Explaining the California QME/AME process

Sometimes there is confusion between a QME, an AME, a QME Panel and other bodies involved in the California workers’ compensation process.  In this article we explore some of the key principles.  

QME/AME General Definition

A Qualified Medial Examiner (QME) has been certified by the state of California Division of  Workers’ Compensation (DWC) to provide an expert, objective opinion on a work injury case.  QMEs can come from many medical fields including psychology, orthopedics, chiropractic, etc.  The primary job of the physician is to provide their objective review of the claim.  This might include a pain impairment rating of the patient which would ultimately determine what benefits you should receive as an injured worker.  If the injured worker has an attorney, the claims administrator could involve a doctor to settle medical disputes.  In this case, the doctor would be serving as an Agreed Medical Evaluator (AME) on the case.

What is a “Panel QME”?

A panel, or in this case a list, of QMEs is a randomly generated board of three QME physicians issued to the injured worker.  The job of the panel is to determine whether the injuries in question are work related.  Additional the panel of QMEs resolves any medical disputes that haven’t been resolved by the treating physician’s report.  The specialty (psychiatric or orthopedic for example) of the panel QME is chosen by the person requesting the panel QME.

Educational and Licensing Requirements

A QME candidate must first pass a test that is administrated by the DWC several times a year.  QMEs must undergo an extensive 12-hr report writing class.  This class involves training on writing a QME evaluation report and includes constructive feedback on an example QME report.  After two years and each following 2 year period the QME doctor must participate in ongoing education on the workers’ compensation evaluation process.  This training involves 12 continuing education (CE) credits for each 2-year period.  The DWC continually audits CE credits with the re-licensing process and QMEs are required to track the number of credits they have received for each period.  CE credits can be earned through online QME CE courses or in-person seminars which are commonly offered at conferences and other live events.  CE providers will issue certificates of completion and the number of credit hours earned by the participate.  Each CE course must cover a number of learning objectives which are tested with an end-of-course examination.