California’s workers’ compensation system relies heavily on medical-legal evaluations to determine causation, impairment, apportionment, disability, and future medical needs. Two types of physicians perform these evaluations: AMEs (Agreed Medical Evaluators) and QMEs (Qualified Medical Evaluators). While both provide legally binding medical-legal reports, their roles, selection processes, and regulatory requirements differ significantly.
Understanding these differences is essential for physicians considering entering the medical-legal field or seeking to improve their performance and compliance.
What is an AME (Agreed Medical Evaluator)?
An AME is a physician selected by mutual agreement between the injured worker’s attorney and the defense attorney. AMEs are used only in represented cases. Because both sides agree on the physician, AME reports often carry substantial influence in disputes.
Key features of an AME:
- Not required to be a certified QME
- No exam or formal state credentialing required
- Selected specifically for expertise or neutrality
- Provides comprehensive medical-legal evaluations
- Typically allowed more time and flexibility in reporting
The California DWC explains that AMEs are used when parties want a single, mutually trusted medical authority to resolve disputed medical-legal issues.
What is a QME (Qualified Medical Evaluator)?
A QME is a physician certified by the California Division of Workers’ Compensation (DWC) to perform medical-legal evaluations when the parties cannot agree on an evaluator. QMEs are selected through the panel QME process, which assigns three potential evaluators for the injured worker to choose from.
To become a QME, physicians must:
- Complete required training
- Pass the DWC-administered examination (many use structured QME test preparation)
- Comply with strict timelines for report submission
- Maintain certification through ongoing education
According to the California DWC Physician’s Guide, the QME role is highly regulated to ensure consistent, impartial medical-legal evaluations across the state.
1. AME vs. QME: Key Differences (Clear Comparison)
Before choosing whether to serve as an AME or QME, physicians should understand how the roles differ in selection, regulatory oversight, reporting standards, and compensation.
Comparison Table: AME vs QME (Overview)
| Feature | AME (Agreed Medical Evaluator) | QME (Qualified Medical Evaluator) |
|---|---|---|
| How selected | Chosen by agreement between both attorneys | Chosen through DWC panel list |
| Used when? | Only if the worker is represented | In represented or unrepresented cases |
| Certification required? | No | Yes — state exam + training |
| Regulation level | Flexible | Highly regulated by DWC |
| Reporting deadlines | More flexible | Strict (usually 30 days) |
| Influence in litigation | Very high (mutually chosen) | High, but subject to panel rules |
| Administrative burden | Moderate | High — often needs QME services |
| Typical caseload | Lower volume, complex disputes | Higher volume, standard evaluations |
| Compensation | Typically higher per case | Standardized Medical-Legal Fee Schedule |
Both AMEs and QMEs play vital roles, but QMEs have more standardized responsibilities and higher compliance obligations. Many physicians rely on a QME management company to assist with scheduling, documentation, and regulatory deadlines.
2. Training, Certification & Exam Requirements
Becoming an AME does not require formal certification, licensing beyond a medical degree, or passing an exam. Attorneys choose AMEs because of their reputation, experience, or expertise with a particular injury type or specialty. The AME’s authority comes from mutual agreement rather than state certification.
In contrast, becoming a QME requires completing a structured credentialing process governed by the DWC. Physicians must undergo specific coursework, pass an examination, and commit to ongoing education. The QME exam covers impairment rating (using the AMA Guides 5th Edition, widely used across the U.S. healthcare system), California workers’ compensation law, medical-legal documentation standards, apportionment analysis, causation, and reporting requirements.
Because QME certification is examined and regulated, many physicians turn to QME test preparation programs to master exam content—similar to how clinicians prepare for specialty board examinations. The exam is known for its legal and procedural complexity rather than pure clinical difficulty, reinforcing the need for prior regulatory understanding before entering the field.
QMEs must also follow strict reporting timelines, abide by formatting requirements, justify medical conclusions using evidence-based standards, and document impairment using AMA Guides methodology. Due to this administrative and documentation workload, many practices rely on QME services provided by a specialized QME management company, which assists with compliance, report structure, scheduling, file organization, and communication with attorneys and adjusters.
These regulatory differences mean physician experience can vary dramatically depending on whether they choose AME or QME work.
3. Evaluation & Reporting Workflow
AME evaluations usually offer more flexibility. Since both legal parties chose the evaluator, AMEs often conduct longer interviews, more detailed reviews of medical records, and deeper diagnostic analysis. This flexibility leads to AME reports that are often highly comprehensive. Attorneys may request supplemental questions, follow-ups, or clarifications directly, and AMEs typically have greater discretion in how they structure the report.
QME evaluations follow a more standardized process defined by the DWC. Reports must be submitted within a specified timeframe (usually 30 days). They must include mandatory components such as causation, work restrictions, future medical needs, apportionment, and impairment rating using the AMA Guides. The structure of the QME report is tightly regulated to ensure consistency across evaluations statewide.
The DWC documentation guidelines, similar to the structure used in other regulated medical-legal arenas (e.g., Social Security impairment evaluations), emphasize clarity, reproducibility, and medical justification.
Because the QME reporting workload is substantial, physicians commonly delegate administrative tasks to a QME management company, which provides essential QME services such as:
- organizing and indexing medical records
- tracking deadlines
- ensuring compliance with DWC rules
- formatting reports appropriately
- handling communication with attorneys
- scheduling evaluations and follow-ups
Comparison Table: Reporting Requirements
| Reporting Element | AME | QME |
|---|---|---|
| Format rules | Flexible | Strict DWC rules |
| Timelines | Negotiable | 30-day deadline |
| AMA Guides usage | Expected but flexible | Mandatory |
| Supplemental reports | Common and allowed | Strictly monitored |
| Administrative support needed | Moderate | Often essential |
4. Compensation, Caseload, and Professional Considerations
AMEs and QMEs differ significantly in workload, compensation, and scheduling flexibility.
AMEs typically handle fewer but more complex disputes. Because attorneys select the AME intentionally, the volume of cases is lower, but the depth and length of evaluations—and therefore compensation—are often higher. AMEs may spend hours reviewing extensive medical files, answering supplemental questions, and preparing long-form reports. This makes AME work ideal for physicians who prefer highly detailed, deeply analytical medical-legal work.
QMEs, on the other hand, may see a higher volume of evaluations due to the structured panel process. Compensation is standardized under the California Medical-Legal Fee Schedule, which ensures predictable reimbursement. The fee schedule compensates QMEs for record review, complexity factors, follow-up evaluations, and supplemental reports. Because QME evaluations attract consistent referral volume, many physicians treat QME work as a stable parallel revenue stream alongside their clinical practice.
However, the administrative burden for QMEs is significantly higher. QMEs must adhere to strict timelines and formatting rules or risk penalties—and even suspension—from the QME program. For this reason, physicians frequently use a QME management company to streamline caseload workflows. Administrative QME services support record organization, report formatting, billing, scheduling, and communication with attorneys, allowing physicians to focus on clinical analysis rather than logistics.
AME work offers high depth and flexibility. QME work offers high consistency and structure. Many experienced evaluators choose to perform both.