Where this sits
- Division 1. Department of Industrial Relations
- Chapter 1.
- Division of Workers' Compensation -- Qualified Medical Evaluator Regulations
- Article 3. Assignment of Qualified Medical Evaluators, Evaluation Procedure
The regulation, as printed
(a) A replacement QME to a panel, or at the discretion of the Medical Director a replacement of an entire panel of QMEs, shall be selected at random by the Medical Director and provided upon request whenever any of the following occurs: (1) A QME on the panel issued does not practice in the specialty requested by the party holding the legal right to request the panel. (2) A QME on the panel issued cannot schedule an examination for the employee within ninety (90) days of the initial request for an appointment, or if the 90 day scheduling limit has been waived pursuant to section 31.3(e) of Title 8 of the California Code of Regulations, the QME cannot schedule the examination within one-hundred and twenty (120) days of the date of the initial request for an appointment. (3) The injured worker has changed his or her residence address since the QME panel was issued and prior to date of the initial evaluation of the injured worker. (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 (Unavailability of the QME). (6) The evaluator who previously reported in the case is no longer available. (7) A QME named on the panel is currently, or has been, the employee's primary treating physician or secondary physician as described in section 9785 of Title 8 of the California Code of Regulations for the injury currently in dispute. (8) The claims administrator, or if none the employer, and the employee agree in writing, for the employee's convenience only, that a new panel may be issued in the geographic area of the employee's work place and a copy of the employee's agreement is submitted with the panel replacement request. (9) The Medical Director, upon written request, finds good cause that a replacement QME or a replacement panel 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. (10) The Medical Director, upon written request, filed with a copy of the Doctor's First Report of Occupational Injury or Illness (Form DLSR 5021 [see 8 Cal. Code Regs. §§ 14006 and 14007]) and the most recent DWC Form PR-2 (“Primary Treating Physician's Progress Report” [See 8 Cal. Code Regs. § 9785.2]) or narrative report filed in lieu of the PR-2, determines after a review of all appropriate records that the specialty chosen by the party holding the legal right to designate a specialty is medically or otherwise inappropriate for the disputed medical issue(s). The Medical Director may request either party to provide additional information or records necessary for the determination. (11) The evaluator has violated section 34 (Appointment Notification and Cancellation) of Title 8 of the California Code of Regulations, except that the evaluator will not be replaced for this reason whenever the request for a replacement by a party is made more than fifteen (15) calendar days from either the date the party became aware of the violation of section 34 of Title 8 of the California Code of Regulations or the date the report was served by the evaluator, whichever is earlier. (12) The evaluator failed to meet the deadlines specified in Labor Code section 4062.5 and section 38 (Medical Evaluation Time Frames) of Title 8 of the California Code of Regulations and the party requesting the replacement objected to the report on the grounds of lateness prior to the date the evaluator served the report. A party requesting a replacement on this ground shall attach to the request for a replacement a copy of the party's objection to the untimely report. (13) The QME has a disqualifying conflict of interest as defined in section 41.5 of Title 8 of the California Code of Regulations. (14) The Administrative Director has issued an order pursuant to section 10164(c) of Title 8 of the California Code of Regulations (order for additional QME evaluation). (15) The selected medical evaluator, who otherwise appears to be qualified and competent to address all disputed medical issues refuses to provide, when requested by a party or by the Medical Director, either: A) a complete medical evaluation as provided in Labor Code sections 4062.3(i) and 4062.3(k), or B) a written statement that explains why the evaluator believes he or she is not medically qualified or medically competent to address one or more issues in dispute in the case. (16) The QME panel list was issued more than twenty four (24) months prior to the date the request for a replacement is received by the Medical Unit, and none of the QMEs on the panel list have examined the injured worker. (b) Whenever the Medical Director determines that a request made pursuant to subdivision 31.5(a) for a QME replacement or QME panel replacement is valid, the time limit for an unrepresented employee to select a QME and schedule an appointment under section Labor Code section 4062.1(c) and the time limit for a represented employee to strike a QME name from the QME panel under Labor Code section 4062.2(c), shall be tolled until the date the replacement QME name or QME panel is issued. (c) In the event the parties in a represented case have struck two QME names from a panel and subsequently a valid ground under subdivision 31.5 arises to replace the remaining QME, none of the QMEs whose names appeared on the earlier QME panel shall be included in the replacement QME panel. (d) Form 31.5 shall be used to request a replacement QME. NOTE: Forms referred to above are available at no charge by downloading from the web at http://www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.
The statute above this rule
Every regulation names the Labor Code it was written under. This is where the two halves of the law meet.
ImplementsLabor Code § 4060Labor Code § 4061Labor Code § 4062Labor Code § 4062.1Labor Code § 4062.2Labor Code § 4062.3Labor Code § 4064Labor Code § 4067
Authority and history
Note: Authority cited: Sections 133, 139.2, 4061, 4062, 4062.3, 4062.5, 5307.3 and 5703.5, Labor Code. Reference: Sections 139.2, 4060, 4061, 4062, 4062.1, 4062.2, 4062.3, 4064 and 4067, Labor Code.
1. New section filed 8-23-96; operative 9-22-96 (Register 96, No. 34). 2. Amendment of subsections (b), (b)(1) and (b)(3) and new subsections (b)(4)-(5) filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). 3. Amendment of section and Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3). 4. New subsection (d), including new Form 31.5, filed 9-16-2013; operative 9-16-2013 pursuant to Government Code section 11343.4(b)(3) (Register 2013, No. 38). 5. Amendment filed 4-6-2020; operative 4-6-2020 pursuant to Government Code section 11343.4(b). Submitted to OAL for filing and printing only pursuant to Labor Code section 142.3(a)(3) (Register 2020, No. 15). 6. Amendment of subsection (a)(2) filed 2-2-2023; operative 2-2-2023 (Register 2023, No. 5).
What panels did with this rule
Released decisions that named § 31.5, with the passage each turned on. A panel decision persuades; it does not bind.
- ADJ11238147 · 2025-10-13 · Sacramento District Office8 CCR § 31.5
Determinative passage · p.13As noted in applicant's Trial Brief, applicant argues that there is good cause for the court to order an additional panel pursuant to 8 CCR § 31.7(b). Applicant argues that Dr. Shirikian, a psychologist cannot adequately address causation for applicant's alcohol abuse. However, as noted above when questioned what type of doctor could address the causation aspects of alcohol abuse Dr. Shirikian stated that she was able to do so and obtained the training to do so when she obtained her degree. The problems with analyzing the causative factor of applicant's disorder was not due to Dr. Shirikian's education or training but due to the lack of evidence as the applicant is deceased. In addition, 8 CRR § 31.7 addresses when a party requests an additional PQME in a different specialty; applicant is requesting the same specialty (psychology) that has specific expertise in alcohol disorders. It is unknown how applicant would obtain such a list. As applicant is requesting the same specialty, it would be considered a replacement PQME and addressed under 8CCR § 31.5. This section allows for 16 specific reasons a party may obtain a replacement PQME, none of which pertain to the matter at hand. It is therefore found that there is no good cause for either a replacement or additional PQME.
Applicant requested a replacement QME in the same specialty; no good cause found for replacement or additional QME.
Official decision · page 13 → - ADJ12088514 · 2025-10-10 · Anaheim District Office8 CCR § 31.5
Determinative passage · p.1Applicant seeks removal of the Findings and Order (F&O) issued on July 22, 2025, wherein the workers' compensation administrative law judge (WCJ) found that (1) while employed as a professional athlete during the period of June 16, 2004 through July 15, 2010, applicant claims to have sustained injury arising out of and in the course of employment to the shoulders, elbows, wrists, hands, fingers, thoracic spine, lumbar spine, cervical spine, hips, feet, ankles, knees, and head; (2) at the time of injury, the employer's workers' compensation earner was Ace American Insurance, administered by Sedgwick Claims Management Services, Inc.; (3) Dr. David Kim is disqualified as the Qualified Medical Examiner (QME) for violating AD Rule 41(a)(4); and (4) the reports of Dr. Kim can be sent to a subsequent examiner.
The petition was evaluated under this standard and denied as removal was not warranted.
Official decision · page 1 → - ADJ17646368 · 2024-12-16 · Los Angeles District Office8 CCR § 31.5
Determinative passage · p.10Title 8 Cal. Code of Regs. § 31.5(a) provides that a replacement panel shall issue whenever one of sixteen enumerated grounds for replacement occurs. Defendant argues that it is entitled to a replacement QME panel for an appropriate specialty under Title 8 Cal. Code of Regs. § 31.5(a)(10). The section reads as follows:
The court found no good cause for replacement panel as the selected specialty was appropriate.
Official decision · page 10 → - ADJ12549416 · 2024-04-26 · Riverside District Office8 CCR § 31.5
Determinative passage · p.4As to defendant's first argument, we find that a party must timely object to an untimely report per AD Rule 31.5(a)(12). (Cal. Code Regs., tit. 8, § 31.5(a)(12).) Defendant's argument to the contrary is not persuasive. Rule 31.5 does not exceed the scope of Labor Code section 4062.5, which expressly states that when a formal medical evaluation is not timely completed, "a new evaluation may be obtained upon the request of either party[.]" (§ 4062.5, (emphasis added).) First, the Legislature did not use mandatory language in the statute. To the contrary, the statute says a party `may' obtain a new evaluation. May is permissive. (§ 15.) Next, the statute expressly requires that a party request the new evaluation. The fact that the regulation refers to this request as an `objection' is entirely appropriate and does not exceed the scope of the enabling statute. Finally, the regulatory requirement that an objection issue prior to the QME's service of the report is an equitable principle grounded in waiver, laches, and estoppel. If a party is genuinely concerned about timeliness, they must object timely.
The regulation does not exceed the scope of Labor Code section 4062.5 and requires timely objection to preserve the right to a replacement evaluation.
Official decision · page 4 → - ADJ11412367 · 2023-09-08 · Pomona District Office8 CCR § 31.5
Determinative passage · p.4(11) The evaluator has violated section 34 (Appointment Notification and Cancellation) of Title 8 of the California Code of Regulations, except that the evaluator will not be replaced for this reason whenever the request for a replacement by a party is made more than fifteen (15) calendar days from either the date the party became aware of the violation of section 34 of Title 8 of the California Code of Regulations or the date the report was served by the evaluator, whichever is earlier.
Applied to find that the doctor's inability to conduct the evaluation at the listed office required a replacement panel.
Official decision · page 4 → - ADJ11629114 · 2022-09-16 · San Francisco District Office8 CCR § 31.5
Determinative passage · p.3Whether or not a medical report is substantial evidence is a determination regarding the weight of the evidence, not its admissibility. (Cal. Code Regs., tit. 8, § 10682(c).) Moreover, there has been no finding of grounds for replacement of the PQME pursuant to Labor Code section 4062.3 or Administrative Director (AD) Rule 31.5 and the WCJ has not cited any legal authority for disqualifying him. Therefore, while we agree with the WCJ that Dr. Wellborn's reports are not substantial medical evidence, that the WCJ may assign the reports whatever weight she deems appropriate, and that the WCJ has the discretion to appointment a regular physician pursuant to Labor Code section 5701 if the parties cannot or will not agree to an agreed medical examiner (AME), Dr. Wellborn's reports, which were admitted at the February 7, 2022 trial, must remain part of the record and there are presently no legal grounds for disqualification or replacement of the PQME.
The WCAB found no legal grounds for disqualification or replacement of Dr. Wellborn as PQME.
Official decision · page 3 → - ADJ12372302 · 2022-05-03 · Marina Del Rey District Office8 CCR § 31.5
Determinative passage · p.5(d) Whenever the employee is represented by an attorney and the parties have completed the striking processes described in Labor Code section 4062.2(c), the represented employee shall schedule the appointment with the physician selected from the QME panel. If the represented employee fails to do so within ten (10) business days of the date a QME is selected from the panel, the claims administrator or administrator's attorney may arrange the appointment and notify the employee and employee's attorney.
Applied to determine that applicant could schedule with the untimely struck doctor within 90 days of appointment request.
Official decision · page 5 → - ADJ14533246 · 2022-04-11 · San Jose District Office8 CCR § 31.5
Determinative passage · p.1Applicant seeks removal or in the alternative reconsideration of the Findings and Order (F&O) issued by the workers' compensation administrative law judge (WCJ) on January 21, 2022. By the F&O, the WCJ found that applicant's objection to the report of the qualified medical evaluator (QME) was defective. The WCJ issued an order denying applicant's request for a replacement panel.
Applied to deny replacement panel because objection was not timely made before report service.
Official decision · page 1 →
Rules beside this one
Article 3. Assignment of Qualified Medical Evaluators, Evaluation Procedure — regulations rarely stand alone, and the answer is often two sections away.