate.

(c) Any person who claims that a payment, rebate, discount, loan, forgiveness, or other thing of value is not a gift by reason of receipt of consideration has the burden of proving that the consideration received is of equal or greater value.

(d) A Qualified Medical Evaluator who violates any portion of this section shall be subject to disciplinary action pursuant to section 60 et seq of these regulations.

Note: Authority cited: Sections 133, 139.2(o) and 5307.3, Labor Code. Reference: Sections 139.2 and 139.3, Labor Code.

HISTORY

1. New section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).