Replacement Panel Request {QME 31.5}

QME Form 31 - REPLACEMENT PANEL REQUEST-8 CAL. CODE OF REGULATIONS SECTION 31.5. This form is used to request a new Qualified Medical Evaluator panel under 8 California Code of Regulations §31.5. The form allows a requesting party—injured worker, attorney, claims administrator, or defense counsel—to identify the existing panel, list each QME proposed for replacement, and state the applicable regulatory reason for replacement, such as unavailability, improper specialty, scheduling delays, conflicts of interest, or other qualifying grounds. Supporting documentation must be attached for the request to be considered. The form also requires updated address information for panel issuance and includes a mandatory declaration of service confirming that copies were mailed or delivered to all parties. This request must be properly documented to avoid delays or denial. www.FormsWorkflow.com