The QME questions I see online worry me more than most, because the mistakes people describe are often irreversible.
One worker says their attorney wants them to resign and settle without ever having a QME. Another is thinking about accepting a settlement before the QME appointment. Another does not understand why their QME appointment is being canceled now that a settlement is tentatively in place.
Each of those situations may be perfectly fine, or may be a serious problem, and the difference depends on facts a stranger online cannot see. But all three share a common thread: the worker does not understand what the QME actually does in a California case. So let me explain that clearly.
What California Workers Are Asking on Reddit About QMEs
- What is a QME and why do I need one?
- Who picks the QME? Can I choose my own?
- My attorney wants me to settle without a QME. Is that normal?
- Should I cancel my QME because the case is settling?
- What happens if the QME report is bad for me?
- Is a QME the same as an IME?
- Is the QME my new doctor?
First, the Terminology
People search for “IME” and “CME” constantly, and in California workers’ compensation those are usually the wrong words.
An Independent Medical Examination is what many other states and other kinds of insurance call this. California workers’ compensation uses the Qualified Medical Evaluator, a physician certified by the state’s Division of Workers’ Compensation Medical Unit. If you are represented, the parties may instead agree on an Agreed Medical Evaluator, which is a different and often better path.
Getting the vocabulary right matters, because searching for the wrong term returns rules that do not apply to your case.
The QME Is Not Your Doctor
This is the most consequential misunderstanding, and it changes how you should behave at the appointment.
Your primary treating physician treats you. They prescribe, refer, and request authorization for care. You have an ongoing relationship with them.
The QME evaluates you. They are performing a medical-legal examination to answer disputed questions for the claim. They will not treat you, will not prescribe for you, and will not follow up with you. You will likely see them once, for a limited appointment, and their report may determine the outcome of your entire case.
Workers who think of the QME as a doctor visit tend to minimize their symptoms, because that is what polite patients do. Workers who understand it is an evaluation describe their limitations accurately. The difference shows up in the report, and the report shows up in the rating.
Who Chooses the QME
Not you, and not the insurance company. The process is set out in Labor Code section 4062.2 for represented workers.
A party requests a panel from the Medical Unit, which issues a panel of three QMEs in the requested specialty. Each side strikes one name, and the remaining evaluator becomes the QME. The specialty requested is a strategic decision that shapes everything downstream, which is why panel requests are not a formality.
The strike deadline is real. When the other side requested the panel, there are only 10 days to strike. Missing that window can mean losing your say in which of the three evaluates you. This is one of the most common and most damaging unforced errors in an unrepresented case.
If you are represented, the parties can agree on an AME instead. An AME’s opinion carries substantial weight precisely because both sides chose the doctor, which is a real advantage when the evaluator is one you trust.
What the QME Decides
Depending on what is disputed, the QME may address:
- Industrial causation. Is the injury work related at all? On a denied claim this is the whole ballgame, and Labor Code section 4060 routes the question here.
- Which body parts are involved.
- Whether you have reached maximum medical improvement.
- Permanent impairment, expressed as whole person impairment under the AMA Guides, which then gets adjusted into a permanent disability rating.
- Apportionment. Under Labor Code section 4663, how much of your disability is caused by work and how much by other factors. This single opinion can cut your case substantially.
- Future medical care.
- Work restrictions.
Note what that list means. The QME does not merely confirm you were hurt. The QME largely determines what your case is worth.
Can I Settle Before the QME?
You can. Whether you should is a real question, and it depends on facts and your particular situation.
Settling before a QME means settling before anyone has measured your permanent disability. Sometimes that is sensible. On a small claim with an obvious minor injury, the cost and delay of a full evaluation may exceed what it would add, and a reasonable offer in hand may beat a better offer eight months from now.
Often it is not sensible. If your impairment has not been measured, neither you nor the carrier knows what the case is worth, and you are negotiating blind against someone who does this for a living. On a serious injury with contemplated surgery, settling pre-QME can leave a great deal on the table.
If your attorney recommends settling without a QME, that is not automatically wrong, but you are entitled to a clear explanation of why, and you should ask for it. A good attorney will welcome the question. If the reasoning does not make sense to you, a second opinion costs nothing.
Should I Cancel My QME Because We Are Settling?
Be careful. A tentative settlement is not a settlement. Until documents are signed and a judge has approved them, the deal can fall apart, and re-obtaining a panel and getting back on an evaluator’s calendar can cost months. I generally do not want a client canceling an evaluation on the strength of an agreement that is not yet approved. Talk to your attorney before canceling anything.
What If the Report Is Unfavorable?
An adverse QME report is a setback, not necessarily the end.
Depending on the circumstances, options can include sending supplemental questions to the evaluator, deposing the evaluator, obtaining a replacement panel where the rules permit it, and objecting under the regulations if the report is untimely. A report is also only as good as the records the evaluator reviewed, and evaluators who did not receive complete records can sometimes be addressed on that basis.
Reports are due within 30 days of the examination, with one 30-day extension permitted. Late reports can be objected to, which sometimes opens the door to a replacement panel.
Common Misconceptions
That the QME is your new treating doctor. They evaluate; they do not treat.
That you should tough it out and minimize symptoms. Be accurate, neither exaggerating nor downplaying. Describe your worst days as well as your best.
That the insurance company picks the QME. The panel process governs, and each side strikes one name.
That you can skip the appointment. Failing to attend without good cause can seriously harm your claim.
That the QME’s report is the final word. There are avenues to address a flawed report, though they are time sensitive.
That QME and IME mean the same thing in California. The QME panel process is what governs a California workers’ compensation case.
How to Prepare for a QME
- Make sure the evaluator has your complete records. Missing records produce bad reports.
- Know your history. Dates, mechanism of injury, prior injuries to the same body part. Prior injuries you forget will surface later and damage your credibility.
- Be accurate about function. What can you actually lift, carry, sit through, sleep through? Specifics beat adjectives.
- Do not exaggerate. Evaluators screen for it, and it is the fastest way to lose a case.
- Arrive on time and be civil. Reports comment on demeanor.
- Understand that an advocacy letter should go out before the exam, framing the disputed issues for the evaluator. This is a significant part of the work in a represented case and one of the clearest advantages of having counsel.
Frequently Asked Questions
What is a QME in California workers’ compensation?
A Qualified Medical Evaluator is a physician certified by the state’s Division of Workers’ Compensation to perform medical-legal evaluations. The QME resolves disputed medical issues such as industrial causation, permanent impairment, apportionment, and future medical care. The QME does not treat you.
Who chooses the QME?
Neither party alone. Under Labor Code section 4062.2, the Medical Unit issues a panel of three evaluators in the requested specialty and each side strikes one name. Represented parties may alternatively agree on an Agreed Medical Evaluator.
How long do I have to strike a QME panel?
When the opposing party requested the panel, there are 10 days to strike. Missing that deadline can forfeit your say in which of the three evaluators is selected.
Is a QME the same as an IME?
No. Many states and other types of insurance use Independent Medical Examinations. California workers’ compensation uses the QME panel process, and represented parties may use an Agreed Medical Evaluator.
Can I settle my case before the QME?
You can, but settling before a QME means settling before your permanent impairment has been measured. That is sometimes reasonable on small claims and often disadvantageous on serious injuries.
What happens if the QME report is unfavorable?
Depending on circumstances, options may include supplemental questions, deposing the evaluator, seeking a replacement panel where permitted, and objecting to an untimely report. QME reports are generally due within 30 days of the examination, with one 30-day extension available.
The QME Is Where Cases Are Won and Lost
Panel specialty, strike strategy, and the advocacy letter that reaches the evaluator before your exam are decisions that shape everything that follows. If you have a QME coming up, or a report you do not understand, contact my office for a free consultation.
Ryan D. Kayrell, PC represents injured workers throughout California from Irvine, Orange County. This page is general information about California workers’ compensation law, not legal advice for your situation, and reading it does not create an attorney-client relationship. Questions described here are paraphrased from public online discussions and do not reflect any client of this firm.