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

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

Last updated: 5/30/2015

Unrepresented Replacement Panel Proof Of Service

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Description

PROOF OF SERVICE BY MAIL.This form is used in California workers’ compensation cases to certify that a Replacement Panel Order issued by the Division of Workers’ Compensation (DWC) Medical Unit was properly served by mail. This form is typically completed when an injured worker is unrepresented and a replacement Qualified Medical Evaluator (QME) panel has been issued. By signing the form, the server declares under penalty of perjury that they mailed a true copy of the Replacement Panel Order to the required parties, including the Medical Unit, using the U.S. mail with proper postage. The form includes space for the date, location, server information, and mailing details. www.FormsWorkflow.com

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