QME or AME? What attorneys need to know before scheduling a medical-legal evaluation

Short answer: A QME is a DWC-certified physician assigned from a state panel to resolve a disputed medical issue in a workers’ compensation claim. An AME is a physician both sides’ attorneys agree on in a represented case.

Panel QMEs in represented cases

A party requests a panel from the DWC Medical Unit, which issues three QMEs in the requested specialty. Each side may strike one name within 10 days, and the remaining physician becomes the panel QME under Labor Code §4062.2. The faster the appointment is booked and the records are served, the sooner the case moves.

When an AME makes sense

When both attorneys trust the same evaluator, an AME can reduce disputes over the report and the need for supplemental reports or depositions. AME evaluations are billed with a higher modifier under the Medical-Legal Fee Schedule.

What to send with the appointment

• The cover letter, with the issues you want addressed.
• Records, served after the meet-and-confer and with the page-count attestation the Medical-Legal Fee Schedule requires.
• Claimant and claim details, including the claims administrator.

Timelines worth tracking

QMEs generally must serve the report within 30 days of the evaluation unless an extension applies under 8 CCR §38. Knowing the exam date, attendance, and the service date tells you whether to follow up or prepare a supplemental request.