In California workers’ compensation cases, medical opinions often determine the direction and outcome of a claim. When disputes arise, a formal workers’ compensation medical evaluation becomes necessary to clarify complex medical issues. One option available to represented parties is the Agreed Medical Evaluation (AME). However, confusion remains around who can use an AME, when it is legally permitted, and what requirements must be met.
This article explains agreed medical evaluator eligibility, outlines the attorney requirement, and corrects common misconceptions surrounding AME workers’ compensation cases—while complementing, not duplicating, existing AME service content.
What Is an AME in Workers’ Compensation?
An AME is a medical-legal evaluation conducted by a physician jointly selected by both parties in a workers’ compensation dispute. The agreed medical examiner provides an independent opinion on disputed medical issues such as causation, impairment, apportionment, or future medical care.
Under guidance published by the California Division of Workers’ Compensation, AMEs are specifically intended for cases where both sides are legally represented and agree on the evaluating physician. This framework is designed to reduce procedural conflict and streamline dispute resolution within the workers’ compensation system.
Who Can Use an AME in Workers’ Comp?
Attorney Representation Is Mandatory
The most important eligibility rule is the AME attorney requirement. California workers’ compensation regulations allow an AME only when both parties are represented by attorneys.
In practical terms:
- The injured worker must have legal representation
- The employer or insurance carrier must also be represented
- Both attorneys must agree on the same physician
This directly answers one of the most common questions in the system: do you need an attorney for an AME? Yes. Without representation, an AME is not an available option.
As a result, an unrepresented injured worker cannot initiate or participate in an AME process, even if they believe it would be beneficial.
Agreed Medical Evaluator Eligibility Criteria
Who Qualifies for an AME?
To understand who qualifies for an AME, several conditions must be satisfied simultaneously:
- The claim falls under California workers’ compensation jurisdiction
- A medical dispute exists that requires resolution
- Both parties are represented by legal counsel
- Both sides mutually agree on the evaluating physician
When these criteria are met, agreed medical evaluator eligibility is established, and the AME may proceed.
For an AME-represented worker, attorney involvement is critical—not only for selecting the physician but also for defining the scope of issues addressed during the evaluation.
Who Is Eligible for an AME — and Who Is Not
Eligible
- Represented injured workers
- Employers or insurers with legal counsel
- Claims involving disputed medical issues
Not Eligible
- Unrepresented injured workers
- Cases where parties cannot agree on a physician
- Situations requiring mandatory panel evaluations
These distinctions are rooted in California’s statutory framework governing medical-legal evaluations and are often misunderstood by claimants unfamiliar with the system.
Can an Injured Worker Request an AME?
A frequent misconception is the belief that an injured worker can request an AME directly. In reality, this is not permitted.
Only attorneys may initiate the AME selection process. If the parties cannot agree on a physician, the dispute typically proceeds under alternative evaluation mechanisms rather than an agreed process.
This procedural rule aligns with the broader structure of medical-legal evaluations in the United States workers’ compensation system, where legal representation plays a central role in dispute resolution.
Understanding the Role of the Agreed Medical Examiner
An agreed medical evaluator workers’ comp case relies heavily on the physician’s neutrality and procedural compliance. The agreed medical examiner is expected to:
- Review all submitted medical records
- Conduct a thorough, unbiased evaluation
- Address only the disputed issues outlined by the parties
- Produce a medically sound and legally defensible report
Failure to follow procedural rules or address the agreed scope may undermine the credibility of the evaluation.
Common Misconceptions About AMEs
“AMEs Are Always Faster”
While coordination can be smoother, AME timelines still depend on record availability, scheduling, and report preparation requirements set by regulation.
“AME Reports Cannot Be Challenged”
Although highly influential, AME opinions may still be scrutinized if procedural errors or omissions are identified.
“Any Physician Can Serve as an AME”
In reality, physicians must meet specific AME legal requirements California and agree to act within the medical-legal framework.
Practical Considerations for Physicians
Physicians acting as agreed medical examiners must navigate both clinical and legal expectations. This includes maintaining professional neutrality, understanding procedural timelines, and ensuring clear documentation—particularly in areas such as medical-legal communication and report clarity.
In more complex or adversarial cases, maintaining professionalism under scrutiny becomes equally important.
These competencies are essential not only for QMEs but also for physicians serving in AME roles.
Why AME Eligibility Rules Matter
Misunderstanding who is eligible for an AME can create unnecessary delays, unrealistic expectations, or procedural errors. For injured workers, clarity helps set appropriate expectations. For attorneys, it ensures a correct case strategy. For physicians, it prevents improper appointment acceptance.
A clear understanding of AME eligibility ultimately supports more efficient dispute resolution and more defensible medical opinions within the workers’ compensation system.