When there's a medical disagreement in your claim — about whether your injury is work-related, how much you're impaired, or what treatment you need — California resolves it with a special evaluation by a QME or AME. The report from that doctor often decides the value of your case.
QME vs. AME
- QME (Qualified Medical Evaluator) — a state-certified doctor used when you and the insurer can't agree on a doctor. If you don't have an attorney, you request a panel of three QMEs from the state and choose one. If you have a lawyer, the two sides may agree on an evaluator instead.
- AME (Agreed Medical Evaluator) — a doctor that you (through your attorney) and the insurer agree to use. Because both sides accept the AME, their opinion usually carries a lot of weight.
How the panel process works
If you're unrepresented, you ask the state's Medical Unit for a QME panel in the right specialty. You'll receive three names, you pick one, and you schedule the exam. Strict deadlines apply to selecting and scheduling, so don't delay when a panel arrives.
What the evaluation covers
The QME or AME reviews your medical records, examines you, and writes a report addressing the disputed questions: Is the injury work-related? Are you permanent and stationary? What's your impairment rating? Is any of it apportioned to other causes? What work restrictions apply?
How to prepare
- Be honest and consistent. Exaggerating hurts your credibility; minimizing hurts your rating.
- Know your history. Be ready to describe how the injury happened, your symptoms, prior injuries, and how the injury affects daily life and work.
- Bring a list of your current symptoms, medications, and treatments.
- Be on time — missing a QME appointment can cause real delays.
Why this matters so much
The QME/AME report frequently determines your permanent disability percentage — and therefore the value of your claim. Because the stakes are high, this is a stage where many workers choose to have an attorney, who can help select a favorable specialty, frame the disputed issues, and challenge a weak report.