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.
Q: What is the QME Form 112?
A: QME Form 112 is a form used for requesting an extension of the time frame to submit a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) report in California.
Q: What is a QME report?
A: A QME report is a medical evaluation report conducted by a Qualified Medical Evaluator (QME) in California. It provides an assessment of a worker's medical condition related to a work-related injury.
Q: What is an AME report?
A: An AME report is an Agreed Medical Evaluator (AME) report in California. It is similar to a QME report and provides an assessment of a worker's medical condition related to a work-related injury.
Q: What is the time frame for submitting a QME or AME report?
A: The usual time frame to submit a QME or AME report in California is 30 days after the evaluation is completed.
Q: What is a time frame extension request?
A: A time frame extension request is a formal request to extend the deadline for submitting a QME or AME report beyond the usual 30-day period.
Q: How can I request a time frame extension for a QME or AME report?
A: You can request a time frame extension for a QME or AME report by using QME Form 112 and submitting it to the appropriate authority in California.
Q: Who can request a time frame extension for a QME or AME report?
A: Both the injured worker and the medical evaluator (QME or AME) can request a time frame extension for a QME or AME report in California.
Q: What information is required in the QME Form 112?
A: The QME Form 112 requires information such as the injured worker's name, case number, reasons for the extension request, and the proposed new deadline for submitting the report.
Q: What happens after submitting the QME Form 112?
A: After submitting the QME Form 112, the appropriate authority in California will review the request and determine whether to grant or deny the time frame extension.
Q: Are time frame extensions for QME or AME reports always granted?
A: No, time frame extensions for QME or AME reports are not always granted. The request will be evaluated based on the reasons provided and the circumstances of the case.
Form Details:
Download a fillable version of QME Form 112 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.