How to request a QME panel online in California

Fourteen steps through the eight pages of the DWC online Form 106 panel request system, from opening the blank form to the issued panel and the notices that can replace it. Every screenshot is a still from the source video and links to the exact second it was taken.

1. 1

   Open the online Form 106 panel request and read the eight-step bar

   A represented initial QME panel request goes through the DWC online Form 106 panel request system, which the training video opens from the DWC Medical Unit web page. The header reads "Step 1 of 8" and a row of eight page buttons shows what is coming: Panel Request Information, Employee Information, Applicant Attorney Information, Employer & Claims Administrator Information, Defense Attorney Information, Declaration Confirmation, Upload Document, Review & Submit. You cannot move to the next page until the current one is finished, an asterisk marks every mandatory field, and a question mark beside a field opens a tool tip explaining what that field wants. The DWC moved represented initial panel requests onto this system on October 1, 2015, and an online panel now issues as soon as the request is submitted.

   

2. 2

   Fill the claim header: claim number, injury date and requesting party

   The top of page 1 collects the claim number and the date of injury; you can type the date or use the calendar widget beside it. The Requesting Party drop-down offers exactly three answers — Applicant Attorney, Defense Attorney or Claims Administrator — and the one you choose decides which later pages are optional. Below it sit the treating physician’s first and last name, and the video’s own tip: if you do not know the treating physician, enter UNKNOWN in both the first-name and last-name fields rather than leaving them blank. Specialty of Treating Physician, QME Specialty Requested and Opposing Party’s QME Specialty Preferred are alphabetical drop-downs that jump when you type a letter of the alphabet, and the two specialty fields put UNKNOWN at the very bottom of the list.

   

3. 3

   Pick the Labor Code section, then the dispute type it unlocks

   Labor Code section is the hinge of page 1, because everything under it changes with your choice. Choose 4060 and the dispute type is compensability, and the form then asks for the date of the report being objected to and the date of the request for a comprehensive exam. Choose 4061 and the dispute types are permanent disability and future medical treatment, with the date of the objection communication. Choose 4062 and the list widens to temporary disability, permanent and stationary status, work restriction, ability to return to work, apportionment, diagnosis and causation, and it adds one more question about timing: was the written objection communicated within 20 days of your receipt of the report you are objecting to? Answer no and the form asks you to select a reason — mutual agreement satisfies it, while good cause requires a written explanation of up to 2,000 characters.

   

4. 4

   Know the 2005 date-of-injury rule before you start typing

   This online system handles represented initial panel requests only for dates of injury of January 1, 2005 or later. The recording proves the limit on purpose: it changes the date of injury to a pre-2005 date and presses Continue, and the form answers with a red banner saying the Medical Unit is unable to issue an online panel because the date of injury is prior to January 1, 2005, then tells the filer to e-mail the Medical Unit at [email protected] for assistance. If your date of injury falls before 2005, the panel request does not come out of this portal and you need the Medical Unit rather than a retry.

   

5. 5

   Let the ZIP code fill in the city and state on page 2

   Page 2 takes the injured worker’s first name, middle name, last name, mailing address, city, state and ZIP code. City and State are disabled on purpose: you enter the ZIP code and the system populates them for you. When several cities share one ZIP code, a drop-down appears so you can choose the correct city instead of accepting a default. The address typed here is the one the panel geographies are built around, so it should be an address where the worker actually receives mail.

   

6. 6

   For an out-of-state address, answer the geographical agreement question

   Type a ZIP code outside California and a new question appears underneath: is there an agreement between the parties as to the geographic area for this panel request? The tool tip beside it gives the rule — in order to have a panel in the state of California, the request needs a ZIP code for the employee, for the alternate address, or for the applicant attorney. Answer yes and the form opens an alternate-address block. Answer no and, when the panel is issued, it defaults to the applicant attorney’s ZIP code. The recording demonstrates the out-of-state path and then swaps the Las Vegas ZIP for a California one to carry on.

   

7. 7

   Add the applicant attorney and the EAMS UAN behind the firm name

   Page 3 is the applicant attorney’s name, phone number, e-mail and firm. E-mail carries no asterisk, so it is not mandatory; the firm name is. Applicant Attorney Firm Name really means your EAMS UAN, and the tool tip under the field is blunt — you must have an EAMS UAN to use this system, and if you do not have one you register on the DWC website. The waiting period is the part filers miss: the DWC FAQ says a newly assigned firm name is posted within 10 business days of the request, so register well before you need the panel and do not count on next-day turnaround. The firm list behaves like the specialty lists, alphabetical with letter-jump, and the UAN Search button looks a firm up by its number when you already know it.

   

8. 8

   Complete the employer and claims administrator page

   Page 4 names the employer and the claims administrator. The phone number auto-formats while you type, and too many digits produce an error message telling you that you typed too many digits rather than quietly truncating the number. E-mail is optional here too. Claims Administrator Company Name is another EAMS UAN field, filled from the same alphabetical pick-list or by number through UAN Search. The next page, Defense Attorney Information, carries no asterisks anywhere: it is optional when the applicant attorney or the claims administrator initiates the request, even though the recording fills it in to show the fields.

   

9. 9

   Affirm both declaration statements — one is not enough

   Page 6 is the declaration, and it holds two separate statements that are both required. The first certifies, under penalty of perjury under the laws of the State of California, that the information provided in the eForm is true and correct. The second is the agreement that, by clicking Agree, you will serve a copy of the panel request form, the panel list and the uploaded documents on all parties within one business day. The recording checks only the first statement and presses Continue; the form answers with a red error saying that certifying both the penalty of perjury and the agreement to serve the QME panel on all parties is a mandatory step of the online QME request process. If any part of the declaration is unclear, the form directs you to the Medical Unit.

   

10. 10

    Upload the objection letter or the request for a compensability exam

    Page 7 is the mandatory upload. You attach either the letter of objection or the request for a compensability exam, and the page states the limits plainly: a single file, only in PDF or TIFF format, no larger than 10 MB. Once the file is added, its name appears as a blue link next to File Attached, so you can confirm exactly what you attached before continuing. A panel request will not be submitted without this supporting document, which is why the page calls the upload a mandatory step.

    

11. 11

    Review every page, then submit the request

    Page 8 repeats everything you entered, section by section, so a wrong claim number or a missing UAN is caught before the request reaches the Medical Unit. Each section header carries a blue link that jumps straight back to that page for an edit, and the eight page buttons across the top still work as well. When the review page is right, submit. Because the online panel issues immediately, the last duty lands on the requesting party: the DWC requires the panel request form, any required documentation and the QME panel itself to be served on all parties with a proof of service within one business day.

    

12. 12

    Read the issued panel: three QMEs and their addresses

    The panel comes back as soon as you submit. It looks like the paper panels the Medical Unit used to issue — the same three qualified medical evaluators, each with a name, a practice address, a specialty, a practice start year and a telephone number — except that it arrives in the browser instead of the mail. The recording’s issued panel carries a panel number and three physicians in the requested specialty. That list is the point of the whole request, so it is worth reading every address and specialty before the panel is served.

    

13. 13

    Print the panel package and serve it on every party

    The final screen hands over the package. The recording shows a panel number and three attachments you can open, print or save: the issued QME panel together with the declaration of service, the QME Form 106 showing every input from the request, and a copy of the supporting document you uploaded. A declaration-of-service page comes first as a courtesy — it pre-populates the parties on the claim, lets you add more, and produces the proof of service the DWC requires within one business day. Two links at the bottom of the print page lead back to the Medical Unit home page and back to the start of the form for another request.

    

14. 14

    Understand the three ineligibility notices

    The system can decline a request, and the recording demonstrates all three ways. A duplicate request produces a letter saying that a panel with the same claim number, date of injury and injured worker name has already been issued, and it prints the previously issued panel so the filer can see what exists. A request filed too early produces a letter saying the request is premature as defined in Labor Code section 4062.2 and 8 CCR sections 10507 and 10508. A request for a specialty with too few evaluators produces a letter saying the selected specialty has an insufficient pool of QME panelists at this time and inviting a request for a different specialty. All three letters carry the Medical Unit help desk address, [email protected], and the Medical Unit telephone number, 1-800-794-6900.

    

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