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

Review the primary official source.

California Labor Code section 4062.3 regulates information and communications provided to qualified and agreed medical evaluators. Substantive communications generally must be in writing and served as required. An unserved call, email, or document can create an ex parte-contact dispute and may affect the evaluation process.

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. Identify each item, date, author, page range, and purpose. A clean log helps all parties and the evaluator confirm what was actually reviewed.

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 and a period to object to nonmedical records. Service method can affect response time under other procedural rules. Apply the current text to the actual case rather than counting from memory.

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, audit five things: relevance, completeness, record log, service and objection timing, and consistency between the letter and documents. That process improves the medical record and reduces the risk that procedure overshadows the evaluator’s opinion.

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