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This information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov. These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at https://www.dir.ca.gov/od_pub/disclaimer.html.
 
TITLE 8. INDUSTRIAL RELATIONS
DIVISION 1. DEPARTMENT OF INDUSTRIAL RELATIONS
CHAPTER 1. DIVISION OF WORKERS' COMPENSATION-QUALIFIED MEDICAL EVALUATOR
Article 10.5. QME Process Forms

New Query


§ 105. The Request for Qualified Medical Evaluator Panel - Unrepresented Form.


NOTE: Forms are available at no charge by downloading from the web at http://www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.
Note: Authority cited: Sections 53, 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, 4060, 4061, 4061.5, 4062, 4062.1, 4062.2, 4064 and 4067, Labor Code.
HISTORY
1. New article 10.5 (sections 105-117) and new section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior history see Register 94, No. 31.
2. Amendment of section heading, repealer and new section and new Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
3. Amendment of section heading, new QME Form 105a and amendment of informational note filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day.
4. Amendment of section heading, new QME Form 105a and amendment of informational note refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 7-1-2013 order, including amendment of section heading and repealer and new Form 105, transmitted to OAL 8-2-2013 and filed 9-16-2013; amendments operative 9-16-2013 pursuant to Government Code section 11343.4(b)(3) (Register 2013, No. 38).
6. Change without regulatory effect amending form and explanatory Note filed 11-6-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 45).
7. Amendment filed 8-12-2015; operative 9-1-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 33).


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