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Instructions for QME Form 106 Request for Qme Panel Under Labor Code 4062.2 Represented - for Injuries Occurring Prior to January 1, 2005 - California
This document contains official instructions for QME Form 106 , Request for Qme Panel Under Labor Code 4062.2 Represented - for Injuries Occurring Prior to January 1, 2005 - a form released and collected by the California Department of Industrial Relations - Division of Workers' Compensation. An up-to-date fillable QME Form 106 is available for download through this link.
FAQ
Q: What is the QME Form 106?
A: QME Form 106 is a form used to request a Qualified Medical Evaluator (QME) panel in California.
Q: What is Labor Code 4062.2 Represented?
A: Labor Code 4062.2 Represented refers to the section of California labor law that governs the process of requesting a QME panel.
Q: Who can use QME Form 106?
A: QME Form 106 is used by individuals who have suffered injuries in California prior to January 1, 2005 and want to request a QME panel.
Q: What is a Qualified Medical Evaluator (QME) panel?
A: A QME panel consists of three independent medical professionals who evaluate the medical condition of an injured worker in California.
Q: Why would someone need to request a QME panel?
A: A QME panel is requested to obtain an unbiased medical opinion regarding the extent of a worker's injuries and their impact on their ability to work.
Q: How can I submit QME Form 106?
A: QME Form 106 can be submitted to the Division of Workers' Compensation (DWC) in California by mail or in person.
Q: What is the deadline for submitting QME Form 106?
A: The deadline for submitting QME Form 106 is within 10 days after the injured worker receives a request for a panel from the employer or insurance company.
Q: What happens after submitting QME Form 106?
A: After submitting QME Form 106, the DWC will assign a QME panel and notify the injured worker and the parties involved in the case.
Q: Can I choose my own QME doctor?
A: No, the QME panel is randomly generated by the DWC and the injured worker is required to choose one of the doctors from the panel for the evaluation.
Instruction Details:
- This 2-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the California Department of Industrial Relations - Division of Workers' Compensation.
Download Instructions for QME Form 106 Request for Qme Panel Under Labor Code 4062.2 Represented - for Injuries Occurring Prior to January 1, 2005 - California
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