Garza: An AME/QME Dispute Needed a Complete Hearing Record Before It Could Be Decided

Another medical-legal examination can mean more appointments and uncertainty while your benefits remain disputed. If the parties previously agreed on a doctor and a new injury claim is later filed, the choice of evaluator can itself become a legal dispute. The agreement, the questions sent to the doctor and the hearing evidence all matter.

In Garza v. County of Kern, Nos. ADJ18724961 and ADJ15255319 (WCAB Nov. 3, 2025), a Workers’ Compensation Appeals Board panel set aside an order barring an additional QME evaluation because the hearing record was incomplete. The panel also explained how issues submitted to an agreed medical evaluator could affect a later panel request. It gave that guidance conditionally, while returning the dispute for further proceedings.

The dispute concerned an agreed evaluator and a second claim

An agreed medical evaluator, or AME, is a doctor chosen by agreement between the parties in a represented worker’s case. A panel qualified medical evaluator, or QME, is selected through a different statutory process. That distinction was central to the employer’s challenge in Garza.

The judge found that Scott Graham, M.D., was serving as the AME in both of Tina Garza’s cases. The judge also found that the employer had waived entitlement to an examination from a QME panel for the cumulative-injury claim by previously seeking the AME’s opinion. The order granted Garza’s request to invalidate the panel and excuse her from attending an examination drawn from it.

The employer’s arguments recorded in Garza challenged that waiver finding. It argued that waiver had not been raised or supported by evidence and that a new claim entitled it to another panel. It relied on Navarro v. City of Montebello, 79 Cal.Comp.Cases 418 (WCAB en banc 2014), and cases involving prior panel QMEs.

The hearing minutes did not establish the issues and evidence

At the June 2025 expedited hearing, the parties asked to submit the dispute for decision and were allowed to provide later argument. The minutes described it by referring to the worker’s request for a discovery order barring an additional QME. The panel had been issued, but an examination had not been set.

The Board’s review of the minutes in Garza identified what was missing: The specific issues, the parties’ stipulations and the exhibits received for identification or admitted into evidence. The judge’s later findings and order listed and admitted exhibits, but the Board explained that the required hearing record had to identify them at submission, rather than for the first time in the decision.

The panel applied Hamilton v. Lockheed Corporation, 66 Cal.Comp.Cases 473, 475–476 (WCAB en banc 2001), requiring a decision grounded in an identifiable record of issues, agreements and admitted evidence. Rule 10761 addresses submission at a conference, and Rule 10787 specifies the required hearing minutes and summary of evidence. Agreeing to have a judge decide a dispute still requires that evidentiary foundation.

The procedural discussion in Garza also distinguished the overall order from the particular discovery issue challenged. Because the judge’s order included an injury finding, the Board treated the petition as reconsideration. It reviewed the discovery challenge under the extraordinary “removal” standard, which requires significant prejudice or irreparable harm and an inadequate later remedy. The missing record justified intervention on this record.

The AME rule asks which issues were agreed to or submitted

The panel then gave guidance on the evaluator dispute. Labor Code section 4062.2(f) provides that a panel may not be requested on an issue agreed to be submitted to, or already submitted to, an AME unless the agreement has been canceled by mutual written consent. The provision focuses on the issue sent to the agreed evaluator.

The AME discussion in Garza distinguished that process from the prior panel-QME cases cited by the employer. A rule governing a new claim after a panel-QME evaluation does not by itself answer what the parties subsequently agreed to submit to an AME.

The panel’s account of the referral in Garza described wrists, fingers and upper extremities in the original application and issues that appeared to have been submitted to the AME. The employer later sought a panel based on a permanent-and-stationary-status dispute for the cumulative claim. If that issue had already been submitted to the AME, the panel explained, it would no longer supply a basis for a separate panel under section 4062.2(f).

The conditional nature of that explanation matters. The Board expressly said it could not consider the merits because the record was missing. Its guidance identified the agreement and submission questions for the further proceedings. The next decision needed evidence establishing what had actually been agreed to and sent.

Information sent to an AME also has its own requirements. Section 4062.3(c) requires agreement on the information to be provided. Comparing the actual cover letter, attachments and agreement helps identify both the material the doctor received and the issues the doctor was asked to address. Our Maxham analysis explains the distinct information-and-communication questions.

The Board set the order aside and required further proceedings

The operative order in Garza granted reconsideration, rescinded the July 29, 2025 decision and returned the matter to the judge. That removed the existing discovery ruling and required a properly supported decision. The parties still needed to establish the hearing record and resolve the evaluator dispute through those proceedings.

Review the actual agreement, referral and hearing record

If another evaluator is proposed after an AME has already examined you, ask your attorney to compare the original agreement, later claim forms, referral letters, attachments, reports and any written cancellation. Identify the exact disputed issue—for example, permanent-and-stationary status—and where the record shows it was agreed to be submitted or actually submitted to the AME.

If the disagreement reaches a hearing, counsel should make the issue and exhibits clear in the minutes. A broad reference to a request for a discovery order can leave unanswered whether the judge is deciding an agreement’s scope, an alleged waiver, the validity of a panel or another question. Each needs a clear evidentiary basis.

Garza connects those two tasks: Understanding what the AME was asked to decide and proving that history in the hearing record. Seek advice before deciding how to respond to an examination notice; the next step should follow the actual agreement and current order. Our Hamilton analysis explains the broader distinction between documents in the file and evidence admitted for a decision.