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QME and AME explained

By Richard Vaughn CPCU, ARM, AIS. Reviewed November 8, 2026. Richard is an insurance professional, not an attorney. This page explains the law; it is not legal advice.

What a QME is for

A qualified medical evaluator (QME) is a physician certified by the Division of Workers' Compensation Medical Unit to perform medical-legal evaluations: examinations whose purpose is to answer a disputed question in a claim rather than to treat you. QMEs include medical doctors, osteopaths, chiropractors, psychologists, dentists and other licensed providers, certified by specialty (Labor Code §139.2). The evaluator examines you, reviews the records, and writes a report that becomes evidence in the claim.

The QME system exists because the treating doctor's opinion is not the last word. Either side can object to it, and when they do, the law sends the question to a neutral evaluator rather than letting each side hire its own.

Which disputes go to a QME

Four kinds of disagreement are resolved by a QME evaluation, each under its own section:

• Whether the injury is work-related at all, when the claim has been denied or is being investigated (Labor Code §4060).
• Permanent disability: whether you are permanent and stationary, what the impairment is, and apportionment to other causes (Labor Code §4061).
• Other medical questions the treating doctor has decided and one side disputes, such as whether you can return to work or what restrictions apply (Labor Code §4062(a)).
• Treatment is not one of them. Whether a requested treatment is medically necessary goes to utilization review and independent medical review, not to a QME (Labor Code §4062(b)); a dispute with an MPN doctor's diagnosis or plan goes to second and third opinion inside the network (Labor Code §4062(c)). The medical treatment page covers those.

The objection to a treating doctor's report has to be in writing within 20 days of receiving it if you have an attorney and 30 days if you do not, extendable for good cause (Labor Code §4062(a)).

If you do not have an attorney: Form 105

An unrepresented worker cannot use an agreed medical evaluator; the claims administrator may not even propose one (Labor Code §4062.1(a)). The route is a panel. Either you or the claims administrator asks the DWC Medical Unit for a panel of three QMEs in a named specialty, using the QME Form 105. If the claims administrator gives you the form and you do not submit it within 10 days, it can submit the request itself (Labor Code §4062.1(b)).

When the panel arrives, you have 10 days to choose one of the three doctors, make the appointment and tell the claims administrator. If you do not, the claims administrator chooses the doctor and makes the appointment (Labor Code §4062.1(c)). The claims administrator pays estimated travel costs once the appointment is set. At the examination you can ask the evaluator about the process and the evaluator's background; you must take part in the examination unless there is good cause to stop, such as bias or an unnecessary procedure (Labor Code §4062.1(d)).

Once an unrepresented worker has had a QME evaluation, hiring an attorney afterward does not entitle you to another one (Labor Code §4062.1(e)). That rule is the reason many people decide about representation before the panel request, not after the report.

If you have an attorney: Form 106 or an AME

When you are represented, the two sides can agree at any time on a single doctor, an agreed medical evaluator (AME), to decide the dispute (Labor Code §4062.2(f)). If they do not agree, either side may request a three-doctor panel on QME Form 106 once 10 days have passed since the objection or evaluation request was mailed, naming the specialty (Labor Code §4062.2(b)). Each side then has 10 days to strike one name from the panel; the remaining doctor is the evaluator, and a side that fails to strike loses the choice to the other (Labor Code §4062.2(c)). You schedule the examination; if you do not within 10 days of the doctor being selected, the claims administrator may (Labor Code §4062.2(d)).

An AME is used when both sides trust the doctor's judgment, because an AME report is close to final: both sides chose the evaluator and neither can easily attack the result. A panel QME is the fallback when they cannot agree.

What the report decides

The QME or AME writes a comprehensive medical-legal report answering the questions put to the evaluator: whether the injury arose out of work, whether you are permanent and stationary, your whole-person impairment under the AMA Guides, work restrictions, future medical needs and apportionment to other causes. For an unrepresented worker the report goes to the claims administrator and to the DWC Disability Evaluation Unit, which issues a summary rating from it; the permanent disability page explains how the rating becomes dollars. For a represented worker the report is the basis for negotiation or trial.

If the report contains factual errors you can request corrections within 30 days of receiving it, and the evaluator must consider whether the corrections change the opinions. Disagreement with the opinions themselves is a different matter: a judge weighs the report against the treating doctor's and any other evidence if the case goes to trial.

Timing

A QME evaluation is usually requested at one of two points: at the start, when a claim has been denied and the question is whether the injury is covered, or at the end, when the treating doctor has found you permanent and stationary and one side disputes the impairment or apportionment. The QME regulations set the panel-request procedure and the evaluator's deadlines: if the evaluator cannot offer an appointment within 90 days you may ask for a replacement panel (8 CCR §31.5), and the report is due 30 days after the evaluation, with limited extensions (8 CCR §38); in practice the interval from objection to report is several months, which is why the 10-day deadlines on your side are worth meeting.

Questions people ask

Richard Vaughn CPCU, ARM, AIS

Richard Vaughn spent 35 years in commercial property and casualty insurance, most of it in workers' compensation: running a self-insured group, auditing premiums, and implementing claims systems for carriers and third-party administrators. He is not an attorney. dickvaughn.com