California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 1 - Division of Workers' Compensation - Qualified Medical Evaluator Regulations
Article 10.5 - QME Process Forms
Section 106 - The Request for Qualified Medical Evaluator Panel - Represented Form - for Injuries Occurring Prior to January 1, 2005
NOTE: Forms are available at no charge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.
1. New section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior history see Register 94, No. 31.
2. Change without regulatory effect amending section filed 5-2-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 18).
3. Amendment of section heading, repealer and new section and new NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
4. Amendment of section heading, new QME Form 106a and amendment of informational note filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day.
5. Amendment of section heading, new QME Form 106a and amendment of informational note refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 7-1-2013 order, including amendment of section heading and repealer and new Form 106, transmitted to OAL 8-2-2013 and filed 9-16-2013; amendments operative 9-16-2013 pursuant to Government Code section 11343.4(b)(3) (Register 2013, No. 38).
7. Amendment of section heading and section filed 8-12-2015; operative 9-1-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 33).
Note: Authority cited: Sections 53, 133, 139.2 and 5307.3, Labor Code. Reference: Sections 139.2, 4060, 4061, 4062, 4062.1, 4062.2, 4064 and 4067, Labor Code.
