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STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION MEDICAL UNIT MAILING ADDRESS: P. O. Box 71010 Oakland, CA 946123 (510) 286-3700 or (800) 794-6900 Fax: (510)

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What is qme form 120 voluntary?

QME form 120 voluntary is a form used in the workers' compensation system in California. It is used to request a Qualified Medical Evaluator (QME) panel.

Who is required to file qme form 120 voluntary?

In the workers' compensation system in California, the injured employee, the employer, or the insurance carrier may file the qme form 120 voluntary.

How to fill out qme form 120 voluntary?

To fill out qme form 120 voluntary, you need to provide information about the injured employee, the employer, the treating physician, and the reason for requesting a QME panel. The form must be completed accurately and submitted to the appropriate Workers' Compensation Appeals Board (WCAB) office.

What is the purpose of qme form 120 voluntary?

The purpose of qme form 120 voluntary is to request a QME panel, which is a group of qualified medical evaluators who assess an injured employee's medical condition and provide an expert medical opinion on issues related to the workers' compensation claim.

What information must be reported on qme form 120 voluntary?

QME form 120 voluntary requires information such as the injured employee's name, contact information, date of injury, treating physician's name, and the reason for requesting a QME panel. It may also ask for additional details specific to the workers' compensation claim.

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