LC 4062.2 Panel QME for Represented Workers: Strikes and AME

Under California Labor Code Section 4062.2, the panel QME process is how a represented injured worker and the insurance carrier pick a neutral doctor to resolve a disputed medical issue: they wait 10 days to try to agree on an evaluator, then either side can request a three-name panel of Qualified Medical Evaluators from the Division of Workers’ Compensation, each side strikes one name, and the remaining doctor examines the worker and writes the report that drives the claim.¹ Every step has a deadline, and missing one can cost you the ability to choose your doctor or, worse, invalidate the entire evaluation.

When Section 4062.2 Applies

Section 4062.2 governs comprehensive medical evaluations for injuries on or after January 1, 2005, when the employee is represented by an attorney.¹ Unrepresented workers follow a different track under Section 4062.1, with different rules for panel selection, striking, and scheduling.

Three kinds of disputes trigger the process:

Compensability disputes under Section 4060, where the carrier denies the injury is work-related.²
Permanent disability disputes under Section 4061, where a party disagrees with the treating doctor on impairment or future medical care.³
Other medical disputes under Section 4062, such as whether a specific treatment is appropriate. The objecting party must give written notice within 20 days of receiving the treating doctor’s report.⁴

One boundary worth knowing: if you go through a 4062.2 evaluation and later fire your attorney, you do not get a second bite as an unrepresented worker. The evaluation stays with the claim.¹

The 10-Day Wait and the AME Option

The statute wants both sides to try for an Agreed Medical Evaluator before defaulting to the state’s panel system. Parties can agree on an AME at any time, and if they do, no panel request is needed.¹ An AME often carries more weight in settlement talks because neither side can complain later that the doctor was randomly assigned.

Neither party may request a panel until the first working day that is at least 10 days after the evaluation request was mailed (for a compensability dispute) or the written objection was mailed (for permanent disability or other medical disputes).¹ Once a panel has been requested on an issue, the parties can no longer submit that same issue to an AME unless they mutually cancel the panel request in writing.

Requesting the QME Panel

After the waiting period, either side can request a three-member panel from the DWC. In represented cases, the request goes through the DWC’s online QME system using Form 106, and the panel issues immediately upon submission. Paper submissions are not accepted for initial panel requests in represented cases.⁵

The requester picks the medical specialty, such as orthopedic surgery, neurology, or psychiatry. If the other party has already stated a preferred specialty, it must be included on the form, along with the treating physician’s specialty.¹ The specialty choice matters. Ask for orthopedics when the real fight is about nerve damage, and you may end up with an evaluator who cannot address the actual issue.

Supporting documents have to be attached: for compensability disputes, the claims administrator’s denial or examination request; for permanent disability or treatment disputes, a written objection identifying the treating physician, the date of the disputed report, and the medical question in play.⁶ The requester then serves the form and the panel list on the other side.

Striking a Name Within 10 Days

Each side has 10 days from issuance of the panel to strike one name. The doctor left standing becomes the evaluator.¹ Most attorneys use those 10 days to research each candidate’s prior reports and reputation.

Miss the deadline and you lose your veto. If one party fails to strike in time, the other party can choose any of the remaining doctors on the panel, which effectively lets the timely party pick the evaluator.¹ The party who struck on time should notify the other side of their selection promptly after the deadline passes.

Scheduling the Examination

In represented cases, the employee schedules the appointment. If the employee does not inform the employer of the appointment date within 10 days after the evaluator is selected, the employer can take over scheduling.¹ That is rarely a good outcome for the worker.

The selected QME has to be able to schedule the exam within 90 days of the request. If not, the scheduling party can waive that right and accept an appointment up to 120 days out. If even 120 days will not work, either side can report the unavailability to the Medical Director and request a replacement panel. The parties can also agree in writing to waive the 120-day limit if they want a particular doctor.⁷

Sharing Records and the Ex Parte Ban

The rules on what reaches the evaluator are strict, and breaking them can invalidate the report. Any records a party wants the QME to review must be served on the other party at least 20 days before being sent to the evaluator. If the opposing party objects to non-medical records within 10 days, those records cannot go to the evaluator at all.⁸ That rule keeps surveillance footage, personnel files, and similar material from slipping in unnoticed.

All pre-evaluation communications with the QME must be in writing and served on the opposing party at least 20 days in advance. Post-evaluation communications also have to be in writing and served on the other side at the same time they are sent to the doctor.⁸ Private contact with the evaluator, known as ex parte communication, is prohibited.⁹

The consequences for ex parte contact are severe. The other side can throw out the evaluation and start over with a new QME from a fresh panel. The offending party can also be held in contempt before the Workers’ Compensation Appeals Board and ordered to pay the other side’s costs, including the new evaluation, additional discovery, and attorney’s fees.⁸ The one carve-out: the employee, or a deceased employee’s dependents, may speak with the evaluator orally during the exam or when the evaluator requests information in connection with it.

The Report and What Comes After

The QME has 30 days after the exam to prepare and submit the written report, and both sides receive copies at the same time.¹⁰ The report typically addresses causation, permanent impairment, work restrictions, and future medical treatment.

If a party thinks the report is incomplete or fails to address a contested issue, they can ask for a supplemental report. Follow-up evaluations by the same physician are limited to those within 18 months of the original comprehensive exam.¹¹ Either side can also depose the QME, though depositions are open-ended and can give the doctor an opportunity to reinforce unfavorable findings.

Replacement Panels and Disqualification

Sometimes the selected QME cannot serve, or should not. The regulations recognize over a dozen grounds for a replacement doctor or a new panel. Common ones include:

The QME does not actually practice in the specialty listed on the panel.
The QME cannot see the worker within 90 days, or within 120 days with a waiver.
A panel member is or was the employee’s treating physician for the disputed injury.
Two doctors on the panel belong to the same medical group.
The QME has a disqualifying financial or personal relationship with a party.
The panel was issued more than 24 months ago and none of the listed doctors have examined the worker.
The evaluator violated appointment notification rules or missed report deadlines.¹²

When a replacement is granted in a represented case after both strikes have already been used, the new panel cannot include any doctor from the original panel.¹²

Conflicts of Interest

A conflict exists when the evaluator has a relationship with a party and does not disclose it. Disqualifying relationships include family ties (spouse, parent, child, sibling, and others), a financial interest of 5% or more in a business entity connected to the case, and situations where the evaluator gets 5% or more of their income from referrals by or contracts with a party. A catch-all covers any relationship that would cause a reasonable person to doubt the evaluator’s impartiality.¹³

An evaluator who spots a potential conflict has to notify both sides in writing within five business days. A party that learns of a conflict has to notify the evaluator in writing at the earliest opportunity, no later than five business days after learning of it. The evaluator then has five business days to disqualify themselves or explain why they can proceed fairly.¹³

Who Pays

The employer is liable for the cost of each reasonable and necessary comprehensive medical-legal evaluation obtained by the employee under Sections 4060, 4061, or 4062, and each evaluation must address all contested medical issues from every injury on the claim. The worker does not pay out of pocket for the exam, the report, or the associated medical-legal fees.

1
California Legislative Information. California Code LAB 4062.2 – Determination of Medical Issues
2
Justia. California Code 4060-4068 – Determination of Medical Issues
3
California Legislative Information. California Code Labor Code LAB 4061 – Employee Medical Evaluations
4
California Legislative Information. California Code Labor Code LAB 4062 – Medical Issues
5
Department of Industrial Relations. DWC Online QME Form 106 Panel Request
6
Legal Information Institute. California Code of Regulations 8 CCR 30 – QME Panel Requests
7
Department of Industrial Relations. California Code of Regulations Title 8 Section 31.3 – Scheduling Appointment With Panel QME
8
California Legislative Information. California Code Labor Code LAB 4062.3
9
Department of Industrial Relations. California Code of Regulations Title 8 Section 35 – Exchange of Information and Ex Parte Communications
10
Department of Industrial Relations. California Code of Regulations Title 8 Section 38 – Medical Evaluation Time Frames
11
Department of Industrial Relations. California Code of Regulations Title 8 Section 9795 – Reasonable Level of Fees for Medical-Legal Expenses
12
Department of Industrial Relations. California Code of Regulations Title 8 Section 31.5 – QME Replacement Requests
13
Department of Industrial Relations. California Code of Regulations Title 8 Section 41.5 – Conflicts of Interest by Medical Evaluators