You are wondering how to request a Qualified Medical Evaluator when there is a dispute in your workers compensation case.
Request a QME by using the correct DWC panel form, choosing a specialty, and scheduling within the strict ten day and fifteen business day timelines.
I have guided injured workers through the QME process for decades, from choosing the right specialty to fixing scheduling problems and biased reports. If you want experienced help, start with my San Jose workers compensation services or call (408) 739-5300. In this article, I’ll cover what to expect, how the rules work, and how to protect your benefits.
Alt: San Jose workers compensation attorney explaining the California QME panel request process
What a Qualified Medical Evaluator Is in California
A Qualified Medical Evaluator is a physician certified by the state to resolve medical disputes in workers compensation cases. When there is disagreement about diagnosis, work restrictions, or permanent disability, a panel of three QMEs is issued. One doctor from the panel performs a comprehensive medical legal exam and writes a report that judges and insurers use. The exam is independent of your treating doctor.
Why the QME process matters for San Jose workers
The QME report often decides whether you receive benefits, how much you are paid, and what future care is approved. In Santa Clara County, judges in the San Jose district office read QME reports closely when setting conferences and trials. Choosing the right specialty, meeting deadlines, and correcting mistakes can change outcomes. A strong evaluation shortens disputes and supports fair settlement.
How to Request a Qme Step by Step
- Step 1. Identify the dispute. Typical issues include work relatedness, treatment, work restrictions, or permanent disability rating. A QME is not needed for every claim.
- Step 2. Confirm whether you have an attorney. Represented workers use the online Form 106 system. Unrepresented workers use the paper Form 105 with required attachments.
- Step 3. Wait the required time. In most unrepresented cases, you may request a panel on the sixteenth day after receiving the administrator’s letter asking you to do so.
- Step 4. Choose the specialty that best fits the dispute. Orthopedics is common for musculoskeletal injuries. Other examples include neurology, pain medicine, or internal medicine.
- Step 5. Complete the request form accurately. Include the claim number, body parts in dispute, and your preferred exam location. Attach proof of service and keep copies.
- Step 6. Submit the panel request correctly. Mail or deliver Form 105 to the DWC Medical Unit and serve the adjuster. Represented parties request Form 106 online and receive a panel immediately.
- Step 7. Act quickly when the panel arrives. In unrepresented cases you must pick a QME and schedule within ten days or the insurer may select the doctor.
- Step 8. Prepare for the exam. Bring photo identification, prior medical records, medication lists, and a timeline of your symptoms and work duties.
- Step 9. Attend the appointment on time. Provide complete and honest answers. Do not exaggerate symptoms or minimize activity limits.
- Step 10. Follow up after the exam. Request a copy of the report. If there are factual errors, you can ask for corrections and, when needed, seek help from a judge to resolve disputes.
Alternatives and Options if Problems Arise
- Agreed Medical Evaluator when both sides have lawyers and agree on one doctor to decide the dispute.
- Replacement panel if the doctor has a conflict or is unavailable within required timeframes.
- Additional panel in a different specialty when good cause exists and a judge approves.
- Treating physician supplemental report if the QME needs clarification on specific issues.
San Jose and California Qme Specifics to Remember
Local venue. Disputes about QME scheduling and replacement are heard at the San Jose Workers Compensation Appeals Board at 224 Airport Parkway, Suite 600. Find WCAB offices here. Many status conferences occur by video, and the clerk can provide connection details.
Panel timelines. If a panel is not issued within fifteen business days after a valid request, remedies may apply, including selecting any QME and notifying the parties.
Form differences. Unrepresented workers use QME Form 105. Represented workers must use the online Form 106 system. Each has unique instructions and proof of service requirements.
Scheduling rules. You must contact the selected QME and schedule promptly. If you do not schedule within ten days in an unrepresented case, the insurer may choose the examiner from the panel.
How to Choose the Right Specialty and Examiner
Pick the specialty that fits the main body part and dispute. For a rotator cuff tear, orthopedics is usually best. For nerve symptoms, consider neurology. For complex pain complaints, pain medicine may be appropriate. Review each doctor’s profile and office locations. If travel is difficult, ask the Medical Unit for a replacement due to unavailability.
What Insurers Commonly Argue and How to Counter It
Insurers often question causation or claim you can return to full duty. Counter those arguments with specific job duty descriptions, imaging results, and consistent treatment notes. If a report omits important facts, request a supplemental report. When the examiner ignores obvious restrictions, I can seek a hearing so a judge orders clarification or a new panel if warranted.
Timeline From Request to Report
Represented panels issue instantly online, and exams are often set within thirty to sixty days. Reports usually arrive a few weeks after the appointment. In unrepresented cases, mailing times can extend the process. Keep copies of all letters and log your calls to the doctor’s office. Strong organization helps prevent missed deadlines and lost benefits.
Exceptions and Edge Cases You Should Know
If new body parts are added later, an additional panel in a different specialty may be appropriate. If the selected QME stops taking cases or is booked too far out, a replacement panel can be requested. When both sides have lawyers and agree on one evaluator, an Agreed Medical Evaluator can replace the panel process entirely. These tools help move cases toward a fair decision.
Qme and Ame Comparison at a Glance
This quick comparison shows who requests the evaluation and which form applies.
| Situation | Who requests | Form or agreement |
|---|---|---|
| Unrepresented dispute | Worker requests QME panel | Form 105 |
| Represented dispute | Either party requests online panel | Form 106 |
| Both sides agree on one doctor | Attorneys select AME | Written agreement |
Official instructions for unrepresented panel requests appear on QME Form 105 instructions. Represented parties must use the online system described in QME Form 106 FAQs. California regulations detail timelines and replacement rules in CCR Title 8 Section 30 and CCR Title 8 Section 31.3.
Alt: California QME exam preparation with forms and ID at a San Jose law office
Get Help Selecting the Right Qme and Protecting Your Benefits
I will help you request the right specialty, meet every deadline, and respond to biased or incomplete reports. Start with San Jose workers compensation services or call (408) 739-5300. There is no fee unless we win.
Resources
QME Form 105 unrepresented request
WCAB office locations including San Jose
Further Reading
What benefits can you get from workers compensation in California
What is the 90 day rule for workers comp in California
How to file a workers compensation claim in San Jose
