The QME Appointment: Scheduling Deadlines, Required Disclosures, and Ex Parte Rules
Short answer: once a QME is selected from a panel, the appointment must be scheduled within 90 days of the request, at the office listed on the panel, and the appointment notification (Form 110) must be served on every party within five business days. At the evaluation the QME must tell the injured worker they may ask questions, that they may discontinue for good cause, and, if applicable, that the evaluator is on probation. Minimum face-to-face time is 60 minutes for psychiatric evaluations, 20 minutes for neuromusculoskeletal, and 30 minutes for the rest. Communications with one party alone are prohibited.
Everything in California workers' compensation runs on timelines, because without them nothing would move and the injured worker would be the one waiting. The rules below are the ones that generate the most QME discipline, and they are heavily tested on the QME exam.
Scheduling: the 90-day window
After the panel issues and an evaluator is selected, the QME must schedule the appointment within 90 days of the request. That window used to be 60 days; it was extended by 30 days as a COVID-era accommodation, and the extension was made permanent effective February 2023. If the party with the right to schedule agrees, the appointment may go out to 120 days.
Those are ceilings, not targets. There is an injured worker on the other end of the appointment, sometimes without benefits, and evaluators who schedule at 45 or 60 days are doing the system and their own reputation a favor. When an attorney calls to ask how far out you are booking, the answer that keeps you on panels is a short one.
The appointment must be scheduled at the office identified on the panel form. Not a satellite office, not a home office, not the location that happens to be convenient that week. The parties check this address, and moving the initial evaluation elsewhere is a discipline issue.
Form 110 and the five-business-day rule
The appointment notification is QME Form 110. It has to be completed and served within five business days of scheduling, on the employee, the employee's representative, the employer, and the defense attorney: every party in the case.
The form carries the date of the appointment call, the date of the appointment, and the examination address, and the parties will scrutinize all three for compliance. It also serves as notice for sending records, and it identifies whether a state interpreter is needed.
Failure to serve the appointment notification is grounds for a replacement panel, which means the case is taken away from you and reassigned. Five days is the outer limit; same day or next day is better.
Cancellation and rescheduling
Once scheduled, the appointment may not be cancelled by the QME or any party less than six business days before it, absent good cause.
Good cause here is narrow: serious illness of the evaluator, a death in the family, a natural disaster or comparable community catastrophe. Being overbooked is not good cause. During the COVID period some evaluators successfully framed the emergency in those terms, which gives a sense of the threshold.
When an evaluator cancels, three things follow. The evaluator must advise the parties in writing of the reason, so they can assess whether it qualifies as good cause. The appointment must be rescheduled to a date within 30 days of the cancellation. And the rescheduled date may not fall more than 60 days from the date of the original request, unless the parties agree in writing.
Cancellations by others must also be in writing, with a reason. An oral cancellation has to be followed by a confirming letter, fax, or email within 24 hours. The practical rule for the office: never accept a cancellation by phone without asking for it in writing, and always capture the reason.
One thing that does not justify cancelling: not having received the medical records. The exception is a psychological evaluation, where the records are necessary to the evaluation itself.
Two further restrictions. You may not schedule differently based on whether a worker is represented, and you may not demand advance assurance of payment or refuse to schedule because you expect collection to be difficult.
The disclosures you must make before examining
This is the single most commonly omitted requirement in the whole system, and it is the one the DWC has been pushing hardest on, because it governs how evaluators treat injured workers.
Before or at the evaluation, the QME must advise the injured worker of the following:
They may ask questions about the evaluation process, and you must answer them promptly. Not about your conclusions; about the process and your background.
They may discontinue the evaluation for good cause. Good cause is defined and includes discriminatory conduct based on race, sex, national origin, religion, or sexual orientation; abusive, hostile, or rude behavior, including conduct that demonstrates bias against injured workers; and a request that the worker submit to an unnecessary examination or procedure.
If you are on probation with the Administrative Director or your licensing board, you must disclose it. The worker may then decide whether to proceed, and if they decline, the termination is treated as having occurred for good cause. You are entitled to explain the circumstances.
If they decline to ask questions and do not object during the examination, they lose the right to object afterward on these grounds.
You must document in the body of the report that you completed this procedure.
Evaluators resist this, for an obvious reason: it feels like handing the examinee a script for walking out. The better way to see it is as a discipline you impose on yourself. Reading a worker their right not to be treated dismissively is a reliable way to remember not to treat them dismissively. Eye-rolling, sighing, impatience, and not listening are the behaviors the regulation names, and they are behaviors evaluators drift into without noticing.
In practice, hand the worker a form carrying the regulatory language, let them read it, then go through it with them. Explain what the examination will involve, including anything that requires disrobing, and get an explicit acknowledgment before you begin. Evaluators who do this consistently report that walkouts are rare, and that the conversation improves the rest of the encounter.
Ethical obligations at the office
Alongside the disclosures, the ethics regulation imposes obligations that catch people out:
- Maintain a clean, professional physician's office with functioning instruments and equipment appropriate to your scope of practice, and a working business phone listed with the Medical Director for that location. A chiropractor using space in a podiatry office, with podiatry equipment, does not meet this.
- Schedule without regard to whether the worker is represented.
- Never request an unnecessary examination or procedure.
- Never provide treatment advice or solicit the examinee as a patient. That is a conflict of interest.
- Communicate respectfully and professionally.
- Do not reschedule the same case more than twice.
- Review all available relevant medical and non-medical records before generating the written report, and list and summarize them in it.
Note the timing on that last one. The records must be reviewed before the report is written, not necessarily before the face-to-face. Records frequently arrive after the examination, and that is normal.
Ex parte communication
Communications in a QME case are tightly controlled. An ex parte communication is one with a party outside the presence or knowledge of the others, and a finding of ex parte communication is taken seriously enough to justify a replacement panel.
The workable rule: do not discuss the case with anyone. Written communications are acceptable when served on all parties simultaneously. When a claims administrator calls to fill you in on Mr. Smith, that call is the problem, and the answer is to ask for it in writing to all parties.
This is different from personal injury practice, where a call from the retaining attorney is routine. Evaluators moving into comp work from PI need to unlearn the habit.
The same logic governs conflicts of interest. A personal, financial, family, or social connection to any party compromises the evaluation, and every report carries a declaration that no conflict exists.
Minimum face-to-face time
The regulations set minimum face-to-face times by evaluation type:
| Evaluation type | Minimum face-to-face |
|---|---|
| Psychiatric | 60 minutes |
| Neuromusculoskeletal | 20 minutes |
| All others (pulmonary, cardiac, and the rest) | 30 minutes |
These are floors, and they exist because the alternative is a fifteen-minute examination behind a hundred-page report. The evaluation protocols themselves, in the regulations covering psychiatric, pulmonary, cardiac, neuromusculoskeletal, foot and ankle, and immunologic evaluations, largely say one thing for injuries on or after January 1, 2005: measure impairment as described in the AMA Guides 5th Edition.
Answering the cover letters is the job
One more rule shapes what happens after the appointment. The evaluator must address all contested medical issues arising from all injuries reported on claim forms before the appointment, within their scope and competence, and must attempt to answer every question raised by each party in their cover letters.
Two cover letters can mean thirty questions, some of them intricate. Answer them one at a time. The purpose of the evaluation is to give the parties specific answers to the specific questions they asked, not the report you think they need. Importing the questions into the report and answering each in turn is the reliable method.
If the records show treatment to a body part the cover letters never mention, write to the parties, in writing to all of them, and ask whether it is in scope before you guess.
What to gather in the room
Two parts of the encounter get shortchanged more than any other: the review of systems, which is where conditions outside the claim and issues outside your specialty surface, and the activities of daily living assessment, which is what the impairment rating rests on under the AMA Guides. Both have their own checklists.
Where the preparation happens
Most of what makes an appointment go well happens before it. Knowing which Labor Code section generated the panel tells you what the evaluation is for. Knowing what the records say tells you what to ask about, which prior injuries to explore, and which cover-letter questions are actually contested.
Lexamed reads the full production and returns a page-cited chronology with the causation and MMI evidence flagged, so you walk into the room knowing the case rather than reading it afterward.
Frequently asked questions
How soon must a QME appointment be scheduled? Within 90 days of the request, at the office listed on the panel. The window may extend to 120 days if the party with the right to schedule agrees. Before February 2023 the standard window was 60 days.
What is QME Form 110? The appointment notification form. The evaluator must complete and serve it on all parties within five business days of scheduling. Failure to serve it is grounds for issuing a replacement panel.
Can a QME cancel an appointment? Not less than six business days before it without good cause, which means serious illness, a death in the family, or a natural disaster. The evaluator must notify the parties in writing with the reason, reschedule within 30 days of the cancellation, and not schedule beyond 60 days from the original request without written agreement.
What must a QME tell the injured worker before the examination? That they may ask questions about the process and the evaluator's background and will receive prompt answers; that they may discontinue the evaluation for good cause, including discriminatory, abusive, hostile, or rude conduct or a request for an unnecessary procedure; that the evaluator is on probation, if applicable; and that failing to raise an objection during the evaluation forfeits the right to object afterward on those grounds. The report must document that this was done.
How long must a QME spend face-to-face with the injured worker? At least 60 minutes for a psychiatric evaluation, 20 minutes for a neuromusculoskeletal evaluation, and 30 minutes for other specialties. These are minimums.
What is ex parte communication in a QME case? Communication with one party outside the presence or knowledge of the others. It is prohibited. Written communications are acceptable only when served on all parties, and a finding of ex parte communication can result in a replacement panel.
Does a QME have to answer every question in the cover letters? Yes. The evaluator must attempt to address each question raised by each party in their cover letter, along with all contested medical issues within the evaluator's scope and competence.