EXCLUDING DEFENSE QME REPORT //
Rule overruled no longer applies
Pursuant to 8 CCR 30 (d)(3), once a claim has been denied in its entirety, only the employee may request a Panel QME. Therefore, the
Courts must look to the reports of the self-procured treating physician.
8 CCR 30 (d)(3) "Whenever an injury or illness claim of an employee has been denied entirely by the claims administrator, or if none by
the employer, only the employee may request a panel of Qualified Medical Evaluators, as provided in Labor Code sections 4060(d) and
4062.1 if unrepresented, or as provided in Labor Code sections 4060(c) and 4062.2 if represented."
8 CCR § 30. QME Panel Requests
(a) Unrepresented cases. Whenever an injured worker is not represented by an attorney and either the employee or the claims
administrator requests a QME panel pursuant to Labor Code section 4062.1, the request shall be submitted on the form in section 105
(Request for QME Panel under Labor Code Section 4062.1)(See, 8 Cal. Code Regs. § 105). The claims administrator (or if none the
employer) shall provide Form 105 along with the Attachment to Form 105 (How to Request a Qualified Medical Evaluator if you do
not have an Attorney) to the unrepresented employee by means of personal delivery or by first class or certified mailing.
(b) Represented cases. Requests for a QME panel in a represented case, for all cases with a date of injury on or after January 1, 2005,
and for all other cases where represented parties agree to obtain a panel of Qualified Medical Evaluators pursuant to the process in
Labor Code section 4062.2, shall be submitted on the form in section 106 (Request for a QME Panel under Labor Code Section
4062.2)(See, 8 Cal. Code Regs. § 106). The party requesting a QME panel shall: 1) identify the disputed issue that requires a
comprehensive medical/legal report to be resolved; 2) attach a copy of the written proposal, naming one or more physicians to be an
Agreed Medical Evaluator, that was sent to the opposing party once the dispute arose; 3) designate a specialty for the QME panel
requested; 4) state the specialty preferred by the opposing party, if known; and 5) state the specialty of the treating physician. In
represented cases with dates of injury prior to January 1, 2005, and only upon the parties' agreement to obtain a QME panel pursuant
to Labor Code section 4062.2, the party requesting a QME panel shall submit QME Form 106 in compliance with this section and
provide written evidence of the parties' agreement. Once such a panel in a represented case with a date of injury prior to January 1,
2005, is issued, the parties shall be bound by the timelines and process as described in Labor Code section 4062.2.
(c) In the event a request form is incomplete, or improperly completed, so that a QME panel selection cannot properly be made, the
request form shall be returned to the requesting party with an explanation of why the QME panel selection could not be made. The
Medical Director also may delay issuing a new QME panel, if necessary, until the Medical Director receives additional reasonable
information requested from a party or both parties, needed to resolve the panel request. Reasonable information as used in this
subdivision includes but is not limited to whether a QME panel previously issued to the injured worker was used.
(d)(1) After a claim form has been filed, the claims administrator, or if none the employer, may request a panel of Qualified Medical
Evaluators only as provided in Labor Code section 4060, to determine whether to accept or reject a claim within the ninety (90) day
period for rejecting liability in Labor Code section 5402(b), and only after providing evidence of compliance with Labor Code Section
4062.1 or 4062.2.
(d)(2) Once the claims administrator, or if none the employer, has accepted as compensable injury to any body part in the claim, a
request for a panel QME may only be filed based on a dispute arising under Labor Code section 4061 or 4062.
(d)(3) Whenever an injury or illness claim of an employee has been denied entirely by the claims administrator, or if none by the
employer, only the employee may request a panel of Qualified Medical Evaluators, as provided in Labor Code sections 4060(d) and
4062.1 if unrepresented, or as provided in Labor Code sections 4060(c) and 4062.2 if represented.
(d)(4) After the ninety (90) day period specified in Labor Code section 5402(b) for denying liability has expired, a request from the
claims administrator, or if none from the employer, for a QME panel to determine compensability shall only be issued upon
presentation of a finding and decision issued by a Workers' Compensation Administrative Law Judge that the presumption in section
5402(b) has been rebutted and an order that a QME panel should be issued to determine compensability. The order shall also specify
the residential or, if applicable, the employment-based zip code from which to select evaluators and either the medical specialty of the
panel or which party may select the medical specialty.
(e) If the request form is submitted by or on behalf of an employee who no longer resides within the state of California, the geographic
area of the QME panel selection within the state shall be determined by agreement between the claims administrator, or if none the
employer, and the employee. If no agreement can be reached, the geographic area of the QME panel selection shall be determined for an
unrepresented employee by the employee's former residence within the state, and for a represented employee by the office of the
(f) To compile a panel list of three (3) independent QMEs randomly selected from the specialty designated by the party holding the
legal right to request a QME panel, the Medical Director shall exclude from the panel, to the extent feasible, any QME who is listed by
another QME as a business partner or as having a shared specified financial interest, as those terms are defined in sections 1 and 29 of
Title 8 of the California Code of Regulations.
(g) The panel request in a represented case must be sent to the Medical Unit address on the QME Form 106 by means of first class
mail delivered by the United States postal service. The Medical Unit will not accept panel requests in represented cases that are
delivered in person by a party, the party's attorney, any other person or by other commercial courier or delivery services.
(h) The time periods specified in Labor Code sections 4062.1(c) and 4062.2(c), respectively, for selecting an evaluator from a QME
panel and for scheduling an appointment, shall be tolled whenever the Medical Director asks a party for additional information needed
to resolve the panel request. These time periods shall remain tolled until the date the Medical Director issues either a new QME panel
or a decision on the panel request.