QME Form 104 Reappointment Application as Qualified Medical Evaluator - California

What Is QME Form 104?

This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 104?
A: Form 104 is the Reappointment Application as Qualified Medical Evaluator (QME) in California.

Q: Who needs to fill out Form 104?
A: Qualified Medical Evaluators (QMEs) in California need to fill out Form 104.

Q: What is the purpose of Form 104?
A: Form 104 is used for the reappointment process of QMEs in California.

Q: What information is required on Form 104?
A: Form 104 requires personal and contact information, educational background, and QME certification details.

Q: What are the deadlines for submitting Form 104?
A: Form 104 should be submitted at least 90 days prior to the expiration of the current QME certification.

Q: Are there any fees associated with Form 104?
A: Yes, there is a non-refundable fee that needs to be paid when submitting Form 104.

Q: What happens after submitting Form 104?
A: After submitting Form 104, the DWC will review the application and inform the QME of the reappointment decision.

Q: What if my Form 104 is denied?
A: If your Form 104 is denied, you will receive notification from the DWC with the reasons for the denial.