California Agreed Medical Evaluator (AME): Selection and Reports

A California Agreed Medical Evaluator, or AME, is a physician chosen jointly by an injured worker’s attorney and the employer’s insurance carrier to resolve a medical dispute in a workers’ compensation claim. The process is only open to represented workers, and the report the AME produces carries more weight before the Workers’ Compensation Appeals Board than almost any other medical opinion in the case. Because both sides picked the doctor, both sides are largely stuck with what the doctor says.

Who Can Use an AME

Only injured workers represented by an attorney can go through the AME process. Labor Code Section 4062.2 governs comprehensive medical evaluations when the employee has counsel.¹ Unrepresented workers are routed to the Qualified Medical Evaluator (QME) process instead, where the state issues a three-member panel and the parties do not negotiate the physician’s identity.

One rule catches people off guard. If you complete an AME evaluation while represented and then lose or fire your attorney, you are not entitled to a fresh evaluation on that issue. The AME report stands, whatever your representation status looks like afterward.¹

What Disputes an AME Resolves

A medical-legal evaluation becomes necessary when the treating physician’s report cannot resolve a disagreement between the worker and the carrier. Labor Code Section 4060 identifies the categories, most commonly whether the injury is work-related at all.¹ Other frequent issues include the degree of permanent disability, the need for future medical treatment, and apportionment — how much of your current condition comes from the work injury versus pre-existing problems.

If the employer has already accepted the injury as work-related, compensability is off the table and the dispute has to involve something else. And utilization review disputes cannot be routed to an AME; those go through independent medical review instead.¹

How the Physician Is Chosen

The parties can agree on an AME at any point in the claim. In practice, the applicant’s attorney and the insurer’s representative negotiate over a specific doctor, weighing clinical specialty, thoroughness, and perceived neutrality. Experienced attorneys keep short lists of physicians they consider fair, and a name can be settled quickly when preferences overlap.

When the parties cannot agree, the fallback is the state QME panel. Either side may request a three-member panel no earlier than 10 days after the initial request for a medical evaluation is mailed. Each party then strikes one name, and the remaining physician conducts the evaluation.¹ A party who fails to strike within 10 days loses that turn, and the other side picks from whoever is left. Once an issue is submitted to an AME, neither side can request a panel on that issue unless both cancel the agreement in writing.

After selection, the represented worker is responsible for scheduling the appointment. If the worker doesn’t notify the employer of the appointment within 10 days, the employer may schedule it and inform the worker.¹

Preparing for the Evaluation

Both sides assemble a packet for the evaluator before the appointment. The claims administrator must provide treating physician records, prior medical records relevant to the dispute, and any non-medical records that bear on the medical issues, such as surveillance video or a job description.² Diagnostic imaging, payroll records, and wage statements come in when earnings or temporary disability rates are at issue. The worker can also submit records directly.

A letter of instruction accompanies the file, describing the treating physician’s findings and listing the questions the evaluator must address. That letter has to be served on the opposing party at least 20 days before the evaluation.² The questions typically cover whether the injury arose out of employment, the level of permanent impairment, and apportionment between the work incident and any pre-existing condition.

The Ex Parte Rule

Contact with the evaluator is tightly restricted, and violations carry real consequences. All communications must be in writing and sent simultaneously to the other side. A narrow exception for AMEs allows oral or written contact on nonsubstantive matters like scheduling, records delivery, or checking on the report, unless the Appeals Board has already found an improper contact in the case.²

Sending records without copying the opposing party is an ex parte communication. So is any advocacy letter or unauthorized medical report meant to influence the evaluator outside the formal record exchange. The aggrieved party can request a new QME panel, which effectively restarts the medical evaluation and adds months to the claim.²

What Happens at the Appointment

The appointment begins with a detailed history covering the injury, prior conditions, and current symptoms. A physical examination follows, tailored to the body parts and systems in dispute. The physician performs clinical tests, observes functional limitations, and may pull records mid-session to reconcile treatment dates or conflicting information.

Labor Code Section 4628 requires that the physician who signs the report personally conduct the examination. No one other than a nurse handling routine tasks like taking blood pressure may examine the worker or take part in the non-clerical preparation of the report, including the history, the review of prior records, and the conclusions. If someone else outlines the history or excerpts records at the outset, the physician must personally review all of it and follow up as needed. A report that fails these requirements is inadmissible, and the medical-legal fees don’t have to be paid.³

When the Report Arrives

The evaluator has 30 days after the examination to submit a written report.⁴ The physician may ask the DWC Medical Director for more time, but a good-cause extension cannot exceed 15 additional days and must be requested five days before the report is due.⁵ If the evaluator misses the deadline without an approved extension, either party can request a replacement. Most attorneys wait rather than restart, but the option is there.

The finished report goes to the worker’s attorney and the carrier at the same time, and it is filed with the Appeals Board if a hearing is pending. It must include a declaration under penalty of perjury and must disclose who did each part of the evaluation.³

Why the AME’s Opinion Is Hard to Beat

Because both sides picked the physician, the Appeals Board treats the AME’s opinion as presumptively reliable. The standard from case law is that the AME’s opinion should ordinarily be followed unless there is a good reason to find it unpersuasive. That is a high bar for whichever side ends up unhappy with the findings.

A QME report gets no such deference. When a QME opinion conflicts with a treating physician’s report, the judge simply picks whichever is more persuasive, with no thumb on the scale. This is why the AME selection matters so much: agreeing to the wrong physician can lock in findings that are very difficult to unwind.

Challenging an AME Report

An AME report is hard to beat but not bulletproof. A few tools exist for the side that thinks the findings are wrong.

A supplemental report is the least confrontational move. Either side can send written questions asking the evaluator to clarify ambiguities or address something the report skipped.
A deposition puts the physician under oath. The attorney can cross-examine on methodology, inconsistencies, and unsupported conclusions. Depositions are expensive but effective at exposing weaknesses that don’t show on paper.
If the AME report is successfully undermined, the treating physician’s opinion may become credible enough to carry the issue.
When settlement is impossible, either party can bring the dispute before a Workers’ Compensation Administrative Law Judge, who weighs all the medical evidence and decides which opinions to credit.

Supplemental reports and depositions are the common tools. Asking a judge to throw out an AME report entirely is an uphill fight given the presumptive weight the report already carries.

Conflicts of Interest

An AME must be free of disqualifying conflicts, and both the physician and the parties share the duty to flag them. A conflict exists when the evaluator has a familial relationship, a significant financial interest, or a professional affiliation with any party to the claim.⁶

The financial thresholds are specific. An evaluator is disqualified if they hold a 5% or greater interest in a business entity connected to the matter, or if 5% or more of their income comes from direct referrals by the parties involved. A catch-all covers any relationship that would cause a reasonable person to question impartiality.⁶ When a conflict surfaces, the evaluator has five business days to notify both sides in writing, and any party who spots a potential conflict must notify the evaluator on the same timeline. An evaluator may also step aside voluntarily when a relationship makes it improper to continue, even if no formal category fits.

What the Process Costs

A comprehensive medical-legal evaluation carries a standard fee of $2,015 under the state fee schedule, and the claims administrator generally covers it as a medical-legal expense of the claim.⁷

Missing an appointment costs $503.75. The same charge applies if the worker arrives more than 30 minutes late and the evaluation can’t go forward, leaves before it is complete, or cancels within six business days. If the no-show is the worker’s fault, the employer can seek to credit the charge against the eventual award.⁷

When an attorney deposes the AME, the physician gets a minimum of two hours’ pay at $455 per hour. A deposition canceled fewer than eight calendar days out still triggers a minimum of one hour’s pay.⁷ The party requesting the deposition typically pays, though that can become a disputed issue at trial.

Workers who travel to an AME appointment may claim mileage reimbursement. The 2026 IRS medical mileage rate is 20.5 cents per mile.⁸ Keep a mileage log and receipts for parking or transit; those costs are reimbursable as part of the claim.

1
California Legislative Information. California Labor Code Section 4062.2
2
Department of Industrial Relations. California Code of Regulations Title 8 Section 35 – Exchange of Information and Ex Parte Communications
3
California Legislative Information. California Labor Code Section 4628
4
Department of Industrial Relations. California Code of Regulations Title 8 Section 38 – Medical Evaluation Time Frames and Extensions for QMEs and AMEs
5
Department of Industrial Relations. DWC Answers to Frequently Asked Questions About Qualified Medical Evaluators for Injured Workers
6
Department of Industrial Relations. California Code of Regulations Title 8 Section 41.5 – Conflicts of Interest by Medical Evaluators
7
Department of Industrial Relations. California Code of Regulations Title 8 Section 9795 – Reasonable Level of Fees for Medical-Legal Expenses
8
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile