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STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION MEDICAL UNIT P.O. Box 71010 Oakland, CA 94612 (510) 286-3700 or (800) 794-6900 INJURED WORKER INFORMATION Panel

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What is panel qme form 107?

Panel QME Form 107 is a form used in the workers' compensation system in California. It is used to request a Qualified Medical Evaluator (QME) panel in a worker's compensation claim.

Who is required to file panel qme form 107?

The injured worker, the employer, or their respective representatives may be required to file Panel QME Form 107 when a Qualified Medical Evaluator is needed for a worker's compensation claim.

How to fill out panel qme form 107?

To fill out Panel QME Form 107, you need to provide information about the injured worker, the employer, the nature of the injury, and any relevant medical records. The form can be filled out online or submitted in paper format.

What is the purpose of panel qme form 107?

The purpose of Panel QME Form 107 is to request a panel of Qualified Medical Evaluators, who are independent physicians appointed to conduct evaluations and provide medical opinions in worker's compensation cases.

What information must be reported on panel qme form 107?

Panel QME Form 107 requires information such as the injured worker's name, contact information, date of injury, employer's name, and a description of the injury or condition being evaluated.

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