PDF
Word
Instructions for QME Form 105 Request for Qualified Medical Evaluator Panel (Unrepresented Employee) - California
This document contains official instructions for QME Form 105 , Request for Qualified Medical Evaluator Panel (Unrepresented Employee) - a form released and collected by the California Department of Industrial Relations - Division of Workers' Compensation. An up-to-date fillable QME Form 105 is available for download through this link.
FAQ
Q: What is a QME Form 105?
A: The QME Form 105 is a request form used in California to request a Qualified Medical Evaluator (QME) panel for unrepresented employees.
Q: Who can use the QME Form 105?
A: This form is used by unrepresented employees in California who need to request a Qualified Medical Evaluator panel.
Q: What is a Qualified Medical Evaluator (QME) panel?
A: A QME panel is a group of doctors qualified to evaluate and determine medical issues in workers' compensation cases in California.
Q: Why would I need to request a QME panel?
A: You would need to request a QME panel if you are an unrepresented employee and you require a medical evaluation for a workers' compensation case.
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 105 Request for Qualified Medical Evaluator Panel (Unrepresented Employee) - California
1
2
