Sent to a QME in California? From the Panel to the Report

On this page

Why one report weighs so much The objection that starts it Choosing from three Before the exam: the file the evaluator reads The appointment In the room Accurate, in both directions The report: 30 days, then read it When the report is wrong When you do not need a lawyer for this A file to bring to the QME Key takeaways Frequently asked questions Tell us what happened

In thirty seconds

A Qualified Medical Evaluator, a QME, is the doctor California uses when you and the insurance company disagree about a medical question in your claim. You get a randomly generated panel of three. Without a lawyer you pick one; with a lawyer each side strikes one. Either way you have ten days.
The examination is not treatment. The evaluator has usually read your whole file before you arrive, sometimes including surveillance video, and much of the rating is built from what you say about your history and your daily life. Be accurate: not brave, not dramatic.
The report is due 30 days after the exam. Read it when it arrives: every body part, whole person impairment, the reasoning behind any apportionment, and future medical care. The ways to correct or challenge it have short deadlines, and after the settlement conference the record is largely fixed.

The envelope says the panel has been issued, and inside are three names: three doctors in three offices you have never been to, perhaps one in Torrance, one in Riverside and one in Pasadena. For a carpenter in Lancaster or a home health aide in Long Beach, the list can look like a formality. It is not.

This is usually the point where a contested claim stops turning on your treating doctor and starts turning on one examination. The evaluator will see you once, often for a few hours, review everything in the file, and write a report that a judge will rarely set aside.

This article walks through the QME process in the order you live it: why the report carries so much weight, how a panel is requested and chosen, what happens before and during the examination, and how to read the report and what can be done if it is wrong. It does not predict what any evaluator will find.

Why one report weighs so much

The evaluator answers the questions the claim turns on.

When the claims administrator, or you, disagrees with a medical opinion from your treating physician, the disagreement is not settled by argument with the adjuster. It goes to a medical-legal evaluator: a Qualified Medical Evaluator chosen from a state panel, or an Agreed Medical Evaluator, an AME, if both sides have lawyers and agree on one doctor. Elsewhere, an exam like this is often called an independent medical exam, or IME.

The questions the evaluator answers are the ones the money follows:

Is the injury work-related? Whether there is a claim at all.
Are you permanent and stationary? That ends temporary disability and starts permanent disability.
What is your impairment? It becomes a rating, then weeks, then dollars.
How much is apportioned to other causes? That reduces the award directly, and it is usually where the largest sums are lost.
What are your work restrictions? They drive return to work and the voucher.
Do you need future medical care? Whether treatment stays open for life, and what it is worth in a settlement.

Figure 1. What the evaluator decides, and what each answer controls: whether there is a claim, when temporary disability ends, the impairment the rating is built from, the share cut by apportionment, the work restrictions, and future medical care.

It is also a gate. A disputed medical issue, including whether you have permanent impairment and how much, cannot be submitted to a judge at all unless there is a report from the treating physician and a report from a QME or AME. No evaluator’s report, no ruling.

And it is the evidence. The evaluator’s report is the one written to answer the contested questions, and a well-reasoned one becomes the substantial medical evidence a judge relies on.

Impairment is rated under the AMA Guides, Fifth Edition, and much of that rating turns on your activities of daily living: dressing, sleeping, driving, lifting, standing at the sink.

The QME process, every deadline Workers’ comp claim denied? From the letter to the judge

The objection that starts it

No objection, no panel.

A panel follows an objection to a medical opinion, usually a report from your treating physician that one side disagrees with: a finding that you are permanent and stationary, a low impairment, a release to work, an opinion that the injury is not work-related.

The deadline to object is short. It is 20 days from receiving the report if you have a lawyer, and 30 days if you do not. The objection is the legal basis for the panel that follows, and a late or defective objection can undo the panel built on it.

Without a lawyer, you usually ask for the panel yourself. The request is QME Form 105, and you choose the specialty on the form: orthopedic surgery for a back, psychiatry for a psychiatric injury, and so on. Your employer may file the request only if you have not done so within 10 days.

With a lawyer, either side may ask, on QME Form 106, and the specialty can be contested. But not right away: no earlier than the first working day at least 10 days after the objection was mailed. Under Messele v. Pitco Foods, an en banc decision of the Appeals Board in 2011, mail to a California address adds five days, so in practice it is about 15. A premature request is void, and the other side’s later, valid request controls.

The panel has to be served. The party who generates a panel serves it on the other side within one working day, with proof of service and the supporting documents. In Lopez v. Rockstar Staffing, a 2023 panel decision, a panel was struck simply because service was late and the supporting documents were left out.

DO NOT COUNT FROM THE DATE ON THE REPORT

The objection clock runs from the day you received the report. Write that day down when the envelope arrives, and keep the envelope.

Workers’ comp checks stopped? Why they end, and what comes next My doctor said I’m permanent and stationary

Choosing from three

Without a lawyer you pick one. With a lawyer each side strikes one.

The panel is three evaluators in the specialty requested, generated at random by the state.

If you do not have a lawyer. You have 10 days to select one of the three, contact the office, schedule the appointment and tell the claims administrator. If the 10 days pass, the claims administrator selects the evaluator and sets the appointment for you. Your employer is barred from discussing the choice with you. An adjuster who suggests which doctor to pick has given you grounds to ask for relief.

If you have a lawyer. Each side strikes one name within 10 days, five more when the panel was served by mail in California. The doctor left standing is the evaluator. A side that misses its strike lets the other side select any doctor who remains. Your side then has 10 days to schedule the examination and tell the employer, or the defense may set it.

Figure 2. Three names, two ways to choose. Without a lawyer, you select one of the three within 10 days, or the claims administrator selects for you. With a lawyer, each side strikes one within 10 days, five more by California mail, and the name left is the evaluator; a missed strike lets the other side pick.

The requesting side’s own clock is not settled: Crawford v. Northgate Landscape Management, a 2019 panel decision, allowed 10 days flat, and Rodriguez v. Continuing Life, a 2022 panel decision, allowed 15. Panel decisions bind no one. Assume the shorter period.

Or one doctor both sides choose. With lawyers on both sides, the parties can skip the panel and agree on an Agreed Medical Evaluator. An AME is usually more experienced and the route is often faster, but judges give an AME’s report substantial deference, and a side that agreed to the doctor can hardly complain about the result. A bad panel report can be attacked from several directions; a bad AME report is close to final. It turns on the particular doctor and body part, and it is not a choice to make casually.

What is an AME?

Before the exam: the file the evaluator reads

What goes to the doctor, and what you can keep out.

Records reach the evaluator’s office before you do. By the time you walk in, the doctor usually has your claim form, the Doctor’s First Report, every progress report from your treating physician, perhaps your deposition transcript, and often surveillance footage.

Records are served on you first. A side that wants to send records or other information to the evaluator has to serve them on the other side at least 20 days before they go. The letter that sets out the questions for the evaluator is served at least 20 days before the examination.

Some of it you can keep out. If you object within 10 days to non-medical records, such as surveillance video, a personnel file or social media posts, they cannot be sent to the evaluator unless a judge orders it.

Everything else goes in writing. Every communication with the evaluator is in writing and sent at the same time to the other side. Handing the doctor an unserved letter, or calling the office to explain something, is an ex parte contact attributed to your side. In Suon v. California Dairies, an en banc decision of 2018, the Appeals Board made the remedy for that a matter of discretion, which can mean losing the evaluator you wanted. What you say to the doctor during the examination itself is protected.

THE TEN DAYS TO KEEP VIDEO OUT

Surveillance is a non-medical record. When the other side serves it, you have 10 days to object, and a timely objection keeps it from the evaluator unless a judge orders otherwise. After that, assume the doctor has watched it.

Your own deposition may come first. If the employer takes your sworn testimony and you have a lawyer, the employer pays the lawyer’s fee, and you get one free copy of the transcript. Read it, because the evaluator may.

Your deposition, and who pays They’re following me

The appointment

Scheduling, cancelling, and what it costs you.

When. The examination has to be available within 90 days of the request for an appointment, or 120 days if the parties agree to wait. Past that, either side may ask for a replacement evaluator. Those limits were 60 and 90 days until February 2, 2023, so a first appointment four months out is the system working as it now does.

The notice. The evaluator’s office sends an appointment notice, QME Form 110, within five business days of the date the appointment was made. If you do not have a lawyer, you also receive QME Form 108, which tells you, correctly, that there is no charge.

What it costs you. Nothing. There is no fee or co-payment for the examination or for an interpreter. The employer pays reasonable transportation, meals and lodging, and temporary disability continues for time you lose from work to attend. The mileage is supposed to be paid when you are notified of the appointment, not afterward, at 76 cents a mile for travel on or after July 1, 2026.

Cancelling. Do not cancel or reschedule less than six business days before the appointment unless you have good cause. If you do have good cause, cancel in writing and serve your reasons on the other side.

Not going. A worker who fails or refuses to attend, or obstructs the examination, has the right to proceed with the claim suspended. Arriving more than 30 minutes late or leaving before the examination is finished triggers the missed-appointment fee, and so does an interpreter who does not appear. Confirm the interpreter several days ahead.

Mileage and travel reimbursement I need an interpreter

In the room

It is not treatment. It is an examination for a dispute.

The doctor whose name is on the report does the work. Only the signing physician may take your history, review your records and write the conclusions. The report must say so, under penalty of perjury, and a report that breaks the rule is open to attack.

The history is where the case is decided. How the injury happened, in your own words; your job duties; every symptom in every body part; your daily activities; prior injuries, claims and awards; your treatment. Expect the same questions more than once, in different orders.

Then the physical examination. Range of motion, often measured with an inclinometer, strength, sensation, provocative tests and gait. Plan on about one and a half to three hours for a routine orthopedic evaluation, and three to five hours, sometimes over more than one visit, for a psychiatric evaluation with testing.

An interpreter, if you need one. A certified interpreter, identified on the appointment notice and paid by the claims administrator. Never a family member: an inaccurate history in this report follows you through the whole case.

Who else may be in the room. No statute or regulation guarantees you a companion in the examination room. The waiting room, usually yes; the examination room, the evaluator decides. One Appeals Board panel decision allowed a worker to make an audio recording at the worker’s own expense. It binds no one and offices vary, so give advance written notice if you want to record.

The evaluator writes down what you tell them. A limit you leave out is a limit that is not rated.

The evaluator writes down what you tell them. A limit you leave out is a limit that is not rated.

What happens at my QME appointment

Accurate, in both directions

Most value is lost by understatement, not by exaggeration.

Injured workers rarely lose value at a QME by lying. They lose it by being polite, and by forgetting.

Under-reporting. “I manage” and “it’s not that bad” are reflexes, and they end up in the report as findings. The Guides rate impairment substantially through activities of daily living, so a worker who minimizes produces a lower number than the same worker describing the same limits accurately. Stoicism is not rewarded here. It is scored.
Leaving out a body part. The evaluator has to address the contested issues arising from the injuries reported on claim forms filed before your first appointment. A body part you never mention, and that is not in the records, goes unrated. That includes the shoulder that failed from favoring the back.
Inconsistency with the record. The evaluator has the whole file, and a different account of how it happened or when symptoms started reads as a credibility problem.
Hiding a prior injury. On request, the law requires you to disclose prior permanent disabilities, and a prior award of permanent disability is conclusively presumed to still exist at the time of the new injury. The other side will find it; it is a matter of record. Disclose it, then describe how well you had actually recovered. A prior injury does not defeat a claim. Apportionment is to prior disability, not to prior injury.
Effort testing. Evaluations build in validity measures, such as consistency checks and grip-strength testing. Holding back to protect a painful arm can be scored as invalid. Give your real best effort and say out loud when pain stops you. “Stopped due to pain” in the report is data; an unexplained weak effort is a red flag.
Exaggeration. It is as destructive as minimizing, because the testing and the video catch it.

Describe the fluctuation. Most injuries have good days and bad days. “On a good day I can do it, and then I am down for the rest of the day” is truthful, it is what the evaluator needs in order to rate you, and it is consistent with any video of a good day. And be specific. “I can stand for about twenty minutes before I have to sit” is a usable finding. “Standing hurts” is not.

THE MOST EXPENSIVE MISTAKE

Concealing a prior injury or award is the most costly avoidable mistake in the process. The record exists whether you mention it or not; the only question is whether your account matches it.

Apportionment

The report: 30 days, then read it

Due a month after the exam, and read the week it arrives.

The evaluator has 30 days from the day you were seen to complete and serve the report. An extension is requested on QME Form 112, no later than five days before the 30 days run out, and it is not available because records are missing: the evaluator reports on what it has.

Figure 3. From the objection to the report, in order, with each step’s clock: the objection (20 days with a lawyer, 30 without), the panel request, the 10 days to select or strike, the appointment within 90 days of the request (120 by agreement), and the report within 30 days of the examination. Not to scale.

The trap in a late report. A replacement evaluator for a late report is available only if a side objected to the lateness in writing before the report was served, and attaches that objection to the request. Object on day 31 and the remedy is there; wait for an unfavorable report on day 45 and it is gone. When a replacement is properly sought, neither side owes the late evaluator anything.

Realistically, it is four to eight months from the objection to the report. When the report comes, it is long and technical, and almost nobody reads it carefully. Read it in this order.

Is every injured body part addressed? Not mentioned in the history, but addressed, with findings and an impairment. A body part that appears in your treatment records but not in this report contributes nothing to the rating.

Are the work restrictions specific? Pounds, hours, positions, frequencies, surfaces. “Light duty” is not a restriction, and a vague one is the root of most return-to-work disputes.

Is impairment stated as whole person impairment, with the method named? An arm or leg percentage is not a whole person percentage. A total loss of an upper extremity is 60% of the whole person, and of a lower extremity 40%. A shoulder report that says “20% upper extremity” means 12% whole person, not 20, and that is the most common source of confusion in a rating. The report should name the method; a number without one cannot be checked.

Figure 4. Extremity is not whole person, to scale in whole person impairment. A total loss of an upper extremity is 60% of the whole person; of a lower extremity, 40%. Illustrative: a shoulder rated at 20% of the upper extremity is 12% of the whole person.

Does the apportionment paragraph explain itself? It can decide more of the case than any other paragraph. Under Escobedo v. Marshalls, an en banc decision of the Appeals Board in 2005, a doctor who blames part of a disability on something other than the work injury has to explain how and why. A percentage attached to a named condition, with no reasoning, is not substantial evidence. Check the list of records reviewed: a doctor apportioning to an old condition who reviewed nothing from before the injury has no factual basis for the number.

Did the strict rating fail? Some injuries rate poorly by the book. Under Almaraz/Guzman, an en banc decision of 2009, an evaluator may use another method inside the Guides where the strict rating plainly does not capture the impairment, but the report has to explain why the strict rating fails and why the alternative is more accurate.

Is future medical care described? What you will need, and for how long. In any claim involving a device, a joint replacement, ongoing medication or a condition that progresses, read this paragraph before any talk of settlement.

Is causation stated under the right test? For a physical injury, California requires only that the work be a contributing cause, not the only cause and not the main one. A report that holds you to a higher standard is applying the wrong test.

Is the history right? Read it as if it were a deposition transcript, because it will be used like one.

APPORTIONMENT IS NOT A TREATMENT DENIAL

Apportionment reduces permanent disability. It does not reduce your right to medical treatment for the work injury, and adjusters sometimes conflate the two.

How to read your medical-legal report What is Almaraz/Guzman?

When the report is wrong

Correction, a supplemental report, or cross-examination.

If you do not have a lawyer. You may ask the evaluator to correct factual errors, on QME Form 37, within 30 days of receiving the report, served on the evaluator, the claims administrator and the state’s Disability Evaluation Unit. The evaluator then has 10 days to decide whether corrections are needed and file a supplemental report saying whether they change any opinion, or 15 days if the claims administrator asked too. Separately, the Disability Evaluation Unit turns the report into a summary rating, and you have 30 days from receiving that rating to ask in writing for reconsideration.

If you have a lawyer. There is no fixed deadline to object to the substance of the report. The remedies are a supplemental report, due within 60 days of the request and extendable by 30 days by agreement; cross-examination of the evaluator at a deposition, paid for by the employer, with the evaluator available within 120 days of the notice; and a motion attacking the report as not substantial evidence. An apportionment opinion that fails Escobedo is the usual target.

BEFORE THE SETTLEMENT CONFERENCE

Discovery generally closes at the mandatory settlement conference. A missing body part or a wrong history is correctable before it; afterward, generally, it is too late. The weeks after the report arrives are when a review is worth the most and costs the least.

When you do not need a lawyer for this

The unrepresented route is built to be walked alone.

Many workers go through a panel without a lawyer, and the rules are written for that. The forms are free, you choose the evaluator yourself, and the state’s Information and Assistance officer will help with the forms at no cost. If the question is a single body part, the claim is accepted, and the report reads as accurate to you, you may not need anyone.

A consultation is worth having when the stakes rise: an apportionment to a prior injury, surveillance served on you with 10 days to object, a deposition the employer has noticed (where, if you are represented, the employer pays your lawyer’s fee), a report that leaves out a body part or rates an injury the Guides handle poorly, or a choice between a panel and an AME. A consultation with this office costs nothing, and if there is nothing worth doing, we will tell you that.

When you don’t need a lawyer

A file to bring to the QME

Written down before the day, not remembered in the room.

Every body part and every symptom — Written, including the ones that started because you were compensating for the first injury.
What you cannot do at home — Dressing, bathing, cooking, sleeping, driving, lifting a child, opening jars, stairs. Frequency and duration: how long, how often.
Your prior injuries, claims and awards — Dates, body parts, and how well you had recovered before this injury.
Imaging and records you hold — Anything that may not have been sent, served properly on the other side if it is to go to the doctor.
The dates that start clocks — The day you received the report you objected to, the day the panel was served, and the day of the examination, so you can count to 30.

Key takeaways

The evaluator’s report usually decides the medical questions. Whether the injury is work-related, when temporary disability ends, the impairment, apportionment, restrictions and future medical care.
The panel follows an objection, and both are on short clocks. 20 days to object with a lawyer, 30 without; then 10 days to select or strike, five more by mail.
What goes to the doctor is served first. You have 10 days to object to non-medical records such as surveillance, and every contact with the evaluator is in writing to both sides.
In the room, be accurate in both directions. Name every body part, disclose prior injuries, describe your daily limits specifically, and give real effort.
The report is due in 30 days; read it the week it arrives. Body parts, whole person impairment, the apportionment reasoning and future medical care, before the settlement conference fixes the record.

Frequently asked questions

Do I have to go to the QME appointment?

Yes. If you fail or refuse to attend, your right to proceed with the claim is suspended. With good cause, cancel in writing and serve your reasons on the other side.

Who pays for the QME?

The claims administrator. There is no charge to you for the examination or an interpreter, and reasonable travel costs are paid.

Can I choose my QME?

From the panel of three. Without a lawyer, you select one of the three within 10 days. With a lawyer, each side strikes one and the remaining doctor is the evaluator.

Can the insurance company send surveillance video to the QME?

Yes, if it is served on you or your lawyer at least 20 days before it goes, and you do not object within 10 days. A timely objection keeps it out unless a judge orders otherwise.

How long does the QME take to send the report?

The report is due within 30 days of the examination. If it is late, object in writing before it is served; that objection is what preserves the right to a replacement.

What if I disagree with the QME report?

Without a lawyer, ask for factual correction within 30 days, and for reconsideration of the summary rating within 30 days of receiving it. With a lawyer: a supplemental report, a deposition of the evaluator, or a challenge to the report as evidence.

Sources

Labor Code § 4053§ 4060§ 4061§ 4062§ 4062.1§ 4062.2§ 4062.3§ 4062.5§ 4600(e)§ 4628§ 4663§ 4664§ 5710(b)8 CCR § 30§ 31.1§ 31.3§ 31.5§ 31.7§ 34§ 35§ 36.7§ 37§ 38§ 10160Messele v. Pitco Foods (2011) 76 Cal.Comp.Cases 956 (WCAB en banc)Suon v. California Dairies (2018) (WCAB en banc, 2018-EB-2)Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (WCAB en banc)Almaraz/Guzman II (2009) (WCAB en banc), affirmed in Milpitas Unified School District v. WCAB (Guzman) (2010)Lopez v. Rockstar Staffing (2023) (WCAB panel decision)Crawford v. Northgate Landscape Mgmt. (2019) (WCAB panel decision)Rodriguez v. Continuing Life (2022) (WCAB panel decision)AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition.

General information about California law, not legal advice about your case.

Impairment values described are from the AMA Guides, 5th Edition as applied under the California rating schedule; the Guides are a copyrighted medical text and figures here are summarized rather than reproduced. Your rating depends on your own examination findings.

Reviewed by Jamey Teitell, Partner & Trial Attorney · Last reviewed October 20, 2026

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