Free QME Form 108 Template for QME Panel Selection

Why Use the QME Form 108?

The QME Panel Selection Instruction Form (Form 108) is crucial for:

• Guiding injured workers or their attorneys in selecting a QME to assess a work-related injury.
• Ensuring compliance with the required time frame for selecting a QME from the panel.
• Providing step-by-step instructions on how to contact the chosen evaluator and schedule an appointment.
• Facilitating a fair and impartial medical evaluation process.

What Information Does the QME Form 108 Include?

The QME Form 108 contains vital details such as:

• Selection timeline: Deadlines by which the injured worker or attorney must choose a QME.
• Scheduling instructions: How to contact the selected QME and arrange an evaluation appointment.
• Important procedural guidelines: Information on the next steps after selecting a QME, including rescheduling procedures and compliance requirements.
• Legal references: Ensuring the process adheres to California workers’ compensation laws.

Who Needs to Use This Form?

The QME Form 108 is designed for use by:

• Injured workers, to select a medical evaluator for their claim.
• Attorneys representing injured workers, to facilitate the QME selection process.
• Claims administrators, to ensure proper compliance with evaluation procedures.

How to Use QME Form 108

Follow these steps to properly use the Qualified Medical Evaluator Panel Selection Form (Form 108):

• Review the provided QME panel list, which contains three qualified evaluators in the requested medical specialty.
• Select a QME within the specified time frame indicated on the form.
• Contact the chosen QME’s office to schedule an evaluation appointment.
• Confirm the appointment and notify all involved parties, including the employer and claims administrator.
• Retain a copy of the completed form for your records to ensure compliance with workers’ compensation guidelines.

Download Your Free QME Form 108 Template

Ensure a smooth and compliant QME selection process by downloading our free QME Form 108 template today. This easy-to-use template provides clear guidelines for injured workers and attorneys to navigate the selection process effectively.

Download now and take the next step in managing your workers’ compensation claim!