Missed a California QME Appointment? Build the Record Before Seeking a Replacement

Review DWC’s appointment-notification and cancellation rule.

Related case analysis: Vazquez: A Late QME Appointment Does Not Automatically Require Replacement.

After a missed qualified medical evaluator (QME) appointment, contact the evaluator’s office promptly, preserve the appointment notice and explain what prevented the examination. Ask about a new date and keep the response. Rescheduling, a missed-appointment fee and replacement of the evaluator are separate questions. A no-show does not by itself establish a right to a new doctor.

Start by identifying who could not proceed. If you attended but the office was closed or an interpreter did not arrive, document that event rather than accepting an unexplained “worker no-show” description. If you missed the visit, keep the evidence supporting the reason. The notice, communications and timing help determine which rule applies.

Preserve the appointment and notice history

Keep both the date the appointment was made and the date its notice was sent. Rule 34(a) requires the QME’s appointment-notification form to be postmarked or faxed to the worker and claims administrator within five business days of making the appointment, with copies to known attorneys in represented cases. A calendar entry alone does not establish what notice was actually sent.

Then identify what failed on the appointment day. Preserve the notice’s time and location, an office cancellation, a request for an interpreter, travel evidence or a check-in record. If the worker attended but no examination occurred, do not let that event be described without qualification as a worker’s no-show.

If the worker appeared but the evaluation did not occur, document arrival time, waiting time, identification presented, language access, office closure, or refusal. If the worker did not appear, document illness, emergency, transportation failure, defective notice, or other claimed good cause with contemporaneous evidence.

Communicate promptly and narrowly

Contact the evaluator’s office and the other side promptly about rescheduling and any claimed fee. Under Rule 34(h), a party generally may not cancel or reschedule less than six business days before the examination without good cause. The cancellation must state the reason in writing and be served on the other side; an oral cancellation requires written confirmation within 24 hours. Keep the actual communication, not just a note that someone called.

An injured worker is not liable for a missed-appointment fee when an appointment is cancelled for good cause. If good cause is disputed, the WCAB retains authority to resolve the dispute. An illness or travel problem should therefore be explained and supported; merely using the phrase “good cause” does not decide it. Asking for another date does not itself waive a fee objection or settle a panel dispute.

A replacement request needs an actual ground under the governing rules, not simply a missed appointment or dissatisfaction with the doctor. Rule 31.5 lists different grounds with different requirements. In a represented scheduling-unavailability dispute, Vazquez also requires the good-cause analysis described in our linked case analysis. Do not assume that a fee demand establishes a right to choose another doctor.

Separate replacement, fee, and merits issues

Whether a replacement QME is appropriate is different from who owes a missed-appointment fee and different again from the medical merits. A replacement dispute should not become an opportunity to coach medical testimony or select a preferred outcome. Preserve neutrality and the statutory selection process.

Missing medical records are not generally good cause for the evaluator to cancel. Rule 34(f) provides a specific exception for a psychiatrist or psychologist evaluating disputed psychiatric injury who states in the report that prior receipt was needed for a full and fair evaluation. This is different from deciding who failed to exchange records. Our QME communications guide addresses the separate exchange rules.

If an interpreter failed to appear, preserve who requested one, what was confirmed and what happened at the office. See our interpreter-arrangement guide for that problem’s specific rules; a language-access failure does not automatically make every later medical report invalid.

Protect the rest of the claim during the delay

Continue authorized treatment, disability certification, benefit communications, and hearing preparation while the medical-legal issue is resolved. A missed QME does not itself decide industrial causation, temporary disability, permanent disability, apportionment, or future care.

Do not wait for a fee dispute to resolve before reviewing a replacement notice or hearing date. In particular, Rule 31.5(a)(11) places a specific 15-calendar-day limit on a request based on an evaluator’s Rule 34 violation, measured from awareness of the violation or service of the report, whichever is earlier. That is not a universal deadline for every missed appointment or every replacement ground. Ask promptly which rule applies to the actual event.