When they must send it
• Within ten business days of receipt of the unrepresented employee’s objection to the medical determination of the treating physician.
The deadline this notice puts on you
If you wish to obtain a comprehensive medical evaluation, enclosed is a form that you must submit to the state Division of Workers’ Compensation (DWC) within 10 days to request a panel of three Qualified Medical Evaluators (QMEs). In addition, within 10 days after the DWC sends you a panel, you must choose a QME from the panel, make an appointment to be examined by the QME, and inform me of your choice and appointment time.
Quoted from the model notice below. Your letter should say the same — if it does not, that is worth asking about.
Rule text
8 CCR § 9812 · 10 unspecified
Trigger: after the DWC sends you a panel
In addition, within 10 days after the DWC sends you a panel, you must choose a QME from the panel, make an appointment to be examined by the QME, and inform me of your choice and appointment time
8 CCR § 9812 · 10 unspecified
Trigger: to request a panel of three Qualified Medical Evaluators (QMEs)
The notice shall contain the following statement (with the phrase “ 10 days ” in bold font as shown): “If you wish to obtain a comprehensive medical evaluation, enclosed is a form that you must submit to the state Division of Workers' Compensation (DWC) within 10 days to request a panel of three Qualified Medical Evaluators (QMEs)
Quoted from the statute, marked computed. The deadline table is a draft extraction — read the official code if the two disagree.
The rule behind it
8 CCR §9812(i)
The official model notice
BENEFIT NOTICE INSTRUCTION MANUAL Claims Administrator Name Address City_State_Zip Telephone Number [include if available] Website address Date [Option] SENT VIA E-MAIL TO employee’s e- mail address Employee Employer: Address Date of Injury: City_State_Zip Claim Number: NOTICE REGARDING QME PANEL REQUEST FORM CLAIMS ADMINISTRATOR NAME is handling your workers' compensation claim on behalf of EMPLOYER NAME. This notice is to advise you of the status of disability benefits for your workers' compensation injury on the date shown above. We have received your objection to the medical determination of PHYSICIAN’S NAME regarding (choose one or more of the following:) temporary disability / permanent disability / the need for future medical care / INSERT NATURE OF OTHER OBJECTION(S). If you wish to obtain a comprehensive medical evaluation, enclosed is a form that you must submit to the state Division of Workers’ Compensation (DWC) within 10 days to request a panel of three Qualified Medical Evaluators (QMEs). If you do not submit the form within 10 …
Published by the Division of Workers’ Compensation in the Benefit Notice Instruction Manual. Excerpt — read the full manual at the source. p.87.
Source · dir.ca.gov →When this went wrong
Decisions of the Workers’ Compensation Appeals Board on this subject. Each quotes the passage it turned on and links to the official PDF.
- ADJ13039423 · 2026-06-01 · Anaheim District OfficeQME/AME processdefendant prevailed
Determinative passage · p.10Dr. Betancourt's reports contained thorough and detailed discussions of the issues presented. His opinions and conclusions were framed in terms of reasonable medical probability, were not speculative, and were based on pertinent facts and documents and on an adequate examination and history. Dr. Betancourt also thoroughly set forth his reasoning in support of his conclusions. Based thereon, Dr. Betancourt's opinions constitute substantial medical evidence upon which the Court can rely.
The court found no good cause to disqualify Dr. Betancourt, as his opinions were based on reasonable medical probability and substantial evidence.
Official decision · page 10 → - ADJ20106865 · 2026-05-18 · Pomona District OfficeQME/AME processapplicant prevailed
Determinative passage · p.7Not only does the letter not explicitly refer to objection, it does not contain any objection whatsoever. Applicant is entitled to retain the control of the QME process and did nothing to lose that control. Thus, defendant waived its right to an objection.
Defendant's strike letter did not contain any objection to the QME panel specialty, so defendant waived its right to object; applicant was entitled to choose the specialty and chiropractic was appropriate.
Official decision · page 7 → - ADJ20938147 · 2026-04-30 · Pomona District OfficeQME/AME processapplicant prevailed
Determinative passage · p.6Here, defendant's notice of delay was served on May 23, 2025 within California on applicant by regular mail. (Exhibit A.) The parties were therefore required to wait until fifteen (15) days after May 23, 2025, or until the after 5:00 p.m. on June 9, 2025 before requesting a panel. In their panel request, however, defendant indicated that the "date of request for comprehensive exam" was May 22, 2025. (Exhibit B, p. 3.) This is contrary to the facts of the case and contrary to the parties' stipulation to a May 23, 2025 "start date per Labor Code 4062.2." (Minutes of Hearing and Summary of Evidence (MOH & SOE), February 2, 2026, p. 2.) We therefore conclude that considering defendant's usage of an incorrect date, defendant's QME panel request was invalid. Accordingly, the issuance of panel 7823574 is similarly invalid.
Defendant's QME panel request was premature due to incorrect date usage, making the panel invalid and entitling applicant to a replacement chiropractic panel.
Official decision · page 6 → - ADJ17870859 · 2026-04-23 · Lodi District OfficeQME/AME processapplicant prevailed
Determinative passage · p.9Given the above, we find that a QME in the specialty of neurology (MPN) to address the applicant's post-concussion headaches, post-concussion syndrome and closed head injury, as well as any industrial causation of same, is appropriate.
The WCAB found good cause for an additional neurology panel based on Dr. Chow's recommendation, applicant's symptoms, and the stipulation of treating physician Dr. Lin reporting headaches, despite defendant's objection to industrial causation.
Official decision · page 9 →