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Free QME Panel Request Helper for DWC Form 105
For California applicant attorneys and paralegals.
Enter the case basics and get a filled QME panel request checklist for DWC Form 105/106, suggested specialty codes, and key deadlines with Labor Code citations. No signup, 3 uses per day.
Not legal advice; verify against current DWC rules. This helper builds a draft for attorney review. Forms, specialty codes and deadlines change. Confirm everything with the current DWC form and regulations before filing.
QME panel request FAQ
What is DWC Form 105?
DWC Form 105 is the request for a Qualified Medical Evaluator (QME) panel used when the injured worker is represented by an attorney, under Labor Code §4062.2. Form 106 is the version used for unrepresented workers under §4062.1.
When can a represented party request a QME panel?
Under Labor Code §4062.2(b), a panel request may be submitted no earlier than the first working day at least 10 days after serving a §4060 evaluation request or a §4061/§4062 objection. Confirm the current rule before filing.
How do I pick the QME specialty?
Choose the specialty that matches the disputed medical issue and the body parts in dispute. Disputes about the requested specialty go to the DWC Medical Director, and the parties can also agree on an Agreed Medical Evaluator instead of a panel.
What happens after the panel issues?
Each party may generally strike one evaluator within 10 days of the panel's issuance; if a party does not strike, the other party may select. The remaining evaluator is then scheduled. Verify the current strike and scheduling rules in 8 CCR §31 et seq.
Is this helper legal advice?
No. It produces a draft checklist for an attorney or paralegal to review. It is not legal advice and does not file anything; always verify against current DWC rules and the current form.