California Dept of Workers' Compensation (DWC) Reminds Parties to Use Revised QME Form 105 By California Department of Industrial Relations - January 26, 2016
The Division of Workers’ Compensation (DWC) reminds parties to use the revised version of the QME Form 105 that became effective October 1, 2015.
The QME Form 105 is used to request a panel Qualified Medical Evaluator (QME) examination for an unrepresented injured worker. Claims administrators are required to send the current form to injured workers when the claim is disputed or when there is a dispute to the Primary Treating Physician’s report.
The QME Form 105 and instructions for its completion are posted on the DWC website. A Spanish-language version of the form and instructions are also available. The old forms have been removed from the website.
The approved regulations simplified the QME Form 105 for unrepresented injured workers, which must still be mailed to the DWC Medical Unit for processing.
###
California Department of Industrial Relations, Department of Workers' Compensation (DWC), www.dir.ca.gov
Adjuster / Examiner Claims Examiner Santa Ana Unified School District Santa Ana, CA
__May11th2017.gif)
.gif)