What Is 8 CCR §34: QME Appointment Notice and Cancellation?

An injured worker shall not be liable for any missed appointment fee whenever an appointment is cancelled for good cause.

What does 8 CCR §34 require?

It sets a strict notice timeline for your QME exam and limits how and when that exam can be canceled.

This rule applies once a Qualified Medical Evaluator, or QME, appointment is booked. The evaluator's office must notify you in writing within 5 business days of making the appointment. It must also notify the claims administrator, or the employer if there is no claims administrator. In a represented case, it must notify each side's attorney too. The cancellation rules below cover an Agreed Medical Evaluator, or AME, as well. The rule applies whether or not you have a lawyer.

How will I find out my QME exam date, time, and place?

The QME's staff sends a written notice within 5 business days of setting the date.

That notice is called the appointment notification form. It goes to you, the claims administrator, and each attorney if the case is represented. Your first exam must happen at a medical office listed on the panel selection form. Both sides can agree in writing to use a different office listed with the Medical Director instead. A later exam with the same evaluator can happen at another of that evaluator's offices. That other office must be listed with the Medical Director and within a reasonable distance of your home. This card covers only the notice and cancellation rules. This site's guide to the QME panel request forms covers how you request the panel in the first place, and this site's guide to a QME appointment covers what happens once you are in the exam room.

Can my QME appointment be canceled, and by whom?

Yes, but only on 6 business days' written notice, unless there is good cause for shorter notice.

The evaluator cannot cancel a scheduled exam less than 6 business days before the date, except for good cause. The evaluator must also put the cancellation reason in writing for both sides. You, your attorney, or the claims administrator can ask to cancel or move the appointment too. The same 6 business day rule applies, and that cancellation must be in writing and served on the other side. A verbal cancellation still needs a follow up letter. That letter must be faxed or mailed within 24 hours and must confirm the reason. If the parties disagree about whether a cancellation had good cause, the Workers' Compensation Appeals Board decides it. The Administrative Director can also take action against a QME who violates this rule.

Will I owe a fee if I miss my appointment or cancel late?

Not if your cancellation had good cause. A late cancellation without good cause can carry a real cost.

A separate rule, 8 CCR 9795, sets a missed appointment fee of $503.75. That amount has been in place since April 1, 2021. The fee can apply if you do not show up, if your interpreter does not show up, or if you leave the exam early. It can also apply if you arrive more than 30 minutes late, or cancel inside 6 business days of the exam. Section 34 itself protects you from that fee when your cancellation was for good cause. When a missed or late appointment really is your own fault, the employer can later ask to credit that cost against your award. Tell the claims administrator and the evaluator in writing, right away, whenever you cannot make a scheduled date.

What if I am missing medical records before my exam?

Missing records are usually not, by themselves, a valid reason for the evaluator to cancel.

There is one narrow exception. A psychiatrist or psychologist evaluating a disputed psychiatric injury can cancel for that reason. That evaluator must later state in the report that having the records first was necessary for a full and fair evaluation. A related rule, 8 CCR 35, sets the deadline for sending those records to the evaluator in the first place.

What if I need an interpreter at my exam?

The notice has to say whether a certified interpreter is needed and in what language.

Subdivision (c) ties that requirement to Labor Code section 5811, which covers who arranges the interpreter and who pays. A QME exam is one of the settings section 5811 lists for a certified interpreter, along with depositions and Appeals Board hearings. Tell the evaluator and the claims administrator about your language need as early as you can. That way, it goes on the notice before your exam date.

How does this rule fit with the rest of the QME process?

It carries out the panel request rules that start a QME evaluation in the first place.

This rule's own reference list ties it to the panel process that starts a QME case. An unrepresented worker uses Labor Code section 4062.1. A represented worker uses Labor Code section 4062.2. Both build on the QME appointment system that Labor Code section 139.2 sets up. Sometimes the real problem is not a notice or a cancellation. You may want a different evaluator altogether. This site's guide on getting a different QME panel covers those separate grounds.

What should you do about a QME notice or cancellation problem?

Keep every notice you receive, respond in writing, and name the specific rule if a deadline is missed.

Save the appointment notification you get for each exam, along with any cancellation letter. If the evaluator's office or the claims administrator is not following the timelines in this rule, call (661) 273-1780 or use the contact form for a free consultation. The same goes if you are billed a missed appointment fee you believe you do not owe. Yazdchi Law P.C. reviews each workers' compensation matter on its own facts before deciding whether to take it on.