The California QME Process

What this page is

The Qualified Medical Evaluator's report is the single most consequential document in a contested California workers' compensation claim. It sets your impairment rating, decides how much of your disability the insurance company has to pay for, and determines whether you are entitled to future medical care. A judge will rarely disturb it.

Most of what is written about the QME process online is a definition followed by a phone number. This page is the process — every deadline, with its citation, and what happens when one is missed.

The short version. When your doctor and the insurance company disagree about your medical condition, California resolves it by sending you to a QME. You get a randomly generated list of three doctors. Each side strikes one name. The doctor left standing examines you once, reviews your entire file, and writes a report. That report largely decides your case. The deadlines are short, several are jurisdictional, and missing one usually means the other side picks your doctor.

Why this one report decides your case

Three provisions of the Labor Code, working together, put the QME at the center of everything.

It is a gatekeeper. Labor Code § 4061(i) and § 4062.3(l) both provide that a disputed medical issue — including whether you have permanent impairment and how much — cannot be submitted to a judge at all unless there is both a treating physician's report and a report from a QME or an Agreed Medical Evaluator. No QME report, no ruling.

It controls who pays. Under LC § 4064(d) the employer is liable only for evaluations obtained through the statutory process. The same subdivision then says the quiet part out loud: "no party is prohibited from obtaining any medical evaluation or consultation at the party's own expense." So a party may buy its own opinion — it simply cannot bill the other side for it. The panel remains the mechanism the Board relies on.

It is the evidence. In practice, a well-reasoned QME report becomes the substantial medical evidence a judge relies on. Your treating physician's opinion matters, but the QME's report is the one written specifically to answer the contested legal questions.

What the evaluator actually decides

Impairment is rated under the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, and a substantial part of that rating turns on your reported activities of daily living. That fact matters more than almost anything else on this page, and we come back to it below.

Two different systems: represented and unrepresented

The process is not the same for everyone, and most consumer pages get this wrong.

If you are unrepresented, the employer is legally barred from discussing QME selection with you (8 CCR § 31.3(b)). If an adjuster suggests which doctor to pick, that is grounds for relief.

The master deadline table

This is the part to bookmark. Every period below is the raw statutory or regulatory period. Service by mail inside California adds 5 calendar days (8 CCR § 10605); electronic service of medical-legal reports adds 2 business days (8 CCR § 36.7(a)(4)).

Getting the dispute started

Note the asymmetry: LC § 4062 sets a hard 20/30-day objection window, but LC § 4061 — the permanent disability track — contains no express objection deadline. Practitioners commonly object within 20 days by analogy. Treat 20 days as the operating rule.

Requesting the panel (represented)

A premature panel request is void, and the other side's later valid request controls. In Lopez v. Rockstar Staffing (2023), a panel was struck simply because service was late and supporting documents were omitted. This is a step where being one day early costs you the doctor.

The strike window — the highest-stakes ten days

Two honest caveats a careful practitioner will want:

• The requesting party's clock is unsettled. Crawford v. Northgate Landscape Mgmt. (2019) allowed no extension for the requesting party — 10 days flat. Rodriguez v. Continuing Life (2022) went the other way, treating DWC's electronic delivery as service and allowing 15. Both are panel decisions; neither binds. Assume the shorter period.
• The clock is tolled while a valid replacement request under 8 CCR § 31.5 is pending (§ 31.5(b)), and while the Medical Director has requested additional information (8 CCR § 30(g)).

Scheduling the exam

Records going to the evaluator

That 10-day objection window on non-medical records is the one most often blown, and it is the window that governs surveillance video. More on that below.

The report

The trap on late reports. A replacement panel for a late report is available only if you objected to the untimeliness before the evaluator served it, and you attach that objection to the request (8 CCR § 31.5(a)(12)). Object on day 31, and you have the remedy. Wait until the unfavorable report arrives on day 45, and the ground is gone and the report stands. Under LC § 4062.5, when a replacement is properly sought, neither party owes the late evaluator anything.

After the report

For represented workers there is no fixed deadline to object to the report's substance. The remedies are cross-examination by deposition (the employer pays for it under LC § 5710), a supplemental report, or a motion attacking the report as not substantial evidence.

When the panel is wrong: replacements and additional panels

8 CCR § 31.5 enumerates sixteen grounds for a replacement QME or panel. The ones that matter most in practice:

• No available appointment within 90 days (or 120 by agreement)
• The evaluator has a disqualifying conflict of interest under 8 CCR § 41.5
• The evaluator failed to serve a timely report, with the pre-service objection described above
• The evaluator violated the appointment or cancellation rules in § 34
• The panel issued in a medically inappropriate specialty — submitted to the Medical Director under § 31.5(a)(10), with either side able to appeal to a judge
• The panel is stale — the ground ripens at 24 months, and it needs both limbs: the panel list issued more than 24 months ago and no QME on it has examined the worker. The second limb is the one that usually defeats the request

Additional panel in a different specialty is governed by 8 CCR § 31.7, and there is a threshold most people miss: the parties must first attempt a follow-up or supplemental evaluation from the same evaluator "whenever feasible" (§ 31.7(a)). You do not get a second doctor simply because you want one.

Consultations are barred for the permanent disability and apportionment opinion (8 CCR § 32(b)) — that opinion is the QME's to form, not a colleague's. The bar is not absolute: § 32(a) carves out the acupuncturist referral to the Medical Unit under § 31.7(b)(2), and a QME may still await a diagnostic or consulting report, which is why § 38(c) grants an extension for one.

AME instead of QME

If you are represented, your attorney and the defense attorney can skip the panel entirely and agree on a single Agreed Medical Evaluator.

The advantage: an AME is usually a more experienced evaluator, chosen because both sides regard them as fair, and the process moves faster than a panel fight.

The cost: an AME opinion is far harder to dislodge. Because both sides selected the doctor, judges give AME reports substantial deference — the reasoning being that a party who agreed to the evaluator can hardly complain about the result. A bad panel QME report can be attacked from several directions. A bad AME report is close to final.

This is a judgment call that turns on the specific evaluator, the specific body part, and the specific defense firm. It is one of the more consequential strategic decisions in a comp case and it should never be made casually.

What actually happens at the exam

Before you go

You will receive QME Form 110 (the appointment notification) within five business days of the appointment being set, and if you are unrepresented, QME Form 108. Form 108 tells you, correctly, that there is no charge and no co-payment — not for the exam, not for an interpreter. The employer pays the exam, interpreter services, and reasonable transportation and lodging, and your temporary disability continues for time lost attending.

Records arrive at the doctor's office before you do. By the time you walk in, the evaluator has your claim form, the Doctor's First Report, every PR-2, quite possibly your deposition transcript, and — often — surveillance footage.

Check-in and paperwork

You will complete the evaluator's own history questionnaire, pain diagrams, and activities-of-daily-living forms. Psychiatric evaluations add standardized psychometric instruments.

Labor Code § 4628 protects you here. Only the signing physician may take your history, review your records, and compose the conclusions. Assistants may handle routine tasks, but if someone else outlines your history or excerpts your prior records, the physician must personally review that material and make further inquiry. The report must state the date and street address of the evaluation, confirm the physician actually performed it, and carry a declaration under penalty of perjury. A report that violates § 4628 is attackable.

The history — where the case is decided

The evaluator will take your mechanism of injury in your own words and compare it against every document in the file; your job duties and their physical demands; a complete symptom inventory for every body part; your activities of daily living; your prior injuries, prior claims, and prior awards; your treatment history and response; and your current work status.

The activities-of-daily-living section is not small talk. Under the AMA Guides 5th Edition, ADL impact is quantitatively significant to the rating.

The physical examination

For a musculoskeletal evaluation: inspection, palpation, range of motion — often measured by inclinometer under AMA Guides protocol — strength testing, neurologic testing, provocative maneuvers, gait, and atrophy measurement. Psychiatric evaluations include a mental status examination and validity-sensitive testing.

Plan on roughly one and a half to three hours on site for a routine orthopedic evaluation, and three to five hours, sometimes split across sessions, for a psychiatric evaluation with testing.

Interpreters

The QME must state on Form 110 whether a certified interpreter is needed under LC § 5811 and identify the language (8 CCR § 34(c)). You pay nothing. The claims administrator pays, at the rate in 8 CCR § 9795.3.

One practical warning: if the interpreter fails to appear, the missed-appointment fee is triggered exactly as if you had failed to appear. Confirm the interpreter several days in advance.

Recording, and who may be in the room

In Rodriguez v. Waste Management Collection and Recycling, the WCAB permitted an applicant to audio-record the examination at their own expense, relying on Code of Civil Procedure § 2032.510. That is a panel decision — citable, not binding — and evaluator offices vary widely in whether they accept it. Advance written notice to the evaluator and the other side is the safer course.

There is no California statute or regulation guaranteeing you the right to bring a companion into the examination room. A family member is usually welcome in the waiting room; the evaluator controls the exam room.

Remote evaluations are permitted under 8 CCR § 46.3, but only where no hands-on examination is necessary, only for AOE/COE, termination of benefits, or work-restriction disputes, and only with written agreement from you, the carrier, and the QME, plus a written attestation from the evaluator.

Surveillance video

Sub rosa footage is a non-medical record under LC § 4062.3(a)(2). The procedure is: the defense serves it on your attorney twenty days before proposing to send it to the QME; you have ten days to object; a timely objection keeps it out absent a judge's order.

If it goes through, the evaluator watches it and comments — and bills for it under a dedicated fee code, ML205, at $325 per hour. The existence of a billing code specifically for reviewing surveillance footage tells you how routine this has become.

What this means for you: the evaluator has very likely watched video of you before writing a word. What you say about your limitations will be measured against it. This is the most common way a truthful claim starts to look untruthful.

How injured workers lose value at a QME

We are going to be direct about this, because nobody else is.

Under-reporting. The Guides rate impairment substantially through activities of daily living. A worker who minimizes — "I manage, I'm fine" — produces a lower impairment number than the same worker describing the same limitations accurately. Stoicism is not rewarded here. It is scored. Exaggeration is equally destructive, because validity testing and surveillance catch it. What you want is accuracy: not optimism, not advocacy.

Leaving out body parts. LC § 4062.3(j) requires the evaluator to address all contested issues arising from injuries reported on claim forms filed before your initial appointment. A body part you never mention, and that is not in the records, goes unrated. Adding it later usually means a new claim form, a new panel, and months of delay. Compensable consequences count too — the shoulder that failed from overusing it after the back injury, the sleep disruption, the depression.

Inconsistency with the record. The evaluator has everything. Discrepancies about how the injury happened, when symptoms started, or what treatment you had read as credibility problems — and a credibility finding contaminates everything downstream. A report that finds you not credible will apportion aggressively and rate conservatively.

Hiding a prior injury. This is the single most expensive mistake in the system, and it is entirely avoidable.

LC § 4663(d) requires you, on request, to disclose all previous permanent disabilities or physical impairments. And LC § 4664(b) creates a conclusive presumption: if you have a prior award of permanent disability, that disability is conclusively presumed to still exist at the time of your new injury. The defense will find the prior award — it is a matter of record. Concealing it converts a manageable apportionment argument into a credibility collapse that costs you on every body part.

Disclose fully, and then describe accurately how well you had actually recovered. Functional recovery is precisely what a competent evaluator needs in order to apportion correctly.

Effort testing. Modern evaluations embed validity measures — consistency checks in orthopedics, performance-validity instruments in psychology, grip-strength coefficient-of-variation testing in hand evaluations. A worker who holds back to protect a painful limb can be scored as invalid, which can void the impairment finding entirely. Give genuine best effort, and say out loud when pain stops you. A documented "stopped due to pain" is data. An unexplained submaximal effort is a red flag.

Missing the appointment. The ML200 fee is $503.75, payable when you fail to appear, arrive more than thirty minutes late, leave before completion, or cancel within six business days. Claims administrators routinely seek to charge it back. Worse, LC § 4053 provides that a worker who fails or refuses to submit to examination has the right to maintain a proceeding for compensation suspended. If you have good cause, cancel in writing with your reasons served on the other side.

Talking to the evaluator off the record. Every substantive communication must be in writing and served on the other side. Handing the doctor an unserved letter, or calling the office to explain something, creates an ex parte violation attributable to your side — and under Suon v. California Dairies (WCAB en banc, 2018) the remedy is discretionary, which can mean losing the evaluator you wanted. LC § 4062.3(i) does protect what you say during the examination itself.

Apportionment: where the money actually goes

Apportionment is the evaluator's job, and it is where most cases are won or lost.

LC § 4663(a): apportionment of permanent disability is based on causation. § 4663(b): a physician writing a permanent disability report must address causation. § 4664(a): the employer is liable only for the percentage of disability directly caused by the industrial injury.

Under Escobedo v. Marshalls (WCAB en banc), it is not enough for an evaluator to write "50% non-industrial." The report must explain how and why the non-industrial factors are responsible for that portion of the disability, in terms a judge can follow. An apportionment opinion without that reasoning is not substantial evidence, and it can be struck. Knowing that is often worth more than arguing about the percentage.

The case law an evaluator must apply:

• Nunes v. State of California (2023, en banc) — apportionment must be medical, not vocational.
• Benson v. Permanente Medical Group — separate industrial injuries generally get separate awards rather than one combined award.
• City of Jackson v. WCAB — genetic predisposition can be a valid basis for apportionment.
• City of Petaluma v. WCAB (Lindh) — an asymptomatic pre-existing condition can support apportionment.
• Vigil v. County of Kern (2024, en banc) — the Combined Values Chart is rebuttable.

One distinction that costs workers real money: apportionment applies to permanent disability. It does not reduce your entitlement to medical treatment for the industrial injury. Adjusters conflate the two.

Two doctrines worth knowing by name

Almaraz/Guzman. The AMA Guides sometimes produce an impairment number that plainly does not reflect what a worker has actually lost. Under Almaraz/Guzman, an evaluator may depart from the strict Guides methodology and use another portion of the Guides to arrive at a more accurate impairment — provided the report explains the reasoning. For workers whose real disability is poorly captured by the standard tables, this is often the difference between a modest rating and an accurate one. It only happens if the evaluator is asked to consider it.

Ogilvie. Where the standard earning-capacity adjustment understates a worker's actual loss of future earnings, Ogilvie provides a path to rebut it. Narrower than it once was, but live.

Neither doctrine applies itself. Both require the report to be developed deliberately.

A worked example

Illustrative only. Every case turns on its own facts, records, and evaluator.

Maria is 42, works in a Fontana warehouse, earns $1,100 a week, and injures her lower back lifting. Her claim is accepted. After eight months of treatment she is found permanent and stationary. The claims administrator disputes the treating physician's impairment finding.

1. The objection. The administrator objects to the PTP report. Maria is represented, so the window is 20 days (LC § 4062(a)).
2. The panel request. Her attorney may request a panel no earlier than the first working day at least 10 days after the objection was mailed — practically 15 days, applying Messele. The request designates orthopedic surgery and must be served on the defense within 1 working day of generating the panel.
3. The strike. Three orthopedists issue. Each side strikes one within 10 days plus 5 for mail. Maria's attorney researches all three, strikes the one with a pattern of low ratings and aggressive apportionment. The defense strikes another. Dr. C remains.
4. Scheduling. The appointment must be within 90 days of the request. Records go to Dr. C — but the defense must serve them on Maria's attorney 20 days first. Buried in the file is eleven minutes of surveillance video. Her attorney has 10 days to object.
5. The exam. Maria describes her back, her radiating leg symptoms, the sleep disruption, and — critically — the shoulder that has begun to fail from favoring her back. She discloses a 2016 neck claim that resolved with a small award. Exam runs about two hours.
6. The report. Due within 30 days of the exam. Dr. C finds 12% whole person impairment for the lumbar spine, apportions 20% to the prior injury and degenerative changes, and reasons the apportionment out under Escobedo.
7. The math. 12% WPI × 1.4 = 16.8, adjusted for her occupational group and age, yields a permanent disability percentage. Apply the § 4658 schedule: a rating in the 15–24.75% band pays 5 weeks per point, and the permanent disability rate is capped at $290 per week. That produces the permanent disability award — before the analysis of whether to take a Compromise and Release or Stipulations with an open right to future medical care.

The two moments that mattered most were both procedural: the strike, and the ten-day objection to the video.

What changed in 2026

A continuing-education requirement bites this year. 8 CCR § 55.1 has been operative since February 26, 2024; what changes on April 1, 2026 is that its 16-hour requirement attaches to applications for reappointment received on or after that date.

Report standardization is coming. AB 1293 directs the DWC to develop standardized QME report templates, with regulations due by January 1, 2027. Expect the form and content of these reports to change meaningfully in the next eighteen months.

Appointment windows are longer than they used to be. The outer limits moved from 60/90 days to 90/120 days effective February 2, 2023 — a change that reflects a real shortage of available evaluators. The California State Auditor documented QME access problems in 2019, and the RAND Corporation's study of the medical-legal process reached similar conclusions. If you are told the first available appointment is four months out, that is the system working as it currently is, not someone stalling.

What to do right now

If you have a panel in hand, the clock is running. Ten days, extended by five for mail. Do not let it lapse — if you do, the insurance company picks your doctor from the names that are left.

Before the exam: write down every body part that hurts, including the ones that started hurting because you were compensating. Locate your prior claims and awards; disclose them. Write out how your daily activities have actually changed — dressing, sleeping, driving, lifting your children, standing at the sink.

At the exam: be accurate. Not brave, not dramatic. Accurate.

After: the report is due in 30 days. If day 31 passes with no report, object in writing before it is served — that objection is what preserves your right to a replacement.

Frequently asked questions

This page explains California law generally. It is not legal advice about your case, and reading it does not create an attorney-client relationship. Deadlines run from case-specific dates, and several issues discussed above are the subject of unresolved WCAB panel splits.

What people actually ask about the exam

• What happens at my QME appointment?
• What is an AME?
• They want me to see their doctor.
• How to read the report your whole case is built on.
• For treating physicianswhat California actually requires of the report, if you want to hand your doctor something