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ITY, STATE, ZIP CODE (AREA CODE) PHONE # INSURER or CLAIMS ADMINISTRATOR INFORMATION NAME COMPANY ADDRESS CITY, STATE, ZIP CODE (AREA CODE) PHONE # CLAIM NUMBER This Section to be Filled out by the Injured Worker ONLY Please list ONLY ONE specialty (Insert three letter code from the back of this form) Specialty Physician Requested: Signature of Injured Worker PLEASE NOTE: Panels will be issued in the area of the injured worker s residence. If the injured worker resides out of state the pa.

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Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports.

A. A qualified medical evaluator (QME) is a physician who evaluates you when there are questions about what benefits you should receive.

A: The QME doctor writes the report and will send it to the insurance company and to the Disability Evaluation Unit (DEU). The DEU will rate your report by reviewing the language used by your doctor in describing your injury and applying a formula to determine the percentage of disability.

The QME exam is designed to demonstrate the competence of a physician in evaluating medical issues in the workers' compensation system and to evaluate competency with respect to current California Workers' Compensation System terminology, laws, rules, regulations, and medical-legal procedures.

The QME report is used to determine a disability rating. The rating will range from 0% disability (no functional impairment) up to 100% disability (permanently and totally disabled).

They will examine you and all your medical records to determine the extent of your work-related injury. They will decide if you have any permanent disability and what future medical care you may need. It is important that the doctor has all your medical records.

The first problem is that the pass rate for the QME competency exam is extremely low (around 54%). The second problem is that for those few that actually pass the QME exam, starting a QME practice can be quite overwhelming, with several hurdles in the way.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232