State of California Department of Industrial Relations Division of Workers' Compensation Workers' Compensation Appeals Board WCAB Case No (s) Existing QME Panel No. Applicant, v. Finding and Order Re: Replacement QME Panel pursuant to 8 CCR § 31.5 (Represented Case) Defendants, It is hereby found that a replacement panel of QMEs shall issue to replace one or more of the QMEs listed in the panel mentioned above shall because: Panel member shall be replaced because of the reason set forth below: This QME was the last remaining QME after the parties completed the striking process. Panel member shall be replaced because of the reason set forth below: Panel member shall be replaced because of the reason set forth below: IT IS ORDERED THAT the Medical Director, Division of Workers' Compensation, issue within 30 days of the date of service of this order a QME panel in the specialty previously issued pursuant to section 31 of title 8 of the California Code of Regulations. Upon receipt of the panel the parties shall follow the procedures in Labor Code section 4062.2 to determine which qualified medical evaluator from the panel will perform the evaluation. The party designated below shall serve the Medical Unit with the order and the attached proof of service. The applicant's current address is City State Zip Code Date: Workers' Compensation Judge Workers' Compensation Appeal Board Notice to: Pursuant to Rule 10500, you are designated to serve this document on all parties shown on the Official Address Record (a copy of which is attached) and the Medical Unit along with a proof of service. You shall maintain the proof of service, which shall not be filed with the WCAB unless a dispute arises regarding service of the document. Replacement panel represented -2014 American LegalNet, Inc. www.FormsWorkFlow.com