STATE OF CALIFORNIA
Arnold Schwarzenegger, Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF WORKERS' COMPENSATION
P.O. Box 8888
San Francisco, CA 94128-8888
To: Injured Worker
This list of Qualified Medical Evaluator (QME) physicians is being issued to you because a "Request for a
Qualified Medical Evaluator" form was received in our office. These physicians were randomly selected
by a computer. The QME you choose will evaluate or make determinations on medical questions about
your work injury. For injuries prior to 1/1/94, the QME performs the final permanent disability evaluation
once your treating physician determines that you condition is permanent and stationary. For injuries as of
1/1/94, a QME is only used when there is a dispute over the primary treating physician's report.
Please take the following steps:
Select one QME physician off the list
Your claims administrator (or if none, employer) should not select the QME or influence you on which
physician to pick. You may consult with an Information and Assistance Officer in your area by calling
1-800-573-4636 before making a selection. You may also consult with an attorney. If you decide to become
represented by an attorney, you should not select a QME from the list. For injuries on or after 1/1/94, if
your primary treating physician is listed on your panel you must call the Division of Worker's Compensation
(DWC) Medical Unit for a replacement since your primary treating physician(s) cannot also be your QME.
Call the QME physician's office to make your appointment.
Make it clear to the QME’s office staff that you are calling for a "QME exam." The person at the doctor's
office will ask you for information that you will find on the upper right corner of the attached form. If the
doctor you choose from your panel cannot arrange an appointment for evaluation with you within 60 days
of your call, the QME's office may not offer you a substitute QME who is not on the list.