Member Advisory: New QME Form 105 Posted Today

This week the Office of Administrative Law approved a revised version of the QME Form 105 which is used to request a panel QME for an unrepresented employee. Specifically, the phrase "and I am not a party to this case" was removed from the proof of service page and 2 pages of instructions have been added to the form. DWC requested an effective date upon filing with the Secretary of State, so the new form is now in effect, but the Institute has requested that the Division grant a grace period for implementation. The English version of the revised form is on the DWC website at http://www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm105.pdf/, or you can find it on the CWCI website at www.cwci.org/regulation.html?id=44.

Please note: the Form 105 that was posted on the DWC forms page yesterday was a version adopted September 16, but this morning that form was replaced with the revised version approved by OAL yesterday (November 6). Both versions are marked, "QME Form 105 (10/2013)" at the bottom, so please alert your IT staff to use the version that is now posted.

The Institute has confirmed with the DWC that they are actively working on a Newsline announcing the change and a Spanish translation of the new form, which will be posted on the Division’s website once they are finalized. We expect the Division to provide details on the grace period in the Newsline, so stay tuned.