Labor Code 4062.3: QME Communication, Ex Parte Rules, and Penalties

California Labor Code Section 4062.3 governs how injured workers and claims administrators share records with — and communicate with — the doctor conducting an independent medical evaluation in a workers’ compensation case. It sets a 20-day advance service rule and a 10-day objection window for panel Qualified Medical Evaluator (QME) exams, requires parties to agree up front on what an Agreed Medical Evaluator (AME) will see, bans ex parte contact with the evaluator, and attaches real penalties when either side cuts corners.¹

What You Can Send the Evaluator

Either party may send relevant medical and nonmedical records. Medical records cover treatment notes, imaging, and treating-physician reports. Nonmedical records are broader: employment files, job descriptions, surveillance footage, and deposition transcripts, so long as they relate to the medical issue being evaluated.¹

The implementing regulation adds a documentation step. The claims administrator (or the employer, if there is no claims administrator) must attach a log to the front of any packet sent to the evaluator, identifying each item and listing them in the order they appear.² If a dispute arises later about what the doctor actually saw, that log is the record.

Some materials are off-limits regardless of agreement. No party may send the evaluator any report or record that a Workers’ Compensation Administrative Law Judge has stricken, found inadequate, or ruled inadmissible.²

QME Panel Rules: 20-Day Service and 10-Day Objection

For a panel QME, a party planning to send records to the evaluator must first serve the identical packet on the opposing side at least 20 days before delivering it to the doctor. That window gives the other side time to review the materials and object.¹

The 10-day objection window applies to nonmedical records. If the opposing party objects within 10 days of service, those contested records cannot go to the evaluator unless a Workers’ Compensation Administrative Law Judge orders otherwise. Either party may also use discovery to challenge the accuracy or authenticity of nonmedical records before the evaluation.¹ Treating-physician medical records are not subject to the objection process.

Sending records to the evaluator while an objection is pending, or before the 20 days have run, is a procedural violation that can compromise the entire evaluation. Keep a proof of service showing date and method of delivery.

AME Rules: Agreement Up Front

When the parties jointly select an AME, the record-exchange process is handled differently. As part of the agreement to use that evaluator, both sides must also agree on exactly what information the AME will receive.¹ There is no 20-day advance service or 10-day objection window, because disputes over records are expected to be resolved when the AME is chosen.

Written communications with an AME still must be served on the opposing party at the same time they are sent to the doctor.

The Ex Parte Ban

Section 4062.3 prohibits ex parte communication — any private contact between one party and the evaluator that the other side is not told about. All written communications with the evaluator must be served on the opposing party simultaneously, and for QME evaluations, pre-evaluation written communications must also be served 20 days in advance.¹ Neither the worker’s attorney nor the claims adjuster may call the evaluator to discuss clinical findings, expected conclusions, or case strategy.

What Doesn’t Count as Ex Parte Contact

Routine administrative matters are allowed: scheduling appointments, handling missed appointments, requesting the status of a report, and coordinating the delivery of records. These contacts may be oral or written and may be directed to the physician’s staff or, for an AME, directly to the doctor. The exception falls away if the Appeals Board finds that an impermissible communication actually occurred during what was supposed to be an administrative call.¹

The Examination Itself

The pre-evaluation and ex parte restrictions do not apply to the injured worker’s own statements made during the physical examination or in response to the evaluator’s questions connected to that exam. The same applies to a dependent’s statements if the worker is deceased.¹

Extra Protections for Unrepresented Workers

When an injured worker has no attorney, the claims administrator carries an additional disclosure duty. Any records sent to the worker must be accompanied by a cover letter stating in clear language that the enclosed information may be used by the evaluating doctor, and that if the worker does not want the doctor to see it, the worker must notify the claims administrator within 10 days.²

There is also a timing exception. If an unrepresented worker schedules an appointment within 20 days of receiving the QME panel, the claims administrator need not meet the full 20-day advance service period for medical information. Nonmedical records, however, must still be served 20 days before being sent to the evaluator so the worker has a real chance to object.²

What the Evaluator’s Report Must Disclose

Section 4062.3 requires the evaluator to identify three things in every formal report: all information received from the parties, all information reviewed in preparing the report, and all information relied upon in forming the medical opinion.¹ Those three categories will not always match. A doctor may receive material, review it, and then set it aside as irrelevant.

Penalties for Violating Section 4062.3

If a prohibited communication occurs, the aggrieved party has two choices: terminate the current evaluation and start over with a new QME selected through the panel process, or proceed with the existing evaluation despite the violation.¹

Beyond that choice, the party responsible for the prohibited communication may be charged with contempt before the Workers’ Compensation Appeals Board. That party is also liable for the costs the other side incurred because of the violation, including the cost of the medical evaluation, additional discovery expenses, and attorney’s fees related to that discovery.¹

Under Labor Code Section 5813, the Appeals Board can impose separate sanctions for bad-faith actions or frivolous tactics, up to $2,500 per violation, payable to the state General Fund. These sanctions come on top of the cost-shifting described above and require a finding that the conduct was willfully noncompliant or intended to delay the proceedings. The Board will not impose them if the offending party acted with reasonable justification.³

Under Title 8 Section 10421, the Appeals Board can also order payment of reasonable expenses, including attorney’s fees and costs, when a party fails to timely serve documents or comply with the Board’s rules, provided the failure was not due to mistake, inadvertence, or excusable neglect.⁴ Sloppy record service can trigger financial penalties even without any intent to game the system.

1
California Legislative Information. California Code, Labor Code – LAB 4062.3
2
Department of Industrial Relations. California Code of Regulations Title 8 Section 35 – Exchange of Information and Ex Parte Communications
3
California Legislative Information. California Labor Code 5813
4
California Department of Industrial Relations. California Code of Regulations Title 8 Section 10421 – Sanctions