QME vs. AME (Agreed Medical Evaluator) — California Workers' Comp Decision Guide

What does a QME do in your case?

A QME is a neutral doctor. They rate how hurt you are. They also decide how much of it came from work.

QME stands for Qualified Medical Evaluator. The state trains and certifies these doctors. They do not treat you at all. They only judge your injury for the case. The doctor works in a fitting field. A back claim may go to an orthopedist. A hand injury may go to a hand surgeon.

You get a QME when you and the insurer disagree. Maybe they say you can already work. Maybe they call your injury minor. Maybe they deny that your job caused it. The QME steps in to break that tie. Their report can settle the fight. A clear report can also speed up your benefits.

The state sends a list of three QME names. Each side strikes one name off that list. The last doctor left becomes your QME. That panel-and-strike process comes from Labor Code 4062.2. You then attend one exam with that doctor. This can take weeks to set up.

The QME is meant to be neutral. Still, it is a stranger you did not choose. You cannot pick a friendly doctor here. You also cannot swap a QME you dislike with ease. You meet this doctor just once in most cases. That is why the strike step matters so much.

What is an AME, and who can use one?

An AME is one doctor both sides agree to trust. Only workers with a lawyer can use this route. It can save months.

AME stands for Agreed Medical Evaluator. You and the insurer pick this doctor together. There is no random panel of names. There are no strikes to worry about. You both settle on a name you trust. That single doctor then evaluates your injury. You skip the whole strike step this way.

Here is the catch. You can only use an AME if you have a lawyer. A worker on their own must use the QME panel. This is one real perk of being represented. It is a door that opens once you hire help.

Why does this route exist? It saves both sides time and stress. A trusted doctor is harder to fight later. Neither side picked a stranger off a list. So the final report tends to hold up. Even the insurer gains more certainty. That shared trust is the real value here.

An AME does take some trust on your side. You agree to a doctor before you know the result. A good lawyer only agrees to a fair one. That is why the lawyer's local knowledge matters. One trusted exam can replace a long panel fight.

Should you choose a QME or an AME?

Many workers with a lawyer prefer an AME. The doctor is one both sides already trust. That report is hard to attack later.

The choice matters more than it looks. The report drives your money. A higher rating can mean more pay. A harsh doctor can shrink your award. So the doctor you face is a big deal. Here is a side-by-side look at both paths.

An AME has clear upsides. It is faster and feels more fair. The report is hard to attack later. But it has a downside too. A bad agreed doctor binds you as well. You cannot easily undo a report you helped pick. For many represented workers, it is still the safer bet. Speed and fairness usually win the day.

A QME has upsides of its own. Any worker can use it, even with no lawyer. The doctor is a neutral stranger. But the panel is random. It can feel like a gamble. A skilled lawyer helps you choose the better path. They weigh your injury, the doctors, and your goals.

What does the doctor decide about your benefits?

The doctor sets your impairment rating. They also split the cause between work and other things. Both choices change your final pay.

The QME or AME does two big jobs. First, they rate how much you lost. This becomes your permanent disability rating. That rating runs from 0 to 100 percent. It then adjusts for your age and job under Labor Code 4660.1. A higher number means a bigger award. Most injuries land somewhere in the middle.

Second, they decide what caused your harm. Some came from your job. Some may come from age or old injuries. This split is called apportionment under Labor Code 4663. Say the doctor ties 70 percent to work. Then your employer pays only that work-caused share. The other 30 percent may fall outside your claim. A good lawyer fights to keep more tied to work.

Here is what a rating can be worth in 2026. These are top amounts at the highest weekly rate.

A rating of 70 percent or more also adds a lifetime life pension. One thing the doctor does not control is your care. Your treatment stays fully covered with no copay under Labor Code 4600. That holds true while your case plays out. So never skip care over a low rating.