What Is California Labor Code §4062.3: QME Records and Contact Rules?

Ex parte communication with an agreed medical evaluator or a qualified medical evaluator selected from a panel is prohibited.

What is California Labor Code 4062.3?

Labor Code 4062.3 controls what records go to a work injury evaluator and bars private contact with that doctor.

Workers' comp claims often need an outside doctor to settle a medical dispute. California calls this doctor a Qualified Medical Evaluator, or QME, when picked from a state panel. It calls the doctor an Agreed Medical Evaluator, or AME, when both sides pick the doctor together. Labor Code 4062.3 sets the rules for this doctor. It says what records each side may send. It says how the other side learns what was sent. It also says when contact with the doctor turns into a banned private talk. The rule covers the worker, the employer, and the insurance carrier handling the claim.

What records can a party send to the evaluator?

A party can send the treating doctor's records and other records tied to the medical dispute.

Subsection (a) lets either side give a panel QME two things. First, records the treating doctor prepared or kept. Second, medical or nonmedical records tied to the medical question. An AME works differently. Under subsection (c), the parties agree on what the AME gets to see. They set this when they pick the AME. Subsection (d) adds a check on both kinds of evaluator. The report must list every item received from the parties. It must list every item reviewed while writing the report. It must list every item used to reach the final opinion. This list lets both sides check what the doctor actually saw.

What are the notice deadlines for sending records or messages?

A party must give 20 days' notice before sending records to a panel QME.

Subsection (b) sets the main deadline. A party must serve the other side with any records at least 20 days before sending them to a panel QME. The other side then has 10 days to object to a nonmedical record. A timely objection keeps that record from reaching the doctor. Either side can still use discovery to prove a record is accurate. Subsection (e) sets a matching rule for messages. A written message sent to a panel QME before the exam needs the same 20-day notice. A later message also must be in writing. It must go to the other side when it is sent.

When does contact with the evaluator cross the line?

Private, one-sided talk about the case is banned, but routine scheduling calls are not.

Subsection (g) bans ex parte contact. Ex parte means a private talk the other side does not know about. This ban covers both a panel QME and an AME. Subsection (f) covers AME messages: each one must be in writing and go to the other side when sent, with no 20-day wait. A call or note about scheduling, a missed visit, sending records, or asking if a report is ready does not break the rule. That holds unless the Workers' Compensation Appeals Board, often shortened to WCAB, makes a specific finding that the talk was improper. Subsection (i) adds one more exception. A worker, or a dependent if the worker has died, can talk with the evaluator during the exam, or any time the evaluator reaches out about that exam.

What happens if someone breaks the contact rules?

A broken rule can let the other side ask for a new evaluator, and the party at fault can face contempt and costs.

Subsection (g) gives a remedy. Say a party breaks the notice rule in subsection (e). The other side can then stop that exam. It can ask for a new evaluator instead. That new evaluator gets picked the same way as the first one, under Labor Code 4062.1 for an unrepresented worker or Labor Code 4062.2 for a represented worker. Or the other side can choose to keep the first exam instead. Subsection (h) adds a penalty. The party at fault can face contempt before the WCAB. That party can also be ordered to pay costs, including the cost of the exam, added discovery costs, and attorney's fees tied to that discovery. For more on how evaluators get picked in the first place, see the QME overview and the QME versus AME comparison. For the dispute that often starts this process, see Labor Code 4060.

What should I save, and when can I ask for a hearing?

Save proof of what was sent and when, since a disputed medical issue needs an evaluation first.

Keep proof of service. This shows the date records or messages went to the doctor. Keep copies of everything sent. Keep any written objection to a nonmedical record. Subsection (j) sets a duty for the evaluator too. The evaluator must sum up the findings on a state form. The evaluator must serve the full report and that summary on the worker and the employer. The report must cover every disputed medical issue tied to claim forms filed before the first appointment. Subsection (k) covers later issues. If a new medical issue comes up after the report, the parties generally go back to the same evaluator. Subsection (l) adds one more limit. A party cannot yet file a Declaration of Readiness to Proceed on a disputed medical issue. That filing asks the WCAB for a hearing date. It cannot be filed until a treating doctor, AME, or QME has evaluated the issue first.

Talk to a workers' comp attorney about an evaluator problem

A review of your claim file can show whether the records and notice rules in Labor Code 4062.3 were followed.

Maybe the insurance company sent extra records without notice. Maybe it skipped the 20-day window. Maybe someone contacted your evaluator outside these rules. Any of these can affect your case. The firm looks at every workers' compensation matter on its own facts. Call (661) 273-1780 or use the contact form to ask about a review. If your claim was already denied, see what to do after a workers' comp claim denial.