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Santa Maria California Request for Qualified Medical Evaluator for Workers' Compensation
Category:
State:
California
City:
Santa Maria
Control #:
CA-106-WC
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How to fill out California Request For Qualified Medical Evaluator For Workers' Compensation?
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FAQ
You might also need to see a QME if the insurance company disagrees with something in your claim. In that case, the insurance company will give you the form to request a QME. When this happens, you have 10 days to request a QME list by sending the form to the DWC Medical Unit.
A panel request is considered premature if it is made before 15 days (10 days plus 5 days for mailing) have elapsed after the objection communication or delay/denial letter is sent to the opposing party. In other words, an eligible request can be made on the 16th day.
A. The QME should issue the supplemental report within 60 days. Contact the DWC Medical Unit, your attorney or a DWC information & assistance officer for help.
After your injury and at the request of the insurance claims adjuster, the DWC will send you a list of three qualified medical evaluators based on the specialty you select and your location. You then have 10 days to select a QME, make an appointment, and notify your employer.
For Employee: Mail the completed signed form and Proof of Service to: Division of Workers' Compensation ? Medical Unit P.O. Box 71010, Oakland, CA 94612 (510) 286-3700 or (800) 794-6900 5. For Employee: Mail or deliver a signed copy of the form and Proof of Service to your Claims Administrator.
The purpose of a Qualified Medical Evaluator (QME) examination is to obtain a second medical opinion to help resolve disputed. medical issues in your workers' compensation claim(s). If you are an injured worker who is not represented by an attorney, use.
A.In this context, the word panel means a list. A panel QME is a randomly generated list of three QME physicians issued to you when there is a question about whether or not your injury is work related, or if there is a medical dispute that hasn't been resolved by the treating physician's report.
You must have given your employer or the claims administrator a claim form before you may get a QME or any benefits. Answer all of the questions on QME form 105, sign the form and mail it to the DWC Medical Unit. The DWC Medical Unit will use the information on the form to issue a ?QME panel?.