Newsline No. 40-09 printer image Printer friendly

July 22, 2009

Division of Workers' Compensation posts qualified medical evaluator forms in Spanish

The Division of Workers’ Compensation (DWC) has posted on its Web site a Spanish-language version of the qualified medical evaluator (QME) panel request form for unrepresented employees (QME Form 105), including instructions on how to use Form 105 at http://www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm105Spanish.pdf.

Additionally, an example with Spanish language instructions on how to complete the Employee’s Permanent Disability Questionnaire (DWC-AD Form 100 [DEU]) can be found at http://www.dir.ca.gov/dwc/FORMS/EAMS%20Forms/DEU/DEU100Spanish.pdf
The forms can be downloaded or printed from the DWC Web site at no charge and are in Spanish. However, the user is directed to complete the answers on the forms in English. 

The division is hopeful that the Spanish-language versions of these forms will make the QME process easier to understand for injured workers and employers who are primarily Spanish-speaking.

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