QME Frequently Asked Questions

A Qualified Medical Evaluator is a physician appointed by the Administrative Director of the California Division of Workers' Compensation to evaluate disputed medical issues in workers' compensation claims. Under Labor Code §139.2, appointment requires passing a state competency examination and meeting education requirements, and QMEs must seek reappointment every two years with continuing education. It is a state-issued designation that many expert witnesses do not hold.

A QME is a state-appointed evaluator selected through the DWC panel process. An AME (Agreed Medical Evaluator) is a physician both parties in a represented case stipulate to instead of using the panel — a role, not a credential, whose opinions carry particular weight because both sides chose the evaluator. An IME (independent medical examination) is the general term for a non-treating physician's evaluation, used in personal injury, disability, and liability matters outside the workers' compensation panel system.

The claims administrator (the employer's insurer or third-party administrator) pays for the medical-legal evaluation under the state's medical-legal fee schedule. The injured worker does not pay for a panel QME evaluation. Fee disputes between evaluators and administrators are resolved through administrative processes that do not involve the worker.

The DWC Medical Unit issues a randomly generated panel of three QMEs in the appropriate specialty — ophthalmology for eye disputes. In unrepresented cases, the injured worker picks one of the three and schedules the appointment. In represented cases, each side may strike one name, and the remaining physician performs the evaluation. Parties in represented cases may instead bypass the panel by agreeing on an AME.

Current glasses and contact lenses, since best-corrected vision is a central measurement in an eye evaluation; a list of medications including eye drops; and any items the appointment notice requests. Records are ordinarily provided by the parties in advance under the rules governing what may be sent to a QME, rather than hand-carried.

The written report is generally due within thirty days of the examination, with limited extensions available for good cause, such as outstanding test results or records received late. Supplemental reports responding to additional questions or new records are subject to their own shorter deadlines under the regulations.

Only within strict limits. Ex parte communication — one party communicating with the QME without the other — is prohibited, and a violation can entitle the aggrieved party to terminate the evaluation and obtain a new evaluator. Written communications and records sent to the QME must generally be served on the opposing party in advance. The safe practice is simple: nothing goes to the evaluator that the other side has not seen.

The primary tools are a request for a supplemental report addressing specific objections, new records, or claimed factual errors, and a deposition of the QME, where counsel examines the evaluator under oath on the report's reasoning. In represented cases the parties may also agree to an AME. Whether a report can be excluded or a replacement evaluator obtained is a legal question governed by the regulations and case law.

Procedural defects such as untimeliness can, in some circumstances, give a party rights up to and including a replacement panel, and substantive incompleteness — failure to address required elements such as causation or apportionment with reasoning — is a standard basis for supplemental report requests. The remedies available in a particular case are for counsel to assess.

No. The QME provides medical opinions — diagnosis, causation, permanent and stationary status, impairment, apportionment, future care, work restrictions. How those opinions translate into benefits is determined by the parties' resolution or by a workers' compensation judge. The evaluator has no stake in, and no authority over, the legal outcome.

Because the disputed evidence is specialty-specific: interpreting OCT scans, automated visual fields, and gonioscopy findings, and knowing the natural course of conditions such as traumatic cataract and angle-recession glaucoma. Panels are issued by specialty so that eye disputes are evaluated by physicians trained in exactly this evidence.

No. The QME evaluates and reports but does not treat, and no physician-patient treatment relationship is formed. Treatment remains with the worker's own physicians within the workers' compensation medical system. This site is a resource for attorneys and claims professionals, not a patient portal.