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General Information & Contact Forms

Deposition Information
The total fee for the deposition is $1365. (The amount of $1365 includes 1 hour prep, 1 hour for the deposition, 1 hour for depo transcript review billed at $455/hr.) The check and remote link will need to be received at least two weeks prior to the date of the deposition. Please send the check to the following address:

11620 Wilshire Blvd Ste 340, Los Angeles, CA 90025.

Please make the check payable to MDpanel, not to the doctor. If the check is not received prior to the deposition, we will need to receive the check number and a scanned image of the check before the deposition date in order to proceed with the deposition. Our Tax ID is 27-2983375.

We require 8 calendar days prior to the deposition for any cancellations or rescheduled appointments in verbal and written notice. Any time after 8 calendar days is subject to the full applicable fee of $1365. No-shows and failed appointments are charged the same fee.

Cancellation/Reschedule Policy
Reschedule/Cancellation Policy: We require 6 business days prior to the evaluation to cancel or reschedule, any time after business days will incur a $503.75 (+ $3/page in excess of 200 pages) fee. No Show Fee: $503.75 (+ $3/page in excess of 200 pages)

Appointment Duration
On Average Early Arrival Time: 30-60 minutes prior to the evaluation start time. The duration of an evaluation will depend on the complexity of the case, the medical specialty and if an interpreter is required. Applicants and interpreters (if needed) may need to participate in the evaluation from start to finish for approximately 4-6 hours. This includes early arrival time, face-to-face time with the QME and any time required to complete evaluation documents.

Locations and Parking Fees
Some locations might be easier to get to than others. We recommend that applicants plan in advance and allow enough time for travel to get to the location safely. Parking fees may vary depending on the location. On average most locations offer free parking, however, some locations will charge a parking fee ranging from $5 - $30.

Remote Evaluations
For remote evaluations we require the following:
1. Applicant and interpreter (if applicable) should be logged on 60 minutes prior to the evaluation start time.
2. Applicant should download Google Meet, test audio and video before the day of the evaluation.
3. Remote evaluation link will be emailed to all parties 5-7 days prior to the day of the evaluation. If you are scheduled for a remote evaluation and have not received a remote link yet, please email us at: scheduling@calmedeval.com and provide the following information. First name, last name, claim number, date of evaluation, and first and last name of the physician.
4. Applicant should be in a quiet and private location, free from distractions.
5. Please do not be in a moving vehicle during the evaluation.
QME Availability
All MDpanel QME partners provide availability and schedule on a first-requested, first-scheduled basis. On average a QME will have availability within the next 20-90 days at all of the locations they are listed at.

Report Requests
To request a copy of a completed report or to inquire about the status of a report.
Report Assistance:
Applicant Full Name:

First NameLast Name
Claim Number:
Date & Time of Evaluation:

MonthDayYear
DateHourMinutesAM/PM Option
Evaluation/Report Type:
Full Name QME Physician:

First NameLast Name
Notes:
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
CAPTCHA (To confirm you are a Human and not a Bot)

Medical Records
Medical Records & Cover Letters need to be received 3-4 weeks prior to the evaluation. As of April 1, 2021, based on the new California Medical-Legal Fee Schedule, all medical records MUST be accompanied by a corresponding declaration including the number of pages sent to the QME. Without this declaration, the QME cannot review the medical records.

Digital copies of these documents may be submitted through our Secure Upload Site at http://www.calmedeval.com/upload.

Please forward Medical Records & Cover Letters to 11620 Wilshire Blvd, Ste. 340, Los Angeles, CA 90025. When sending by mail, CD's are encouraged.

To inquire if Medical Records were received or if you have any questions regarding medical records please fill the form below:
Applicant Full Name

First NameLast Name
Claim Number
Date of Evaluation:

MonthDayYear
Date
Evaluation/Report Type:
Physician QME

First NameLast Name
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option

Eval Attendance Confirmation
To inquire if an applicant attended a scheduled evaluation.
Applicant Full Name

First NameLast Name
Claim Number
Date of Evaluation:

MonthDayYear
Date
Evaluation/Report Type:
Physician QME

First NameLast Name
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option

Billing & Collections
For any questions regarding billing, collections, statements, or payments, please provide the following information.
Applicant Full Name

First NameLast Name
Claim Number
Date of Evaluation:

MonthDayYear
Date
Evaluation/Report Type:
Physician QME

First NameLast Name
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option

Evaluation Request Status
To inquire on the status of your request to schedule, reschedule, cancel or of a deposition please provide the information below:
Date of Innitial Request

MonthDayYear
Date
Applicant Full Name

First NameLast Name
Claim Number
Evaluation/Report Type:
Physician QME

First NameLast Name
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option

Procedure Request
If you are looking to obtain an order for a procedure that was recommended as part of a worker’s compensation evaluation, please provide the information below. Please note we do not schedule, coordinate or facilitate any procedures.
Applicant Full Name

First NameLast Name
Claim Number
Date of Evaluation

MonthDayYear
Date
Evaluation/Report Type:
Physician QME

First NameLast Name
Type of Procedure
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option

Test Results
Testing Results for Diagnostic Studies:
Applicant Full Name

First NameLast Name
Claim Number
Evaluation/Report Type:
Physician QME

First NameLast Name
Type of Procedure
Submitter's Full Name

First NameLast Name
Submitters Email:
example@example.com
Notes:
CAPTCHA (To confirm you are a Human and not a Bot)
Date

MonthDayYear
DateHourMinutesAM/PM Option
Should be Empty:

General Information & Contact Forms