IME, QME, or Designated Doctor? Workers' Comp Medical Exams
Quick answer: When you and the insurer disagree about your injury, each state has its own tie-breaker doctor. California uses a Qualified Medical Evaluator (QME) picked from a panel of three, or an Agreed Medical Evaluator if you have a lawyer. Texas uses a designated doctor assigned by the state, whose report has presumptive weight unless the greater weight of the evidence is against it. Florida lets each side get one independent medical exam (IME), and a judge can appoint an expert medical advisor whose opinion is presumed correct.
How do workers' comp medical exams differ by state?
| California | Texas | Florida | |
|---|---|---|---|
| Tie-breaker doctor | Qualified Medical Evaluator (QME), or Agreed Medical Evaluator (AME) with a lawyer | Designated doctor, assigned by the Division of Workers' Compensation | Expert medical advisor (EMA), when two doctors disagree |
| How it's chosen | A panel of three QMEs; without a lawyer you pick one within 10 days, with a lawyer each side strikes one | Next available doctor on the state's certified list, within 10 days of approval | By agreement, or the judge picks from the state's certified list |
| Weight of the opinion | The QME or AME evaluation is how the medical dispute is resolved | Presumptive weight unless the preponderance of evidence is to the contrary | Presumed correct unless there's clear and convincing evidence to the contrary |
| Insurer's own exam | Medical disputes go through the QME or AME process | Required medical exam, generally once every 180 days | One IME per accident for each side, paid by the side that asks |
How does a QME work in California workers' comp?
In California, a medical dispute is settled by a Qualified Medical Evaluator. How you get one depends on whether you have a lawyer:
- Without a lawyer: you or the employer request a panel of three QMEs in a chosen specialty. The employer can't submit the request unless you haven't done so within 10 days after it gave you the form. Within 10 days of getting the panel, you pick one doctor, make the appointment, and tell the employer; if you don't, the employer can pick. The employer can't ask you to agree on an Agreed Medical Evaluator (Labor Code §4062.1).
- With a lawyer: either side can request a three-member panel, and within 10 days each side can strike one name. The remaining doctor is the evaluator. The two sides can also agree on an Agreed Medical Evaluator (AME) at any time instead (§4062.2).
What is a designated doctor in Texas workers' comp?
A designated doctor is a doctor the Texas Division of Workers' Compensation assigns to answer questions such as your impairment rating, whether you've reached maximum medical improvement, the extent of the injury, whether your disability comes from the work injury, and whether you can return to work. You or the insurance carrier can ask for one (Labor Code §408.0041(a)).
- Timing: the division assigns the next available certified doctor within 10 days after the request is approved, and the exam has to happen within 21 days after the order. Exams are generally no more often than every 60 days (§408.0041(b)).
- Weight: the designated doctor's report has presumptive weight unless the preponderance of the evidence is to the contrary (§408.0041(e)). Disagreeing with it means bringing better medical evidence, not just a different opinion.
- The carrier's exam: the insurer can also ask the division to require a medical exam, but only after you didn't agree to one, and generally only once in a 180-day period (§408.004(b)).
How does an IME work in Florida workers' comp?
In Florida, in a dispute about medical care, compensability, or disability, you or the carrier may choose an independent medical examiner. Each side gets only one IME per accident, not one per specialty, and the side that asks for it pays for it. That side has to identify its examiner to the other parties within 15 days after the date the exam is to take place, or it can't use the findings before a judge (Fla. Stat. §440.13(5)(a)).
- Expert medical advisor: if two health care providers disagree, for example on your need for more treatment or whether you can return to work, a judge of compensation claims can order an evaluation by an expert medical advisor, on its own or within 15 days of a written request. The EMA's opinion is presumed correct unless there's clear and convincing evidence to the contrary (§440.13(9)(c)).
- Show up: if you don't report to or cooperate with an EMA evaluation, you lose compensation for that period (§440.13(9)(c)).
What people ask
These questions come up again and again in searches and forums. Here's what the law says.
No. In each state there's a process for a neutral doctor: a QME or AME in California, a designated doctor in Texas, and an expert medical advisor in Florida. In Texas and Florida, the law presumes those opinions correct unless the evidence against them is strong enough.
Cal. Labor Code §§4062.1, 4062.2; Tex. Labor Code §408.0041; Fla. Stat. §440.13(9)
Skipping usually costs you. In Florida, failing to report to an expert medical advisor forfeits compensation for that period. In California, an employee with a lawyer can't unreasonably refuse a panel QME evaluation.
Fla. Stat. §440.13(9)(c); Cal. Labor Code §4062.2(d)
No. The statute allows one independent medical exam per accident for each side, not one per medical specialty.
Fla. Stat. §440.13(5)(a)
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This guide is general information, not legal or medical advice. Exam rules have details and exceptions; check with your state's free help office or a lawyer.