What Happens After a QME Report: P&S, Impairment, and the Path to Settlement
Short answer: the QME serves the report on all parties within 30 days of the examination. If the report finds the worker permanent and stationary with permanent impairment, that impairment gets converted into a permanent disability percentage, adjusted for occupation and age, and that percentage determines the award. From there the case either settles, generates supplemental reports and a deposition, or goes before a workers' compensation judge who weighs the medical evidence. Nothing about the report is automatically final, but a well-reasoned report is usually where the case stops moving.
The 30-day clock
By regulation, a QME has 30 days from the face-to-face evaluation to serve the written report. After that it is overdue and the parties may object to it.
Experienced evaluators treat 30 days as the failure line and aim for 14. The reasoning is not just etiquette. Benefits may be suspended pending the report, and the person waiting has no other route forward. Attorneys also notice: evaluators who turn reports around quickly are the ones left standing after the strike process, and speed is one of the few levers a QME can pull, since soliciting work is prohibited.
The report goes to the parties, to the claims administrator, and where the case is litigated, to a workers' compensation judge.
What permanent and stationary means
Permanent and stationary means the condition has reached maximum medical improvement and is unlikely to change substantially over the next year, with or without further medical treatment.
The operative test is the second half of that sentence. Would more treatment make a substantial difference? Not any difference: a substantial one, the kind that would justify spending the money. If the honest answer is no, the worker is likely P&S and can be evaluated for permanent disability.
P&S is the gateway to everything that follows. Before it, there is no permanent disability evaluation and no apportionment. After it, both are required.
From impairment to a disability rating
The QME supplies whole person impairment. The rating happens elsewhere.
Under the Permanent Disability Rating Schedule, three factors combine: the nature of the physical injury or disfigurement, expressed as whole person impairment under the AMA Guides 5th Edition; the worker's occupation; and their age at the date of injury. Two of those are essentially facts. The impairment percentage is the disputed one, and it comes from the report.
Raters at the DWC's Disability Evaluation Unit take the report and produce the rating that determines what is paid. That is the practical reason the Physician's Guide keeps insisting reports be "ratable": a rater who cannot follow the report cannot rate it, and the case stalls while someone pays for a supplemental report to fix an omission.
For injuries before 2013, Labor Code §4660 frames permanent disability in terms of diminished future earning capacity. For injuries on or after January 1, 2013, §4660.1 applies. Either way, the award is compensating the narrowing of what the worker can earn going forward, not the medical condition itself.
Apportionment decides who pays for what
If there is permanent impairment, the report must also apportion it: what approximate percentage was directly caused by the industrial injury, and what approximate percentage by other factors, before and after, including prior industrial injuries.
The employer pays only for the industrial share. Whatever is apportioned to other causes, the worker absorbs. That is why both attorneys read the apportionment section hardest and why it drives most depositions. The apportionment post covers how those opinions are built and where they fail.
An impairment opinion with no apportionment determination is incomplete on the issue of permanent disability, and cannot resolve the dispute.
The four things that can happen next
The case settles. Most do. The report gives both sides a number they can work from, and the parties negotiate a stipulated award or a compromise and release.
A supplemental report is requested. A supplemental answers new questions without a new examination, usually because something was omitted, a new record surfaced, or a party wants a point clarified. Supplementals are common and are separately compensated, but a case that needs several of them is a case that is dragging, and nobody involved benefits from that except, marginally, the evaluator writing them.
A re-evaluation happens. A follow-up comprehensive evaluation involves another face-to-face. Cases frequently require more than one; a worker who was not P&S at the first visit may be at the second.
A deposition is taken. One or more parties disagrees with a determination, usually impairment or apportionment. The attorneys question the evaluator under oath, generally trying to establish either that the opinions are substantial medical evidence or that they are not. Medical-legal testimony is compensated at $455 per hour with a two-hour minimum, so a deposition has a floor of $910.
Why some reports get relied on and others do not
When two physicians disagree, the judge weighs the evidence and adopts the more persuasive opinion. "More persuasive" has a technical meaning here: it means the opinion that qualifies as substantial medical evidence.
Under Escobedo v. Marshalls (2005), an opinion must be framed in reasonable medical probability, avoid speculation, rest on pertinent facts and an adequate history and examination, and set out the reasoning connecting the facts to the conclusion. An opinion stating a conclusion without reasons is conclusory, and a judge cannot rely on it regardless of whether it is correct.
That is the difference between a report that ends a case and a report that generates six more months of litigation.
What injured workers usually want to know
Is the QME's opinion final? No. It is evidence, and often the most important evidence, but the parties may object, obtain supplemental reports, depose the evaluator, or in some circumstances seek a replacement panel. A judge decides contested issues.
How long until something happens? The report is due within 30 days of the examination. What follows depends on whether the parties accept it. Settlements can follow within weeks; contested cases take considerably longer.
Can I get a different QME? Only in specific circumstances, such as a defect in the panel process, an ex parte communication, a disqualifying conflict of interest, or the evaluator failing to meet obligations like serving the appointment notification. Disagreeing with the conclusions is not itself grounds.
What if the QME found no impairment? Then there is nothing to rate on that issue. The worker may still be entitled to medical treatment or other benefits depending on what was found and what was in dispute.
Where the delay actually comes from
The 30-day clock starts at the examination, but the work that fills it is the record review. A comp production runs from a few hundred to several thousand pages, and the report cannot be written until it is read. That is the bottleneck between an examination and a decision, and it is where the case sits while a worker waits.
Lexamed reads the full production and returns a dated, page-cited chronology with the causation and MMI evidence flagged, so the report can be drafted against organized evidence rather than against the deadline. The physician remains the reviewer of record. The difference is how much of the 30 days is spent finding things.
Frequently asked questions
What happens after a QME report is filed? The report is served on all parties within 30 days of the examination. If it finds permanent impairment, the impairment is converted into a permanent disability rating that determines the award. The case then settles, generates supplemental reports or a re-evaluation, proceeds to a deposition, or is decided by a workers' compensation judge.
What does permanent and stationary mean? That the condition has reached maximum medical improvement and is unlikely to change substantially within the next year, with or without further treatment. It is the point at which permanent disability can be evaluated.
What happens after you are declared permanent and stationary? The evaluator assesses whole person impairment and apportions its causes. The impairment percentage is adjusted for occupation and age to produce a permanent disability rating, which determines the award, and the parties typically move toward settlement.
How long does a QME have to write the report? 30 days from the face-to-face evaluation. Many experienced evaluators target 14 days, because benefits may be waiting on the report and prompt evaluators are more likely to survive the strike process.
Is a QME report final? No. It is evidence. Parties may object, request supplemental reports, depose the evaluator, or seek a replacement panel in defined circumstances, and a judge decides contested issues by weighing the medical evidence.
How does a QME report lead to a settlement? The report supplies the impairment percentage and the apportionment, which together determine the value of the permanent disability claim. Once both sides have that number, they can negotiate a stipulated award or a compromise and release.
What is a supplemental report? A report answering additional questions without a new face-to-face examination, usually requested when something was omitted, a new record surfaced, or a party needs clarification.