QME Appointment Notification Form 110 – Free Template Download

The QME Form 110 serves several important purposes, such as:

• Provides key appointment details: It includes the date, time, and location of the medical evaluation.

• Ensures legal compliance: The form meets the requirements of the California Code of Regulations, Section 110, making it a mandatory document.

• Streamlines communication: It informs all parties involved in the workers' compensation claim about the upcoming evaluation.

• Helps with claim processing: Timely notification allows the injured worker, employer, and claims administrator to prepare for the evaluation.

The Qualified Medical Evaluator is responsible for completing and distributing this form to:

• The injured worker- providing them with details of their scheduled medical evaluation.

• The employer and claims administrator- ensuring they are informed about the appointment.

• The injured worker's legal representatives- facilitating their participation in the process.