Attachment To Qme Form 106 - 2009 (Page 3 of 3) in pdf

Attachment To Qme Form 106 - 2009 Page 3

available, or request a replacement QME. If no appointment is available within 90 days of the initial request, either party

may request a replacement QME or QME panel. You are entitled to an evaluation report within 30 calendar days of the

commencement of the exam by an Agreed Panel QME or QME. At times, an AME or QME may request the Medical

Director to extend the deadline for completing the report (for example if the evaluator has not received test results or a

consulting physician’s report or for legal ‘good cause’). The evaluator must notify the DWC-Medical Unit and you of the

request for approval of an extension of time to complete the report. You will be notified of the decision. If the evaluator

selected cannot complete the report within 30 days or the extension of time approved by the Medical Director, the parties

may agree in writing (on QME Form 113 or 116) to wait until the physician can complete the report, or either party may

request a replacement panel of QMEs. If this occurs, you must go through the selection process again.

Obtaining a QME in a different specialty:

As provided in section 31.7(b) of Title 8 of the California Code of Regulations, parties in a represented case may obtain

an additional QME panel in a different specialty under certain circumstances. All such requests for an additional QME

panel must be written and submitted with supporting information or documentation showing how the conditions in § 31.7

are being met.

Attachment To Qme Form 106 - 2009 Page 3