What Can Be Sent to a California QME? Records, Advocacy Letters, and the No-Private-Contact Rule

Review the primary official source.

Before sending a letter or records to a California qualified medical evaluator (QME), check five things: Relevance, completeness, the record index, service and objection timing, and whether the letter accurately describes its attachments. An agreed medical evaluator (AME) has related but different communication rules. A private call, email or packet about the merits can create an ex parte dispute—a dispute over contact the other side did not receive. Labor Code section 4062.3 and the linked regulations control.

Do not contact the evaluator privately about the merits

Administrative scheduling questions are different from presenting facts, records, or argument. When in doubt, put the communication in writing, serve every required party, and verify the applicable timing before sending it to the evaluator.

Separate records from advocacy

Relevant treating records, other medical records, and relevant nonmedical records may be provided under the statute and regulations. A cover or advocacy letter can identify the disputed medical questions and explain a party’s position. But a letter that embeds new records, recites disputed facts as established, or misstates evidence can cross into a contested-information problem.

Create a numbered record log identifying each item, date, author and page range. For example, list an MRI report separately from surveillance video and from the cover letter discussing them. The medical record, nonmedical information and argument are not interchangeable merely because they arrive in one envelope. A clear index lets the other side identify a disputed item without guessing which attachment the letter means.

Advance service and objections require a calendar

Section 4062.3 and title 8 regulation 35 contain advance-service and objection procedures, including a 20-day advance-service rule for proposed information. Under section 4062.3(b), a timely objection to nonmedical records prevents their submission; Rule 35(d) provides for submission if a workers’ compensation judge orders it. Do not send disputed nonmedical information first and ask the evaluator to decide the objection later. Service method, the kind of submission and the applicable exceptions must be checked before fixing the transmission date.

Record the service date, method, addresses, objection deadline, any objection, and the date material was sent to the evaluator. If nonmedical material is disputed, do not simply send it and invite the evaluator to decide admissibility.

Mental-health records need special handling

The regulations provide a process when direct disclosure of mental-health records to the employee presents a substantial risk of significant adverse consequences. The worker must receive the required notice and may designate a health-care provider for the records. This safeguard should be addressed before routine service.

Limit the submission to records relevant to the medical issues. Privacy concerns do not disappear because a workers’ compensation claim is pending, and overproduction can obscure the facts the evaluator actually needs.

Prepare the evaluator’s issue list

State each disputed medical issue neutrally: diagnosis, industrial causation, periods of disability, work restrictions, permanent-and-stationary status, impairment, apportionment, and future care as applicable. Cite the record instead of arguing through adjectives.

Before transmission, compare the finished packet with the earlier served version. If a new attachment or factual assertion has been added, assess its service and objection requirements before sending it. The value of the five checks is a packet everyone can identify, not a larger stack of papers or a more forceful accusation.

For broader claim guidance, review the firm’s California workers’ compensation practice and the primary-source Case Library.