QME Panel Request in California: Complete Guide to Forms 105 & 106

When the parties in a California workers' compensation case cannot agree on a physician to conduct an independent medical evaluation, the next step is a QME panel request. This formal filing asks the Division of Workers' Compensation (DWC) to assign a panel of three Qualified Medical Evaluators Qualified Medical Evaluator (QME) A physician certified by the Division of Workers' Compensation Medical Unit to perform medical-legal evaluations in California workers' compensation cases. Click for full definition from the relevant medical specialty. The process is governed by Labor Code §4062.2, and the specific form required depends on whether the injured worker is represented by an attorney.

What Is a QME Panel Request?

A QME panel request is a written application submitted to the DWC Medical Unit asking for the assignment of a panel of three QME Qualified Medical Evaluator (QME) A physician certified by the Division of Workers' Compensation Medical Unit to perform medical-legal evaluations in California workers' compensation cases. Click for full definition physicians. The DWC selects the panel from its roster of certified QMEs based on the medical specialty relevant to the dispute and the geographic area of the injured worker.

The panel request process exists because California law recognizes that medical disputes in workers' compensation cases require resolution by an independent evaluator. Under Labor Code §4062.1 (unrepresented employees) and §4062.2 (represented employees), the panel QME process Panel QME Process (PQME) The procedure by which the DWC Medical Unit assigns a panel of three QME physicians from which the parties select an evaluator through a strike process. Click for full definition is the default pathway when the parties do not select an Agreed Medical Evaluator (AME).

A panel request is required in several circumstances: when liability for the injury is disputed, when there is disagreement over the nature and extent of permanent disability, when a party challenges the treating physician's opinion on work restrictions or future medical care, or when the primary treating physician's report is contested under the utilization review process.

Form 105 vs Form 106: Which Form Do You File?

The distinction between DWC Form 105 and Form 106 is one of the most critical decision points in the panel request process. Filing the wrong form will result in the request being returned, adding weeks of unnecessary delay.

When to Use Form 105 (Unrepresented Employees)

Form 105 is used exclusively when the injured worker does not have an attorney. In this scenario, the worker or the claims administrator may file the request directly with the DWC Medical Unit. There is no requirement to attempt an AME agreement before filing, because unrepresented workers are not expected to negotiate physician selection independently.

Under Labor Code §4062.1, the unrepresented employee has the right to choose a physician from the panel. The claims administrator does not participate in the strike process for unrepresented cases.

When to Use Form 106 (Represented Employees)

Form 106 applies when the injured worker has retained an attorney. Before filing a Form 106 panel request, the parties must first attempt to agree on an AME. Under Labor Code §4062.2, the requesting party must document that the AME selection process has been exhausted or that the opposing party failed to respond within the statutory timeframe.

Step-by-Step Process for Filing a QME Panel Request

The filing process differs slightly depending on whether you are using Form 105 or Form 106, but the general workflow follows these steps:

Step 1: Confirm the Dispute Requires a QME

Not every medical disagreement triggers the QME panel process. Verify that the dispute involves a compensable medical question (injury causation, permanent disability, future medical treatment, or work restrictions) and that the treating physician's report has been served on all parties. For represented cases, confirm that the AME process has been exhausted.

Step 2: Obtain the Correct Form

Download DWC Form 105 or Form 106 from the DWC website. For represented cases, the online electronic Form 106 system is the preferred method (discussed below). Ensure you are using the current version of the form; outdated versions may be rejected.

Step 3: Complete All Required Fields

Both forms require the following information:

• Injured worker's identifying information: full legal name, date of birth, date of injury, and claim number
• Claims administrator information: name, address, and adjuster contact details
• Medical specialty requested: the specialty relevant to the body part or condition in dispute
• Description of the disputed medical issue: a clear statement of what medical question needs resolution
• Preferred geographic area: typically the county where the injured worker resides or was injured

For Form 106, you must also include documentation of the AME process (the AME demand letter and proof of service, or evidence that the opposing party failed to respond).

Step 4: Serve the Form on All Parties

A copy of the completed panel request form must be served on all parties simultaneously with filing. Under CCR Title 8 §30, the requesting party must provide proof of service to the DWC Medical Unit. Failure to serve all parties is grounds for the Medical Unit to return the request.

Step 5: Submit to the DWC Medical Unit

File the completed form with proof of service with the DWC Medical Unit. Paper forms are mailed or faxed; Form 106 may also be submitted electronically. Retain a copy of the filed form and proof of mailing or electronic submission confirmation for your records.

The Online QME Form 106 Panel Request System

The DWC has implemented an electronic filing system for Form 106 panel requests, allowing attorneys and claims administrators to submit requests online rather than by mail or fax. As of 2026, this system is the fastest and most reliable method for filing a represented-case panel request.

How the Electronic System Works

The online system is accessible through the DWC website. Users must create an account and register with their bar number (attorneys) or adjuster information (claims administrators). The system walks filers through each required field, flags incomplete sections before submission, and provides an immediate confirmation number upon successful filing.

Key advantages of electronic filing include:

• Faster processing: electronic submissions are typically processed before paper filings in the queue
• Built-in validation: the system checks for missing fields and formatting errors before accepting the submission, reducing the rate of returned forms
• Confirmation tracking: filers receive an immediate confirmation number and can track the status of their request online
• Electronic panel delivery: the assigned panel is delivered electronically rather than by mail, saving additional days

Timelines and Deadlines

The QME panel request process is governed by strict statutory deadlines. Missing a deadline can result in waiver of rights or significant case delays.

For unrepresented employees under §4062.1, the timeline is simpler: the injured worker or claims administrator files the Form 105, the DWC issues the panel within 20 business days, and the injured worker selects a physician from the panel.

How QME Panels Are Assigned

When the DWC Medical Unit receives a complete panel request, it assigns three QMEs from the requested medical specialty within the relevant geographic area. The selection process is governed by CCR Title 8 §31.1 and follows specific rules:

• All three physicians on the panel must be certified QMEs in the requested specialty
• The physicians are selected based on geographic proximity to the injured worker's residence or workplace (the form allows specification of a preferred area)
• The DWC uses a randomized rotation system to ensure equitable distribution of panel assignments among certified QMEs
• A QME who has previously evaluated the same injured worker on the same claim will not be included on a subsequent panel

If there are fewer than three certified QMEs in the requested specialty within the geographic area, the DWC may expand the search radius or, in rare cases, assign a panel with fewer than three physicians with notice to the parties.

The Strike Process: How Parties Select From the Panel

Once the panel of three QMEs is issued, the parties must select one physician through the "strike" process. The mechanics differ based on representation status.

Represented Cases (Form 106)

In represented cases, the strike process works through alternating elimination under Labor Code §4062.2:

1. Each party reviews the three QME names, credentials, and office locations on the panel
2. The party who did not request the panel strikes first, eliminating one physician from consideration
3. The requesting party then strikes one of the remaining two physicians
4. The last remaining physician becomes the QME for the case QME Appointment The scheduled evaluation with a Qualified Medical Evaluator, which must occur within the timeframes specified by CCR Title 8 regulations. Click for full definition

The entire strike process must be completed within 10 days of panel issuance. If a party fails to strike within the deadline, the other party may make both strikes or the Medical Unit will assign the QME.

Unrepresented Cases (Form 105)

For unrepresented injured workers, the process is more straightforward. The injured worker receives the panel and selects one of the three physicians. The claims administrator does not participate in the selection for unrepresented cases.

Common Mistakes That Delay or Invalidate Panel Requests

Based on DWC Medical Unit data and practitioner experience, these are the errors most likely to result in a returned or delayed panel request:

1. Using the Wrong Form

Filing Form 105 when the applicant is represented (or Form 106 when unrepresented) will result in an automatic return. Always verify the applicant's representation status before selecting a form.

2. Omitting AME Process Documentation (Form 106)

For represented cases, the panel request must include evidence that the AME selection process was attempted and failed. This means attaching the AME demand letter, proof of service, and either the opposing party's response or evidence that they failed to respond within 10 days.

3. Incomplete or Illegible Form Fields

Missing claim numbers, incorrect dates of injury, absent signatures, and illegible handwriting on paper forms are all grounds for return. The electronic Form 106 system largely eliminates this problem for represented cases.

4. Failure to Serve All Parties

The panel request must be served on all parties simultaneously with filing. Forgetting to serve the applicant, the applicant's attorney, or the claims administrator will result in a return. Include proof of service with your filing.

5. Requesting an Incorrect or Overly Narrow Specialty

If the specialty requested does not match the body part or condition in dispute, the Medical Unit may return the form or reassign the specialty. Conversely, requesting a subspecialty that is too narrow may result in insufficient QMEs in the geographic area, causing delays as the search radius expands.

What Happens After the Panel Is Assigned?

Once the strike process is complete and a QME is selected, the case moves into the evaluation phase (see our complete guide to PQME evaluations for a detailed walkthrough). Several important steps follow:

Scheduling the Evaluation

The selected QME (or the party who "won" the strike) contacts the physician's office to schedule the QME appointment QME Appointment The scheduled evaluation with a Qualified Medical Evaluator, which must occur within the timeframes specified by CCR Title 8 regulations. Click for full definition . Under CCR Title 8 §31.5, the evaluation should be scheduled within 60 days of the QME selection. If the QME cannot accommodate this timeframe, the parties may need to request a replacement panel.

Submitting Medical Records

All relevant medical records must be submitted to the QME before the evaluation, as detailed in our guide to QME record submission . Under CCR Title 8 §35, records must be served on the QME and the opposing party at least 20 days before the appointment. Late record submissions may be excluded from the evaluator's consideration.

Objections to the Panel

A party may object to a panel assignment on limited grounds, including: a conflict of interest involving one of the panel QMEs, evidence that the panel was not properly randomized, or a QME's certification has lapsed. Objections must be filed with the DWC Medical Unit promptly, and the burden of proof is on the objecting party.

Replacement Panels

If the selected QME is unavailable, has a conflict, or is unable to schedule within the required timeframe, either party may request a replacement panel from the DWC. A new panel of three QMEs will be issued, and the strike process begins again. Note that a replacement panel request should reference the original panel number and explain the reason for the request.