Stipulation And Order (Replacement PQME List) (Lodi)

STIPULATION AND ORDER (REPLACEMENT PQME LIST). This form is used in California workers’ compensation cases before the Workers’ Compensation Appeals Board (WCAB) when the parties agree to replace an existing Panel Qualified Medical Evaluator (PQME) list. This form documents the parties’ stipulation that the injured worker requires a medical-legal evaluation and that there are good-faith issues or defects with the current PQME list or listed evaluators. The parties jointly agree to a new list of three evaluators, which supersedes all prior PQME lists and is treated as if it were issued by the DWC Medical Unit. Once signed by counsel and approved by a workers’ compensation judge, the order authorizes the parties to proceed using the replacement list. This version reflects use in the Lodi WCAB district. www.FormsWorkflow.com