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QME Form 105 Request for Qualified Medical Evaluator Panel (Unrepresented Employee) - California
What Is QME Form 105?
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. Check the official instructions before completing and submitting the form.
FAQ
Q: What is the QME Form 105?
A: The QME Form 105 is a request for a Qualified Medical Evaluator panel.
Q: Who can use the QME Form 105?
A: The QME Form 105 is for unrepresented employees in California.
Q: What is a Qualified Medical Evaluator?
A: A Qualified Medical Evaluator is a physician who evaluates a worker's medical condition in workers' compensation cases.
Q: Why would someone need a Qualified Medical Evaluator?
A: Someone would need a Qualified Medical Evaluator to assess their medical condition in relation to a workers' compensation claim.
Form Details:
- Released on September 1, 2015;
- The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of QME Form 105 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.
Download QME Form 105 Request for Qualified Medical Evaluator Panel (Unrepresented Employee) - California
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