Preparing for a California QME or AME Exam: A Worker Checklist

A worker-facing checklist for appointment notices, medical history, records, the evaluation visit, and the resulting report.

Your appointment notice may call the visit an “independent medical exam.” In a California workers’ compensation case, check whether it is actually an examination by a qualified medical evaluator (QME) or an agreed medical evaluator (AME). These doctors write medical-legal opinions when there is a medical dispute. A QME is selected through the state panel process; an AME is a doctor the represented worker’s attorney and the claims administrator agree on. The California DWC’s injured-worker FAQ explains the difference. This checklist helps you prepare for the visit and review what follows without guessing what the notice means.

Start with the appointment packet

Put the notice, the evaluator’s name and specialty, the appointment date and location, and the claim number in one folder. Ask which medical question is in dispute: whether work caused the condition, the degree of disability, work restrictions, or another issue. Find the claim administrator’s and, if you have one, your attorney’s contact information. If you do not understand the selection paperwork or a stated response date, seek help promptly rather than waiting for the exam.

If scheduling becomes a problem, preserve the request and every available appointment date. A delay does not always mean an automatic right to replace the evaluator in a represented case; our Case Library discussion of Vazquez and QME replacement explains the WCAB’s fact-specific good-cause approach.

Do not assume that a QME or AME visit is the same as independent medical review (IMR). IMR is the DWC process for certain treatment requests denied, delayed, or modified through utilization review because of medical necessity. A QME/AME examination addresses a disputed medical issue through an evaluator’s report. Bring the written notice to the person helping you so the correct process is identified.

Make a truthful one-page timeline

Write down the job tasks or incident, when symptoms began, when you told the employer, the first medical visit, major tests and treatment, changes in symptoms, and dates you stopped or resumed work. For a gradual condition, describe the repeated tasks and periods as accurately as you can. If you do not know an exact date, say that rather than inventing one. Include relevant earlier injuries or conditions; an omission can make a later explanation harder to evaluate.

Beside the timeline, list your current limits in ordinary terms: how long you can sit, stand, lift, reach, walk, or do the specific tasks your job requires, if those activities are affected. Note what you can still do. Do not rehearse a script, minimize pain to appear cooperative, or exaggerate it to be persuasive. The evaluator needs a reliable history; the records and your account should be capable of being reconciled.

Check which records the evaluator will receive

Collect the treating physician’s reports, imaging or test results, work-status notes, prior relevant records, and any letters that explain why the evaluation was requested. Then determine which of these were actually sent through the proper channel. The DWC’s QME records guidance describes advance exchange of proposed information and objections to some nonmedical material. Do not arrive with a private stack of advocacy letters and assume the evaluator can simply accept it. Ask your attorney or the DWC Information and Assistance Unit how to correct missing or inaccurate records before the appointment.

If the evaluator’s office says the necessary medical records have not arrived, raise that question before the examination. The DWC explains that rescheduling may be possible, while in other circumstances records can be sent afterward; the evaluator’s office may have a view on whether the visit can proceed. Keep the call, email, and new appointment notice. Do not make a unilateral assumption that missing paperwork cancels the appointment.

What to do during the evaluation

Expect questions about your work, symptoms, treatment, past health, current activities, and how the condition affects your function. The examination itself depends on the medical specialty and disputed issue. Answer accurately and explain when a movement causes pain or cannot be completed. A QME or AME is evaluating a medical-legal question, not serving as your ongoing treating physician. Continue to direct treatment needs and urgent symptoms to your treating care team.

Afterward, write a short, dated note for your own records: approximately when the visit began and ended, the main subjects discussed, any requested tests or records, and any significant error you noticed in the history. If a procedure seems wrong, preserve the facts and discuss them with counsel or a DWC Information and Assistance officer.

Read the report with the question in mind

The DWC says a QME generally has 30 calendar days from the start of an examination to issue a report, subject to specified extensions; use the current DWC guidance and your actual notice to track timing. Ask for your copy if you have not received it. Read whether the report accurately describes your job, dates, symptoms, body parts, testing, and records. Mark a factual mistake or missing issue with the page number and the document that supports your correction.

An unfavorable opinion does not by itself explain the next legal step. The report may concern industrial causation, temporary work limits, permanent disability, or another issue; the applicable response depends on that issue and the posture of the claim. The DWC discusses supplemental reports and certain rating-reconsideration options, but their conditions differ. Take the report and specific concerns to your attorney or DWC Information and Assistance promptly.

A practical appointment-and-report checklist

• Save the appointment and panel/AME paperwork with every stated date.
• Prepare a truthful timeline of work, symptoms, medical visits, restrictions, and prior relevant conditions.
• Check that the evaluator receives the correct medical records through the proper exchange process.
• Bring identification and any items the evaluator’s office actually requests; ask in advance if you are unsure.
• After the visit, request and preserve the report, then list concrete errors or unanswered questions by page.

The appointment is one part of a claim record. Your treating physician’s reports, work documents, decision letters, and the reason for the evaluation remain important. The DWC’s injured-worker guides provide further public help.

Frequently asked questions

Should I hide an old injury from the QME or AME?

No. Give an accurate history and explain what changed with the claimed work injury. If a date or diagnosis is uncertain, say so. Bring the records and discuss gaps with your attorney or treating physician rather than guessing.

Can I hand new records directly to the evaluator?

Do not assume that is permitted. DWC guidance describes advance exchange of information proposed for a QME. Ask how the records should be served and whether the other side has seen them before sending or bringing material to the evaluator.

Is an IMR decision the same thing as a QME report?

No. IMR concerns certain utilization-review medical-necessity treatment disputes. A QME or AME conducts a medical-legal evaluation and issues a report about a disputed medical issue. The paperwork and reason for the dispute identify which route you are in.

Prepare for the actual question, then read the actual report

For an injured worker, the useful preparation is a truthful timeline, complete relevant records sent the proper way, and a clear understanding of the medical question. After the visit, compare the report with that question and your records. That approach is more reliable than treating every “independent exam” notice as if an insurer had chosen its own doctor or as if the visit were an IMR treatment appeal.