Unrepresented Additional Panel Proof Of Service | Pdf Fpdf Doc Docx | California

 California   Workers Comp   General 
Unrepresented Additional Panel Proof Of Service | Pdf Fpdf Doc Docx | California

Last updated: 5/30/2015

Unrepresented Additional Panel Proof Of Service

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Description

PROOF OF SERVICE BY MAIL.This form is used in California workers’ compensation cases to confirm service by mail of an Additional Panel QME Finding and Order issued by the Division of Workers’ Compensation (DWC) Medical Unit. This form applies when an injured worker is unrepresented and an additional Qualified Medical Evaluator (QME) panel has been issued. The person completing the form declares under penalty of perjury that a true copy of the Additional Panel Order was mailed with proper postage to the required parties, including the Medical Unit. www.FormsWorkflow.com

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