What Is California Labor Code §4062.5: Replacing a Late QME Report?

If a qualified medical evaluator selected from a panel fails to complete the formal medical evaluation within the timeframes established by the administrative director pursuant to paragraph (1) of subdivision (j) of Section 139.2, a new evaluation may be obtained upon the request of either party, as provided in Sections 4062.1 or 4062.2. Neither the employee nor the employer shall have any liability for payment for the formal medical evaluation which was not completed within the required timeframes unless the employee or employer, on forms prescribed by the administrative director, each waive the right to a new evaluation and elects to accept the original evaluation even though it was not completed within the required timeframes.

What Is California Labor Code 4062.5?

Labor Code 4062.5 lets either side request a new medical evaluator when a panel QME misses its report deadline, and it excuses payment for that late report unless both sides agree to keep it.

The rule only applies to a Qualified Medical Evaluator, or QME, chosen from a state panel under Labor Code 4062.1 or Labor Code 4062.2. Those are the two paths a California workers' compensation case uses to get an outside medical opinion on a disputed issue: an unrepresented worker uses the 4062.1 process, and a represented worker or employer uses the 4062.2 panel strike process. By its own wording, section 4062.5 covers an evaluator chosen from a panel. An Agreed Medical Evaluator that both sides pick together is not chosen from a panel, so this particular rule does not apply to that kind of evaluator. Either way the panel came together, once that evaluator's deadline passes, Labor Code 4062.5 works the same way.

What Is the Deadline for a QME Report, and What Happens If It Passes?

A panel QME has 30 days from your exam to finish and send the report, and Labor Code 4062.5 lets either side ask for a new evaluator once that deadline passes without an approved extension.

Labor Code 139.2 and Title 8, section 38 of the California Code of Regulations set the clock: a panel evaluator must prepare and serve the report within 30 days after seeing you or otherwise starting the evaluation. If the evaluator needs more time, the request has to go to the Division of Workers' Compensation Medical Director on QME Form 112, and it has to go in at least 5 days before the 30-day period runs out. An evaluator who never asks, or whose request is turned down, is the situation Labor Code 4062.5 is written for. The table below shows the two ways an extension can be approved.

What Counts as Good Cause for a Late Report?

Good cause for the 15-day extension is a short, specific list, and it is about the evaluator's own circumstances, not simply a busy schedule.

Labor Code 139.2 and the matching regulation define good cause the same way: a medical emergency involving the evaluator or the evaluator's family, a death in the evaluator's family, or a natural disaster or other community catastrophe that interrupts the evaluator's office. An evaluator who is simply behind on paperwork, or who is waiting on information that was not test results or a consulting opinion, does not have good cause under this rule. The Medical Director reviews extension requests and can question one that looks unreasonable.

How Do You Actually Request a New Evaluator?

You have to object to the lateness in writing before the evaluator serves the late report, then file the replacement request on Form 31.5 with a copy of that objection attached.

Title 8, section 31.5(a)(12) of the California Code of Regulations is the rule that carries out Labor Code 4062.5 in practice. It lets either side get a replacement evaluator once the deadline in Labor Code 4062.5 and section 38 has passed, but only if that side objected to the report's lateness in writing before the evaluator actually served it. Waiting to see the late report first, then deciding you do not like it, is not what this ground for replacement covers. The replacement request itself goes on Form 31.5 and must include a copy of your written lateness objection. From there, the request follows the same track as your first panel: an unrepresented worker selects from the new panel under Labor Code 4062.1, and a represented worker or employer strikes names under Labor Code 4062.2. The regulation also pauses your 10-day strike or selection clock until the new panel or evaluator name actually arrives, so a late QME does not cost you that deadline too.

Do You Have to Pay for a Late QME Report?

No one owes payment for an evaluation that missed its deadline, unless both sides sign a form agreeing to keep it anyway.

Labor Code 4062.5 says neither the employee nor the employer has any liability for payment for a formal medical evaluation that was not completed on time. That rule only changes if both sides waive their right to a new evaluator and choose to accept the late report instead, in writing. The regulations name the exact forms: QME Form 113 if the Medical Director already turned down the evaluator's extension request, or QME Form 116 if the evaluator never asked for an extension at all. A late report is sometimes still useful to one or both sides, so the waiver gives everyone a way to keep it by agreement instead of starting over with a new evaluator.

How Does Labor Code 4062.5 Connect to Other QME Rules?

Section 4062.5 only works together with the panel and deadline rules in Labor Code 139.2, 4062.1 and 4062.2, so a replacement request should point to all of them.

Labor Code 139.2 sets the medical director's role and the 30-day deadline; our Labor Code 139.2 guide covers how that panel system works. Our Labor Code 4062.1 guide explains the path an unrepresented worker uses to pick a QME from the panel, and our Labor Code 4062.2 guide explains the strike process a represented worker or employer uses instead. Save the date you were examined, the 30-day due date that follows it, any extension notice the evaluator sent, and a copy of any written lateness objection you send. If you are not sure whether your evaluator's report is actually late under these rules, see what happens after a QME exam and what to expect at a QME appointment for the surrounding steps.

A late QME report can affect a deadline you did not expect, so it helps to have it reviewed quickly. Yazdchi Law P.C. reviews each California workers' compensation matter individually and can look at a late evaluation, an extension notice, or a replacement request you are considering. Call (661) 273-1780 or use the contact form for a free consultation. The firm serves injured workers across California from its Palmdale office.