The California QME and AME process: a guide for applicant attorneys

In a represented California workers' comp case, most disputed medical questions end up in front of a medical-legal evaluator: an agreed medical evaluator (AME) or a panel qualified medical evaluator (QME). The process runs on short, fixed deadlines, and a missed one can hand the choice of evaluator to the other side. This guide walks through the steps for injuries on or after January 1, 2005, where the employee has an attorney. It is general information, not legal advice; check the current rule before relying on a date.

When the med-legal process starts

A comprehensive medical-legal evaluation is how the parties resolve a medical dispute the treating doctor's reports don't settle. Labor Code 4060 covers evaluations on whether an injury is compensable. Labor Code 4061 and 4062 cover objections to the primary treating physician's findings, such as permanent and stationary status, impairment, work restrictions or the need for future care.

The first clock is the objection. Under Labor Code 4062(a), a party who disagrees with a treating physician's determination must object in writing within 20 days of receiving the report when the employee is represented (30 days when unrepresented). For a represented employee, Labor Code 4062.2 then controls: the evaluation comes only from an AME or a panel QME, and no other medical-legal evaluation may be obtained for that dispute.

AME or panel QME

An AME is a physician both sides agree on. Under Labor Code 4062.2(f), the parties may agree on an AME at any time, except for issues that belong in independent medical review. Once an issue has gone, or been agreed to go, to an AME, neither side can request a panel for that issue unless both cancel the agreement in writing.

A panel QME is chosen from a three-member panel issued by the DWC Medical Unit. Many firms try for an AME on cases where they know and trust an evaluator in the specialty, and go to a panel when no agreement comes quickly. Either way, write down which issues the evaluator is being asked to decide.

Requesting a panel and striking a name

The panel steps run on short clocks, so most firms calendar every one the moment the objection goes out.

Two details catch firms out. First, timing: under 8 CCR 30(b)(2), an online request made on a weekend or holiday, or between 5 p.m. and midnight on a weekday, is treated as made at 8 a.m. on the next business day. Second, the regulations count the strike period from service of the panel, so record the service date, not just the date you saw the panel.

A party can ask for a replacement panel on the grounds listed in 8 CCR 31.5. They include a QME who can't schedule within 90 days (120 if waived), a change in the employee's residence, two evaluators from the same group practice, a QME who is or was the treating physician, a late report under Labor Code 4062.5, and a panel issued more than 24 months before the request. A valid replacement request pauses the strike and selection deadlines until the new panel issues.

Serving records and avoiding ex parte contact

What the evaluator reads shapes the report. Under 8 CCR 35 (amended in 2024):

• Records you plan to send must be served on the other side at least 20 days before they go to the evaluator.
• The other side has 10 days to object to nonmedical records. Records under objection aren't sent unless a judge orders it.
• Every communication with the evaluator must be in writing and served on all parties at the same time. A communication not copied to everyone is an ex parte communication.
• Nonsubstantive contact with an AME's office, such as scheduling, is allowed.
• If an ex parte violation is found, the other party may choose a new panel or keep the evaluator.

A practical checklist before the exam:

• Records index, served, with the date the 20-day clock ends.
• Cover letter that lists the disputed issues and body parts, served on all parties.
• Job description and any nonmedical records, served early enough to survive a 10-day objection.
• Client prepared: appointment date, location, interpreter if needed, what to bring.
• Proof of service for everything the evaluator receives.

The report, supplemental reports and deposition

Under 8 CCR 38, the evaluator's report is due within 30 days after the exam. The Medical Director must grant up to 30 more days when test or consultant results are pending, and 15 days for good cause. A supplemental report is due within 60 days of the request, and the parties may agree to up to 30 more days.

Evaluators bill under the medical-legal fee schedule in 8 CCR 9795, operative April 1, 2021:

What to check when the report arrives

Read the report against the issues you sent. For each body part, look for:

• Causation, and whether the evaluator addressed cumulative trauma as well as any specific injury.
• Whole person impairment, with the AMA Guides table cited.
• Apportionment. Labor Code 4663 requires the evaluator to give approximate percentages of what was caused by the industrial injury and by other factors, and a report without that is incomplete on the issue.
• Permanent and stationary date, work restrictions and future medical care.
• Periods of temporary disability, which feed straight into a benefits audit.
• A records list that matches what you served.

Gaps usually mean a supplemental report request or a deposition. Our guide to permanent disability ratings covers how the numbers in the report become a rating.

How a firm can track this

The work is mostly dates and documents: the objection, the panel request, the strike, the appointment, the 20-day records window and the report. Whatever system you use, each event should create the next deadline on the case calendar with the rule written next to it, and someone should own each step.

In PlaintiffStack's workers' comp setup, the med-legal process has its own page on each case, a morning check flags records due to the QME before the evaluation, and a case tool drafts the QME cover letter and records index from the case file for a person to review. It doesn't request panels or file anything with the DWC; your team does that on the DWC site.