QME vs AME

A Qualified Medical Evaluator (QME) is a physician certified by the California Division of Workers' Compensation to evaluate disputed medical-legal issues. In the panel process, the evaluator is assigned rather than chosen: a panel of three is issued through the DWC Medical Unit and the case narrows to one of them.

An Agreed Medical Evaluator (AME) is an evaluator that both represented sides agree upon. There is no panel and no striking. The two parties simply settle on a physician they are each prepared to accept, and that physician evaluates the case.

The appeal of an AME is predictability. Both sides know the evaluator's background, approach, and reporting style before the case is sent. Where counsel on both sides have confidence in the same physician, the resulting opinion tends to be accepted rather than contested, and that can shorten the life of the dispute considerably.

The trade-off is that agreement has to be reached. If the parties are far apart, negotiating an evaluator can consume more time than the panel route would have. An AME is also only available where both sides are represented.

The panel process does not require the parties to agree on anything. It is available in unrepresented cases as well as represented ones, and it produces an evaluator through a defined administrative route. For many claims, that neutrality-by-assignment is precisely the point.

Evaluators on a panel are assigned with reference to a geographic area near the injured worker, which also makes attendance more practical than a freely negotiated choice might be. The panel request guide covers the mechanics.

Both QME and AME work is billed under the California medical-legal fee schedule, using the same evaluation codes. The difference is that AME evaluations carry a modifier of 1.35× applied to the schedule amount.

That premium is often weighed against the cost of a contested opinion. A single mutually accepted report can be cheaper overall than a disputed one that generates further proceedings — but that calculation depends entirely on the case. Current schedule figures are listed on the QME fees page.

Whichever route is used, the substance of the evaluation is comparable: a records review, a history, an examination appropriate to the specialty, and a written medical-legal report that answers the questions put to the evaluator. The quality of that report depends far more on the completeness of the records and the precision of the questions than on the label attached to the evaluator.