What Is the QME Panel Process in California Workers’ Comp?

The QME panel process in California workers’ compensation is how injured workers and insurance carriers resolve medical disputes through an independent physician: one side triggers the process under the Labor Code, the Division of Workers’ Compensation Medical Unit issues a randomized three-doctor panel based on the worker’s ZIP code, the parties pick or strike down to a single evaluator, and that doctor’s report sets the medical facts that drive benefits and disability ratings. The steps are short, but the deadlines are unforgiving, and a missed form or a stray phone call to the doctor can shift the whole case.

What Triggers a QME Panel

Three Labor Code sections open the door to a Qualified Medical Evaluator, and which one applies depends on what the parties are fighting about.

Labor Code 4060 covers compensability disputes, where the employer or insurer denies the injury is work-related. It does not apply once the injury has been accepted.¹
Labor Code 4061 covers disagreements about permanent impairment or future medical care after the worker reaches maximum medical improvement.²
Labor Code 4062 covers everything else: diagnosis, treatment recommendations, and other medical questions. The party objecting to the treating physician’s report has 20 days to file a written objection if the worker is represented, or 30 days if the worker is unrepresented.³

Once the dispute is documented, the insurance carrier sends the worker a Notice of Options letter explaining the right to request a QME panel. That letter is the formal starting point. Blow the 20- or 30-day objection window and you may lose the right to challenge the treating physician’s conclusions at all.

Requesting the Panel

Which form you file depends on whether you have an attorney. Unrepresented workers file QME Form 105 by mail to the DWC Medical Unit.⁴⁵ Represented workers’ attorneys file QME Form 106 online. Since October 2015, all represented initial panel requests must be submitted through the online system; paper submissions are no longer accepted.⁶⁷

Both forms require the date of injury, the insurance claim number, and a description of the disputed medical issues. Errors get the request kicked back, and that lost time comes out of your case. Use the current forms directly from the DWC website.⁸

You also pick a medical specialty on the request, and that choice shapes the whole panel. Three-letter codes identify the specialty: MOS for orthopedic surgery, MCH for chiropractic, MPS for psychiatry, and so on. If the specialty doesn’t match the injury, you end up with an evaluator who lacks the right expertise. When the parties disagree about the appropriate specialty, the Medical Director decides, and either side can appeal that decision to a Workers’ Compensation Administrative Law Judge.⁹

The Medical Unit assigns three physicians at random based on the injured worker’s ZIP code. The unit cannot handpick doctors or swap one out just because another office is closer. If the worker and the claims administrator agree in writing, the panel can instead be generated using the workplace ZIP code.¹⁰ The randomization is deliberate: neither side gets to steer the case toward a favored physician. Online Form 106 submissions generate the panel immediately; mailed Form 105 requests take longer because they are processed manually.

Picking Your Doctor From the Panel

This is where the represented and unrepresented tracks diverge most sharply.

If You Don’t Have an Attorney

You pick any one of the three doctors on the panel. There is no striking, no negotiation with the insurance carrier. Research the names, look at their backgrounds, and choose the physician you’re most comfortable with.

If You Have an Attorney

Before a panel is even requested, your attorney can try to agree with the opposing party on a single doctor known as an Agreed Medical Evaluator. An AME agreement bypasses the panel process entirely. If the parties can’t agree, the panel request moves forward, and each side gets 10 days from the date the panel is assigned to strike one name. The remaining doctor becomes the evaluator. Miss that 10-day window and the other side gets to pick any doctor left on the panel. That is one of the quietest ways to lose control of a claim.

Scheduling the Exam

Once a doctor is selected, the appointment has to be scheduled within 90 days of the initial request. If the doctor can’t fit the worker in that fast, the requesting party can waive the deadline out to 120 days. If the QME still can’t schedule within 120 days, either side can ask the Medical Director for a replacement.¹¹

The exam must take place at an office the physician has registered with the Medical Unit. After booking, the QME sends an Appointment Notification Form (Form 110) to the worker and the claims administrator within five business days to confirm the date, time, and location.¹²

Communication Rules Before the Exam

Every communication with the QME must be in writing, and a copy has to go to the other side at the same time. Sending anything to the doctor without copying the opposing party is prohibited ex parte contact, and it can get the entire evaluation thrown out.¹³

At least 20 days before the exam, the claims administrator must serve the QME, with a copy to the opposing party, the treating physician’s records, other relevant medical records, and a letter outlining the disputed issues. Some materials are flatly off-limits: untimely medical-legal reports that have been rejected, consulting reports on permanent disability from non-treating physicians that haven’t been ruled admissible, and anything a judge has stricken.¹³

When improper ex parte contact happens, the Medical Director must give the aggrieved party a new panel, or that party can choose to continue with the original evaluator. Statements the worker makes during the actual exam are not ex parte contact unless the Appeals Board specifically finds otherwise.

The Medical Report

The QME has 30 days after the exam to prepare and serve a comprehensive medical-legal report on the worker, the claims administrator, and the DWC.¹⁴ The report has to disclose when and where the exam took place, confirm that the signing physician personally performed it, and include a declaration under penalty of perjury that the contents are true. Nobody other than the signing doctor can examine the worker or participate in drafting the conclusions, aside from nurses handling routine tasks like taking blood pressure.¹⁵

Extensions are narrow. The QME can request a single 15-day extension on Form 112, and only for a medical emergency involving the evaluator or their family, a death in the evaluator’s family, or a natural disaster that interrupts office operations.¹⁶ Case complexity isn’t a valid reason, and the regulations explicitly bar extensions based on missing records: the evaluator has to issue the report with what they have and note that conclusions may change if more records arrive.¹⁴

Challenging the Report

A bad report isn’t the end of the case. Two main tools exist for pushing back.

Factual Corrections

If the report contains factual errors, an unrepresented worker or the claims administrator can request corrections within 30 days of receiving the report using Form 37. The request goes to the QME, the other party, and the Disability Evaluation Unit. When the claims administrator files, the worker gets five days to respond. The QME then has 10 days to review a worker’s request, or 15 days to review a claims administrator’s request, and issues a supplemental report saying whether corrections are warranted and whether they change the original conclusions.¹⁷ The parties can only submit Form 37 itself; no new records come in through this process, and the QME can’t review anything that wasn’t already part of the original evaluation.

Replacement Panel

You can ask the Medical Director to replace an individual QME or the whole panel in several situations:

The QME cannot schedule within the required timeframe.
A doctor on the panel doesn’t actually practice in the requested specialty, or the Medical Director finds the specialty inappropriate.
The QME has a disqualifying conflict, shares a group practice with another panelist, or is a current or former treating physician for the injury.
The evaluator violated appointment or cancellation rules, or missed the report deadline after the party objected to lateness before the report was served.
The panel is more than 24 months old and none of the QMEs have examined the worker.
The selected QME refuses to perform the evaluation or won’t explain why they can’t address the issues.

Replacement requests go on Form 31.5.¹⁸ For appointment violations or late reports, the request has to be filed within 15 calendar days of discovering the violation or receiving the report, whichever comes first.

How the Report Drives Your Disability Rating

The QME’s findings don’t translate directly into a dollar amount. They feed into California’s Permanent Disability Rating Schedule, which turns clinical findings into a percentage that determines benefits.¹⁹

The QME rates impairment under the AMA Guides to the Evaluation of Permanent Impairment (5th Edition), producing a Whole Person Impairment percentage. That number is then adjusted three times: a future earning capacity adjustment based on the injury type, an occupational adjustment reflecting the physical demands of your job (the state divides occupations into 45 groups), and an age adjustment tied to how old you were when the injury happened. The adjusted number is your permanent disability rating.

When one injury produces multiple impairments, they are combined using a formula that keeps the total from exceeding 100 percent, rather than simply added. The practical point: the raw impairment number in the QME report is a starting point, not a final answer, and the adjustments can swing the final percentage noticeably in either direction.

Who Pays

The employer pays medical-legal costs, including the QME exam and report. Workers do not pay the evaluation fee.²⁰

You’re also entitled to reimbursement for transportation, meals, and lodging to attend the exam.²⁰ The mileage rate for medical and medical-legal travel is 72.5 cents per mile as of January 1, 2026.²¹ Track your mileage and keep receipts, because the claims administrator will want documentation before paying.

One timing boundary to watch: with limited exceptions, neither party is responsible for the cost of comprehensive medical-legal evaluations performed within the first 60 days after a claim is filed.²⁰ Requesting an evaluation too early can create cost exposure that nobody expected.

1
California Legislative Information. California Code Labor Code 4060
2
California Legislative Information. California Labor Code 4061
3
California Legislative Information. California Code Labor Code 4062
4
Department of Industrial Relations. Division of Workers’ Compensation – QME Form 105 Instructions
5
Department of Industrial Relations. QME Form 105
6
Department of Industrial Relations. Frequently Asked Questions About QME Form 106 Online Panel Request
7
Department of Industrial Relations. DWC Online QME Form 106 Panel Request
8
Department of Industrial Relations. DWC Medical Unit
9
Department of Industrial Relations. California Code of Regulations Title 8 Section 31.1 – QME Panel Selection Disputes in Represented Cases
10
California Department of Industrial Relations. DWC Answers to Frequently Asked Questions About QMEs for Injured Workers
11
Department of Industrial Relations. California Code of Regulations Title 8 Section 31.3 – Scheduling Appointment with Panel QME
12
Department of Industrial Relations. California Code of Regulations Title 8 Section 34 – Appointment Notification and Cancellation
13
Department of Industrial Relations. California Code of Regulations Title 8 Section 35 – Exchange of Information and Ex Parte Communications
14
Department of Industrial Relations. California Code of Regulations Title 8 Section 38 – Medical Evaluation Time Frames and Extensions for QMEs and AMEs
15
California Legislative Information. California Labor Code 4628
16
Division of Workers’ Compensation. QME/AME Report Time Frame Extension Request
17
Legal Information Institute. Cal Code Regs Tit 8, Section 37 – Request for Factual Correction of a Comprehensive Medical-Legal Report from a Panel QME
18
Department of Industrial Relations. California Code of Regulations Title 8 Section 31.5 – QME Replacement Requests
19
Department of Industrial Relations. Permanent Disability Rating Schedule
20
Justia. California Labor Code Sections 4620-4628
21
Department of Industrial Relations. Mileage Rate for Medical and Medical-Legal Travel Expenses