The California QME process — every deadline, explained

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

The process is not the same for everyone.

If you are unrepresented, the employer is legally barred from discussing QME selection with you. If an adjusterClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. suggests which doctor to pick, that is grounds for relief.

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; electronic service of medical-legal reports adds 2 business days.

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. 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. When a replacement is properly sought, neither party owes the late evaluator anything.

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), a supplemental report, or a motion attacking the report as not substantial evidenceSubstantial evidence The standard a medical opinion must meet to support a finding..

The law 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); a disqualifying conflict of interest; failure to serve a timely report, with the pre-service objection described above; a violation of the appointment or cancellation rules in § 34; a panel issued in a medically inappropriate specialty, submitted to the Medical Director with either side able to appeal to a judge; and a stale panel — 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 — 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, and a QME may still await a diagnostic or consulting report, which is why § 38(c) grants an extension for one.

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

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.

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 disabilityTD / TTD / TPD Temporary Disability, Total or Partial. Wage replacement while recovering. Two-thirds of average weekly earnings; 2026 maximum $1,764.11/week. 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.

Surveillance video. Sub rosa footage is a non-medical record. 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.

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 — the law 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. 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.
• Hiding a prior injury — The single most expensive mistake in the system, and entirely avoidable. The law requires you, on request, to disclose all previous permanent disabilities or physical impairments. The law 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. Disclose fully, then describe accurately how well you had actually recovered.
• 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. Worse, the law 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. § 4062.3(i) does protect what you say during the examination itself.

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

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.

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.

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 stationaryP&S / MMI Permanent and Stationary / Maximum Medical Improvement. Your condition has plateaued — not that you are healed. Temporary disability ends here.. The claims administrator disputes the treating physician’s impairment finding.

How it unfolds

1. The objection The administrator objects to the PTPPTP Primary Treating Physician. The doctor directing your care. report. Maria is represented, so the window is 20 days.
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 impairmentWPI — Whole Person Impairment The percentage from the AMA Guides that a rating is built from. Extremity percent is not whole person percent: 100% upper extremity = 60% whole person, 100% lower extremity = 40%. This is the most common source of confusion in a rating. 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.

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

• 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 — the law makes a prior award conclusively presumed to still exist. Concealing it is the most expensive mistake in the system.
• Write out how your daily activities have actually changed — Dressing, sleeping, driving, lifting your children, standing at the sink. This is what the rating is built from.
• 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.