Free DWC Form 113 Template – Denial of Time Extension Form

The Notice of Denial of Request for Time Extension has the following vital purposes:

• Notifies the denial of time extension: It informs all involved parties that the QME’s request for additional time has been rejected.

• Ensures compliance: The form helps maintain timelines set by California workers’ compensation regulations.

• Clarifies what to do next: It guides parties on how to proceed after a denied time extension request.

The Denial of Time Extension (Form 113) contains important details such as:

• Claimant and QME details

• Original due date of the report

• Reason for denial of extension

• Instructions for next steps