Qualified Medical Examiner Exams - How To Prepare the Right Way
The Qualified Medical Examiner (QME) exam is usually the single most important event in a California workers’ compensation case. The QME is the “neutral” doctor whose report judges, claims examiners, and defense attorneys use to decide what body parts are accepted, how disabled you are, and what your case is worth.
Two things matter most:
Which QME you end up with; and,
How well you are prepared before you ever walk into the exam room
At Lee Partners Law: Work Injury Attorneys, attorneys David a. Lee and Michael Lee have reviewed and litigated thousands of QME reports from all over the State of California and Los angeles. . We know which doctors tend to be fair, which lean toward insurance companies, and how to position your case so your QME exam actually reflects what you’re going through.
(For a free consult regarding any part of the QME process call or text 310-295-0822)
Step 1: How you get a QME (and why the choice of doctor matters)
In most cases, a QME panel is issued when there’s a dispute. Common examples:
The insurance company denied your entire claim;
They accepted the injury but are fighting certain body parts;
There is a dispute over whether you are Totally Temporarily Disabiled (TTD) and entitled to 2/3 your salary;
There’s a disagreement about when you reached Maximum Medical Improvement (MMI);
There’s a fight over whether your condition arose out of employment and occurred during the course of employment.
How the doctor is chosen depends on whether you have a lawyer.
If you are unrepresented:
The state issues a list of three QMEs in a specialty (orthopedic, internal medicine, psych, etc.). You obtain the list by mailing a request to the state in the speciality of your choice.
You pick one of the three and schedule your own exam. If you do not schedule, the insurance company will. More importantly, if you do NOT pick a doctor, the insurance company will which can destroy your case if you end up with wrong QME.
On paper that sounds simple. In reality, all QMEs are not created equal. They’re all licensed and certified by the state, but they are not the same in how they write, how much time they spend with you, whether they tend to side with injured employees or with insurance carriers, and how well they understand the AMA Guides.
Picking the “wrong” QME can lock you into a doctor whose opinion controls your case and is difficult to challenge. Extremly difficult without representation.
If you are represented:
The state issues the a three doctor panel, in the speciality of choice of your attorney’s choosing.
Your attorney strikes one name, the insurance company strikes one name, and the remaining doctor is your QME. (There is a bit of a process to obtain a panel when represented which is a subject of another article.
This makes it absolutely critical to work with a firm that actually knows the doctors. At Lee Partners Law, David Lee and Michael Leonard track QME outcomes across Los Angeles and the San Fernando Valley. That experience lets us:
Avoid doctors who consistently minimize injuries
Fight for a specialty that actually matches your condition
Position you with a QME who will at least give you a fair shot
The most important part of the QME process may happen before you ever get a date: choosing the right doctor and the right specialty.
Step 2: The “dueling letters” before the exam – Labor Code 4062.3
Once a QME is set, each side has the right to send a written letter and medical records to the doctor. That letter frames the issues, tells the story, and often heavily influences how the QME sees your case.
Under Labor Code section 4062.3:
The documents and letters must be shared with the other side in advance of the exam (there are specific timelines, including a 20-day rule, that must be followed).
The other side has the right to object to certain documents or to how certain facts are being presented.
Here’s why this matters for you:
You want your own letter to the QME, not just the insurance company’s.
If the only detailed letter the doctor sees is written by the insurance adjuster or defense attorney, your story may be buried under their version of what happened.We carefully review the insurance company’s letter for inaccuracies.
We go line by line and look for:Facts that are simply wrong
“Spin” that minimizes your symptoms or job duties
Selective quoting from medical records
We make targeted objections under Labor Code 4062.3.
If the other side tries to send blatantly inaccurate “facts” or reports that shouldn’t go in, we can object and, if necessary, ask a judge to rule before those documents get in front of the QME.
A strong applicant letter, combined with smart objections to the defense package, is one of the most powerful tools in the QME process. It’s also one of the easiest things to get wrong if you’re trying to navigate this alone.
Step 3: The QME’s intake forms – your chance to tell your story
A couple of weeks before the exam, the QME’s office will usually contact you:
They’ll send you questionnaires or a detailed “history” form to complete or request you speak to a historian prior to your exam.
This paperwork is critical, and it works differently than the formal 4062.3 letters:
It is generally not something you have to send to the other side.
It is your opportunity to tell the doctor, in your own words, what happened and what still hurts.
When filling these out:
List every body part that bothers you. Don’t minimize. It’s far worse to leave something out and then try to “add” a body part later than to be thorough from the beginning.
Be detailed about your job duties. Lifting, bending, pushing, overhead reaching, using tools, driving, walking on uneven surfaces—spell it out.
Explain how your symptoms affect your daily life. Sleep, showering, getting dressed, driving, playing with your kids, chores at home.
There is no penalty for listing all of the body parts that truly bother you. There are major problems when a body part is not mentioned anywhere until much later. We routinely help our clients complete these forms so the QME sees a clear, consistent picture.
Step 4: Honesty about prior injuries and medical history
One of the easiest ways to destroy a case is to hide past injuries. The QME will ask about:
Prior work injuries
Car accidents
Old fractures, surgeries, or chronic conditions
Pre-existing back, neck, joint, or psychological issues
You need to be completely truthful.
In many cases:
Old injuries are fully healed and do not reduce your current case value at all.
Even if they do matter, the insurance company has the burden to prove how much of your current condition is due to something that happened before.
What absolutely will hurt you is if:
You deny a prior injury that shows up in old medical records.
You minimize a past surgery, and the doctor later finds out from another source.
When a QME decides you are not being straight with them, they almost never give you the benefit of the doubt on any issue. At Lee Partners Law, we spend time before the exam walking through your history so you can answer honestly, clearly, and confidently.
Step 5: What to expect at the QME exam itself
Most QME appointments last about one to two hours, sometimes longer in complex cases. A typical exam includes:
A detailed interview about how the injury happened, your job duties, your symptoms, and how the condition affects your daily activities.
A full physical exam of the affected body parts. The doctor may:
Check for muscle spasms and tenderness;
Measure range of motion several times and take an average;
Test strength, reflexes, and sensation; and,
Review of medical records and diagnostic tests (X-rays, MRIs, CT scans, EMG/NCV, lab work, etc.).
A few practical points:
If your treating physician says it is medically safe, it can sometimes be better not to take strong pain medication immediately before the exam. If you are heavily medicated, you may move more than you normally can, and the QME might understate your limitations.
Don’t exaggerate or “perform.” Move as far as you truly can, but do not force it into extreme pain.
Answer questions directly. If you don’t know the answer or don’t remember, it is fine to say so.
Our clients often feel much less anxious at the exam because they know exactly what’s coming and what the QME is really looking for.
Step 6: After the QME exam – reports, tests, and referrals
After the initial exam:
The QME generally has 30 days to issue a written report.
If more information is needed, they may:
Order additional diagnostic tests (MRIs, nerve studies, etc.).
Ask to see you again for a follow-up exam.
Refer you to another specialty if they discover other medical issues (for example, you see an orthopedic QME but also have significant stomach problems from medications, or uncontrolled hypertension).
In many cases, more diagnostic testing helps your case because it provides objective proof of what is wrong. At Lee Partners Law, we push for appropriate diagnostic studies so your injuries are documented, not brushed off as “subjective.”
Once the QME decides you have reached Maximum Medical Improvement (MMI), they must:
Describe your permanent work restrictions, if any.
Assign a Whole Person Impairment (WPI) under the AMA Guides, 5th Edition.
Explain whether any part of your disability is due to pre-existing conditions (apportionment).
That WPI percentage is then run through the California Permanent Disability Rating Schedule to produce your disability rating, which directly affects your settlement value.
David A. Lee and Michael Lee are deeply familiar with the AMA Guides 5th Edition. We scrutinize QME reports to make sure:
The correct chapter, table, and method were used.
All affected body parts were rated.
Range of motion measurements were taken and averaged properly.
Apportionment to prior conditions is justified and supported, not just thrown in to reduce your case.
When a QME under-rates your impairment or misapplies the Guides, we fight for supplemental reports, additional records, or, if necessary, trial.
Step 7: Why having a workers’ comp attorney for your QME is so important
The QME process is full of traps:
Deadlines under Labor Code 4062.3 for objecting to records or letters
Technical rules about what can and can’t go to the doctor
Strategy around specialty, panel selection, and which doctor to strike
Complex AMA Guides rating issues that dramatically change case value
At Lee Partners Law: Work Injury Attorneys, our entire practice is focused on California workers’ compensation. We:
Help choose the right QME and specialty for your case
Draft detailed applicant letters and object to misleading defense letters
Prepare you for the exam so you know what to expect and how to present your history honestly and clearly
Push for thorough diagnostic testing and appropriate referrals
Challenge low impairment ratings and improper apportionment
Use the QME report to negotiate fair settlements or, if needed, take your case to trial
If your QME exam is coming up—or if you already had a QME exam that feels unfair—you don’t have to navigate this alone. David Lee and Michael Lee are available to review your QME notice or report and walk you through your options.
Serving workers across Los Angeles and the San Fernando Valley
We represent employees across Southern California, including:
San Fernando Valley communities such as Pacoima, North Hollywood, Panorama City, Van Nuys, Sylmar, Arleta, Sun Valley, San Fernando, Mission Hills, Reseda, Canoga Park, Winnetka, Northridge, Granada Hills, Chatsworth, Burbank, and Glendale
Southeast and central Los Angeles communities with large Spanish-speaking populations, including Downey, South Gate, Huntington Park, Bell, Bell Gardens, Lynwood, Maywood, Montebello, Norwalk, East Los Angeles, and surrounding neighborhoods
If you have a Qualified Medical Examiner exam scheduled—or you think you should have one but don’t—contact Lee Partners Law: Work Injury Attorneys for a free consultation. The sooner we get involved, the more we can do to make sure the QME process actually protects you instead of hurting your case.