How Do I File a Complaint Against My QME or Treating Doctor in California?

What should you do to report a problem with a QME or your doctor in California?

It depends on who you mean. A QME's conduct is a Medical Unit matter. A treating doctor's medical license is usually California's Medical Board, or that provider's own licensing board.

These two paths exist to police conduct and licenses. They were not built to settle a medical disagreement inside your claim.

This page covers both paths: a conduct problem with a QME, and a license problem with your treating doctor. If you disagree with what a QME wrote in a report, rather than how the doctor behaved, see our guide to challenging a bad QME report and what happens after a QME exam instead. If your real concern is a slow check or an adjuster who will not call back, see our guide to complaining about a workers' comp adjuster.

How do you file a complaint against a QME?

Send the QME Complaint form to the DWC Medical Unit's QME Investigations and Enforcement Section, by email or mail, to report a Qualified Medical Evaluator's conduct.

That section sits inside the Division of Workers' Compensation Medical Unit, and it checks a QME's conduct against the rules tied to that doctor's certification. Fill out the QME Complaint form and send it by email to QMEInvestigations@dir.ca.gov, or mail it to: DWC Medical Unit, QME Investigations and Enforcement Section, P.O. Box 71010, Oakland, CA 94612. For questions, call (800) 794-6900. Press one for the QME program, then seven to ask about a complaint against a QME physician.

Title 8 of the California Code of Regulations, section 60 is the general rule a QME can violate. That office's own page lists specific, common reasons, including:

• Not treating you in a courteous, professional manner during the exam, under Title 8, section 41(a)(5);
• Billing problems, such as charging you directly for the evaluation, under Labor Code sections 4620 and 4628(i), and Title 8, sections 9793 and 9795;
• Discrimination, meaning an opinion shaped by your race, sex, national origin, religion, or sexual preference rather than the medical facts, under Title 8, section 41(c)(3) and (d).

An investigation can end with the QME's certification suspended, placed on probation, or terminated. It does not reopen or change the medical findings already sitting in your claim.

How do you report your treating doctor's medical license instead?

Where you file depends on the doctor's license type. A medical doctor, a chiropractor, and an osteopathic physician each answer to a different state licensing board.

The Medical Board of California looks into complaints about M.D.s. That covers bad care, wrong prescriptions, an impaired provider, sexual misconduct, and practicing without a license, among other categories. File by mail, fax, or online through its Central Complaint Unit, or call (800) 633-2322. The Board is clear about what it will not do. It will not handle a billing or fee dispute. It cannot order anyone to pay you. It cannot step in and coordinate your medical care.

A treating doctor licensed as a chiropractor instead answers to the Board of Chiropractic Examiners, and an osteopathic physician, a D.O., answers to the Osteopathic Medical Board of California. Check the license type on your doctor's paperwork before you file, so the complaint lands with the board that can actually act on it.

Will a complaint change the outcome of your workers' comp claim?

No. Both paths are about discipline and licensing, not about your benefits. That same office states plainly that a complaint investigation has no bearing on an individual's workers' compensation case.

A QME complaint or a medical board complaint can take a long time to work through, and neither one reopens your disability rating, your causation finding, or any other medical conclusion already in your claim. If the real problem is the substance of a report rather than the evaluator's conduct, a supplemental report request, a deposition, or a treating doctor's counter opinion are the tools built for that; see our guide to challenging a bad QME report for each one.

What if the real problem is the claims adjuster or the insurance company?

That is a separate complaint about claims handling, not about a person's conduct or license, and it goes to the DWC Audit Unit instead.

A slow check, an unanswered call, or a claim that seems stuck is usually a claims administrator problem, not a doctor problem. See our separate guide to an adjuster problem for that process, or our guide to the Division of Workers' Compensation for how its different units divide up these jobs.

What should your complaint actually include?

Specific dates, names, and a plain factual account of what happened, plus your claim number for a QME complaint. Keep a copy of everything you send.

Write down what happened while it is still fresh: the date, who was involved, and exactly what was said or done. For a QME complaint, include your claim number so that section can match it to your case. For a medical board complaint, expect to fill out a separate form for each individual provider you are naming.

Sorting out a QME or doctor problem in the Antelope Valley and beyond

Picking the right channel the first time saves months of waiting on the wrong one.

Yazdchi Law P.C. helps injured workers across the Antelope Valley, the San Fernando Valley, and the greater Los Angeles area sort out whether a QME or medical problem calls for a licensing complaint, a challenge to the report itself, or both, from its Palmdale office.

Call (661) 273-1780 or use the contact form for a free consultation. The firm reviews each matter individually.

Related questions

These guides cover the medical and claims handling tasks a complaint does not reach.

• What is a QME, and how does the process work?
• What happens after a QME exam in California?
• Can I get a second opinion after a bad QME report?
• What do I do about a problem with my claims adjuster?