What Is a QME?

A QME — Qualified Medical Evaluator — is a physician certified by the Division of Workers' Compensation (DWC) to perform medical-legal evaluations in California workers' compensation claims. When the parties to a claim disagree about a medical issue, a QME examines the injured worker, reviews the relevant records, and produces a written report setting out an independent medical opinion on the questions in dispute.

The QME is not a treating physician. The role is evaluative rather than therapeutic: the evaluator is asked to form and explain an opinion, not to manage care. That distinction shapes everything about the appointment, from the questions asked to the structure of the report that follows.

Workers' compensation claims turn on medical facts. Is the injury work related? Has the condition reached a stable point? What work can the person safely do? When the parties cannot agree on the answer, the system provides an independent evaluator rather than leaving the dispute to be argued on paper alone.

The QME report becomes part of the claim record and is used by the parties — and, where a case is litigated, by the court — to understand the medical position. A clear, well-supported report can move a claim toward resolution. An unclear one usually generates more disputes, which is why report quality matters so much to the people who commission evaluations.

Evaluators are not chosen freely by one side. A QME panel — a list of three certified evaluators — is issued through the DWC Medical Unit. The panel is drawn for the requested specialty and the evaluators are assigned with reference to a geographic area near the injured worker, so that attendance is practical.

What happens next depends on whether the injured worker is represented by an attorney. The represented and unrepresented processes differ, and in represented cases the parties may strike names from the panel before an evaluator is confirmed. Our QME panel request guide walks through the panel step in more detail.

A QME comes from a panel. An Agreed Medical Evaluator (AME) is an evaluator that both represented sides agree upon directly, without drawing a panel. Because an AME is chosen by consent rather than assignment, the route into the case — and often the fee — is different. The QME vs AME comparison sets the two side by side.

An evaluation generally combines three elements: a review of the medical and claim records provided to the evaluator, a history taken directly from the injured worker, and a physical examination appropriate to the specialty and the body parts in dispute. The evaluator may also consider diagnostic studies already in the file or request further studies where they are needed to answer the questions posed.

Remote evaluations may be available in some circumstances, where appropriate for the case and permitted under current California DWC rules. Whether a remote format is suitable depends on the specialty, the issues in dispute, and the examination required — it is a case-by-case decision rather than a default.

For a walkthrough of the appointment itself, see what to expect at a QME exam.

After the examination, the evaluator writes a medical-legal report. It typically records the history, the records reviewed, the examination findings, the evaluator's diagnoses, and reasoned answers to the specific questions raised by the parties. The reasoning matters as much as the conclusion: an opinion that explains how the evaluator moved from the evidence to the finding is far more useful than a bare assertion.

Reports are billed under the California medical-legal fee schedule, which sets defined codes and amounts rather than leaving fees to negotiation. See our QME fees page for the current schedule figures, and reports and timelines for turnaround expectations.

QME California coordinates evaluations for law firms, third-party administrators, employers, and corporate clients across California. We do not work directly with claimants. If you are an injured worker, your attorney, claims administrator, or the DWC Medical Unit is the right place to start.