Request for Factual Correction of an Unrepresented Panel QME Report (QME Form 37) | Free Download

The Request for Factual Correction of an Unrepresented Panel QME Report (QME Form 37) is an essential document in California workers' compensation cases. It allows an unrepresented injured worker to formally request corrections to factual errors in a Qualified Medical Evaluator (QME) report, ensuring accuracy in their medical evaluation. This form is used strictly to correct verifiable factual mistakes and not to dispute medical opinions.

Purpose of QME Form 37

The QME Form 37 serves the following key purposes:

Ensures accuracy: Allows injured workers to correct errors in their QME report that can be verified with existing medical records.

Improves claim fairness: Helps prevent factual inaccuracies from affecting workers' compensation decisions.

Maintains transparency: Gives unrepresented workers a formal process to address factual discrepancies.

When Should QME Form 37 Be Submitted?

The Request for Factual Correction (QME Form 37) must be submitted within a specific timeframe after receiving the QME report. Workers should check their notification letter to confirm the deadline for submitting corrections.

What Information Can Be Corrected?

Corrections are limited to verifiable factual errors in the QME report, such as:

Incorrect dates of treatment or injury.

Misreported job duties or medical history.

Errors in listed medications or past treatments.

Mistakes in identifying pre-existing conditions.

Medical opinions or conclusions made by the QME cannot be challenged using this form.

Related Guides

Free Personal Injury Questionnaire Template – Download Now

Get a free Personal Injury Questionnaire Template to document accident details, medical treatment, and financial losses for your personal injury claim.

Free Download

Free DWC Form RFA to Request Authorization for Medical Treatment

Get the free Request for Authorization for Medical Treatment form template. Simplify the process of requesting medical payment authorization today!

Free Download