In a California workers’ compensation case, an Agreed Medical Evaluator (AME) is a doctor both sides pick together, and a Qualified Medical Evaluator (QME) is a doctor drawn from a state-issued panel when the parties can’t agree or when the injured worker has no attorney. That’s the core of the AME vs. QME question in California workers’ comp: same job, different selection process, and very different legal weight. Which one you end up with is decided almost entirely by whether you’re represented.
Representation Decides Which Evaluator You Get
California law splits the medical evaluation process in two based on whether the injured worker has an attorney.
If you have a lawyer, both sides can negotiate to agree on one doctor, the AME. If they can’t agree, either side can request a three-member QME panel from the Division of Workers’ Compensation (DWC), and each side strikes one name. The doctor left standing performs the evaluation.1California Legislative Information. California Labor Code 4062.2
If you don’t have a lawyer, an AME isn’t an option at all. The employer is prohibited from even proposing one, and your evaluation has to come from a QME panel.2Justia Law. California Labor Code 4062.1 That matters because, as covered below, an AME report is much harder to dislodge than a QME report.
How an AME Gets Selected
Only represented cases use an AME. The two attorneys exchange names and negotiate until they land on one doctor. There’s no formal deadline, and the process is voluntary throughout. Either side can walk away and request a QME panel instead.
The strategic appeal is mutual buy-in. Because both sides picked the doctor, neither side has much room to argue later that the evaluator was biased. The parties can agree on an AME at any point in the case, even after a QME panel has been requested, so long as they cancel that panel by mutual written consent.1California Legislative Information. California Labor Code 4062.2
Once chosen, the AME examines you, reviews records, and may order testing. The resulting report addresses whether the injury is work-related, the level of permanent impairment, work restrictions, and what future medical care you’ll need.
Any licensed physician can serve as an AME if both parties agree; QME certification isn’t required, though many AMEs also happen to be QME-certified.
How a QME Gets Selected
A QME comes into the picture when there’s a dispute over a medical issue: whether the injury is work-related, how impaired you are, or what treatment you still need.3California Legislative Information. California Labor Code 4060 The mechanics depend on representation.
If You Have an Attorney
When the parties can’t agree on an AME, either side can request a QME panel from the DWC’s Medical Unit. The request can’t be filed until at least 10 days after the initial request for evaluation or objection was mailed. The DWC then randomly assigns a three-doctor panel in the relevant specialty.1California Legislative Information. California Labor Code 4062.2
Within 10 days of receiving the panel, each side strikes one name. Whoever remains does the evaluation. If one side doesn’t strike a name in time, the other side can pick any of the remaining doctors.1California Legislative Information. California Labor Code 4062.2 The represented employee schedules the appointment, but if they don’t tell the employer of the appointment within 10 days after the evaluator is selected, the employer can schedule it instead.
If You Don’t Have an Attorney
An unrepresented worker requests a panel using DWC Form 105, which the employer is required to provide. The employer cannot steer you toward an AME.4California Department of Industrial Relations. California Code of Regulations Title 8 Section 30 – QME Panel Requests Once the three-name panel arrives, you have 10 days to pick a doctor and schedule the appointment. Miss that window and the employer gets to choose instead.2Justia Law. California Labor Code 4062.1
That deadline is one of the most commonly missed steps in the whole process. If it lapses, the insurance company picks the evaluator most favorable to its position.
Unrepresented workers get one additional protection at the appointment itself. The QME must give you a brief chance to ask questions about the process and the doctor’s background. If you have reason to believe the evaluator is biased, you can decline to proceed and request a new panel.2Justia Law. California Labor Code 4062.1
One more thing to know if your representation status changes. If you went through a comprehensive QME evaluation while represented and then lose your attorney, you don’t get a second evaluation on the same issues.1California Legislative Information. California Labor Code 4062.2
The Weight Each Report Carries
This is where the AME/QME distinction really bites. The two reports are not treated equally by workers’ compensation judges.
An AME report carries what amounts to a presumption of correctness. Because both sides chose the doctor, the Workers’ Compensation Appeals Board (WCAB) treats the AME’s opinion as the default medical evidence, and a judge will generally follow it unless there’s a compelling reason not to. Overturning an AME report is an uphill fight for either party.
A QME report doesn’t get that deference. When a QME’s opinion conflicts with the treating physician’s, the judge weighs both and follows whichever is more persuasive and constitutes substantial medical evidence. Neither report automatically wins.
The practical result: a favorable AME report is close to bulletproof. A favorable QME report helps, but the insurance company has more room to argue that the treating doctor’s findings should prevail, or vice versa. That’s the structural disadvantage unrepresented workers face without meaning to.
Communication Rules Apply to Both
California prohibits private, off-the-record contact with either an AME or a QME. Ex parte communication is flatly banned, and the rule applies equally to the worker’s attorney and to the insurer’s representative.5Justia Law. California Labor Code 4062.3
Any communication with the evaluator before the exam must be in writing and served on the other side at least 20 days ahead. Communication after the exam must also be in writing and copied to the other side.5Justia Law. California Labor Code 4062.3
If someone violates the rule, the other side can either terminate the evaluation and get a new panel or proceed with the current evaluator. The offending party can be held in contempt before the WCAB and made to pay costs, including evaluation costs, discovery expenses, and attorney’s fees.5Justia Law. California Labor Code 4062.3
Two practical exceptions. Routine scheduling calls with the evaluator’s office are fine, as is sending medical records. And you can speak freely with the evaluator during the actual examination. The ban targets behind-the-scenes advocacy by attorneys and insurers, not the clinical encounter itself.5Justia Law. California Labor Code 4062.3
Disputing the Report
Disagreeing with the evaluation doesn’t mean you’re stuck with it, but the path forward differs.
Challenging a QME Report
If you’re unrepresented and the DWC’s Disability Evaluation Unit hasn’t yet issued a summary rating, you can write directly to the QME asking for a supplemental report. Copy the claims administrator at least 20 days before sending the letter to the evaluator. The QME has 60 days to issue the supplemental report.6California Department of Industrial Relations. DWC Answers to Frequently Asked Questions About Qualified Medical Evaluators
If a summary rating has already issued, either side has 30 days to file a Request for Reconsideration using DEU Form 103. Reconsideration is limited to four grounds: the QME failed to address all disputed issues, addressed them incompletely, Medical Unit procedures were not followed, or the rating was calculated incorrectly.6California Department of Industrial Relations. DWC Answers to Frequently Asked Questions About Qualified Medical Evaluators
If your treating doctor and the QME disagree, you can negotiate a compromise or contact a DWC Information and Assistance officer to discuss your options.7California Department of Industrial Relations. DWC Answers to Frequently Assumed Questions About Qualified Medical Evaluators
Challenging an AME Report
AME reports are harder to attack, because the mutual selection undercuts any argument that the doctor was biased or unqualified. The usual approach is a deposition. Putting the AME under oath about methodology, reasoning, and what evidence was considered can surface errors or gaps that then become part of the record.
If disputes remain unresolved after supplemental reports or depositions, the case goes to a hearing. A workers’ compensation judge weighs the evaluator’s report against the treating physician’s records and any other medical evidence, and can accept the report, reject it, or order a fresh evaluation.
Travel Reimbursement
If you have to travel to the AME or QME, the employer or insurer must reimburse mileage. The DWC’s current rate is 72.5 cents per mile.8California Department of Industrial Relations. Medical Mileage Expense Form The employer must provide estimated travel expenses when scheduling the appointment. Track your mileage and submit the DWC’s mileage expense form to get paid.