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QME panel request (Forms 105 and 106), explained

By the CalCompGuide editorial team · Last updated November 2026 · How we write and check guides

Short answer

To get a Qualified Medical Evaluator (QME) when there's a medical dispute, unrepresented workers use QME Form 105 and represented parties use Form 106 (usually filed online). The DWC Medical Unit sends a panel of three QMEs in the specialty requested. Unrepresented workers then have 10 days to choose one and schedule the exam.

Form 105 (no attorney)

  1. The claims administrator sends you Form 105 with a notice explaining the dispute.
  2. Fill in your information, the claim number and the claims administrator's details.
  3. Choose the specialty that fits your main injury (orthopedic surgery for most bone and joint injuries; psychology or psychiatry for psychiatric injuries; internal medicine for some illnesses). You can name a specialty your treating doctor suggests.
  4. Mail or deliver it to the DWC Medical Unit as the instructions say, with the attachments it lists.
  5. When the panel arrives, choose one doctor and make the appointment within 10 days, then tell the claims administrator.

Form 106 (represented)

The attorney or claims administrator requests the panel online. Each side may strike one name within 10 days, and the remaining QME evaluates you. Represented parties can also agree on an AME instead.

Tips

  • Ask a DWC Information & Assistance officer to help pick the specialty; a mismatch can mean a less useful report.
  • Keep proof of the date you received the panel.
  • Travel to the exam is reimbursable (mileage calculator).

Full guide: QME, AME and the panel QME process.

We link to the official form on dir.ca.gov rather than hosting a copy, so you always get the current version.

Sources

Official sources checked November 2026. Laws and rates change; check the source for the latest version.