QME and AME process

What the Appeals Board did with this

Newest released decisions that turned on this issue. Each quotes the passage it turned on and links to the official PDF. Litigated tail — not a win rate, not a settlement value.

• ADJ21245209 · 2026-08-14 · Fresno District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.4The WCJ found that the QME process was not correctly initiated apparently because the QME process is triggered by an objection to a “primary treating physician” and that neither Nurse Uichanco, nor Dr. Roach was a “primary treating physician.” However, Labor Code section 3209.10(a) plainly states:

  The WCAB found that Nurse Uichanco was acting under Dr. Roach's supervision, making Dr. Roach the primary treating physician under Labor Code section 3209.10, and that the QME process was properly initiated. The WCAB granted reconsideration and reversed the WCJ's removal of Dr. Bolling as QME, allowing Dr. Bolling to remain as QME.

  Official decision · page 4 →
• ADJ21809965 · 2026-08-03 · Oakland District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.1Applicant seeks removal or in the alternative reconsideration of the Findings and Award (F&A) issued on April 13, 2026. The workers’ compensation administrative law judge (WCJ) found, in relevant part, that the Qualified Medical Evaluator (QME) panel request and panel list number 7893809 dated December 17, 2025 requested by defendant was not defective and was the valid QME panel; that applicant is required to be evaluated by a doctor selected from that list pursuant to Labor Code section 4062.2 1; that the QME panel request and list requested by applicant’s counsel dated December 23, 2025, panel number 7895678, is defective and is not valid; and that applicant is not entitled to be evaluated by doctors selected from that list. Applicant contends that defendant’s panel request was defective as it was requested prematurely pursuant to section 4062.2 because Code of Civil Procedure section 1013 adds 10 days to the time to act where an out of state party is involved. Applicant contends that the WCJ erred by calculating the time based only on service, and only adding 5 days for service based on service on in state parties only, and not taking into account that the sending party was out of state. Defendant did not file a response. The WCJ issued a Report and Recommendation (Report) recommending denial of the petition.

  The WCJ and Appeals Board found defendant's QME panel request valid because the denial letter was served on in-state parties, triggering only a 5-day extension under WCAB Rule 10605, not the 10-day extension applicant argued under Code of Civil Procedure section 1013. Applicant's panel request was defective and invalid.

  Official decision · page 1 →
• ADJ16313390 · 2026-07-30 · Santa Ana District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.3It appears that the actual issue in these matters is whether defendant may replace Dr. Krishnareddy due to his alleged unavailability. Rather than try that issue on the merits, the WCJ bifurcated the sub-issue of whether applicant may take the QME’s deposition on the issue of his availability.

  The WCJ bifurcated the issue of QME availability and denied applicant's request to depose the QME. The Appeals Board found no substantial prejudice or irreparable harm to applicant to warrant replacement of the QME and dismissed the petition for reconsideration as the order was non-final and removal was not warranted.

  Official decision · page 3 →
• ADJ19688721 · 2026-07-15 · Fresno District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.6Turning now to the merits of the Petition, applicant contends that the WCJ did not adequately weigh the prejudice caused to applicant by restarting the QME process and that substantial justice requires that Dr. Saadat remain as the PQME in this matter. Applicant further contends that the WCJ did not properly analyze the elements set forth in Vazquez. In Vazquez, we held that for represented cases, “the determination of whether a QME should be replaced due to unavailability to set an evaluation is within the discretionary power of the Appeals Board, and a PQME may be replaced where a party demonstrates good cause for the replacement.” (Id. at p. 523.) Under Vazquez, good cause is determined based upon a balancing of multiple factors, which include: a. The length of delay caused by the QME's unavailability.

  The Appeals Board found that the defendant did not establish good cause for replacement of Dr. Saadat as PQME, considering the length of delay, prejudice to applicant, efforts to remedy availability, and constitutional mandate for substantial justice.

  Official decision · page 6 →
• ADJ22209281 · 2026-07-10 · San Francisco District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.68.) Thus, based upon the language of the ADR Agreement, applicant was within his rights when he sought reconsideration of the January 8, 2026 F&O. Defendant further asserts that applicant “did not suffer prejudice” and was not “denied due process” as applicant “agreed to strike language from the cover letter” to Dr. Teichera on the issue of varicose veins but sought to designate Dr. Noriega instead as he was “unhappy with [Dr. Teicheira’s] initial opinion[.]” (Petition, p. 10.) We disagree. As iterated in our O&O, there was no stipulation between the parties for Dr. Teicheira to act as IME on all of applicant’s claimed injuries. Further, applicant agreed to withhold information pertaining to the cumulative injury in anticipation of another evaluation with a different IME. This was prejudicial to applicant in that he was unable to provide his position on the

  Applicant was entitled to designate Dr. Noriega as IME for the cumulative injury claim because applicant was prejudiced by being unable to provide information or raise inquiries to Dr. Teichera, violating due process rights. The Appeals Board held that denying a separate IME would violate due process and that applicant was within rights under the ADR Agreement to seek reconsideration and removal.

  Official decision · page 6 →
• ADJ20009316 · 2026-07-07 · Los Angeles District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.8Here, as acknowledged in the Petition, defendant stipulated to receipt of the October 22, 2025 email from applicant’s counsel striking Dr. Polushkin. Defendant was thus apprised of applicant’s valid and timely strike. Accordingly, to the extent that defendant seeks reconsideration, the Petition is dismissed, and to the extent that defendant seeks removal of the April 23, 2026 F&O, the Petition is denied.

  The Board found the strike valid despite defendant's procedural objections, emphasizing the informality allowed in workers' compensation proceedings and that the defendant was aware of the strike.

  Official decision · page 8 →
• ADJ13039423 · 2026-06-01 · Anaheim District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.10Dr. Betancourt's reports contained thorough and detailed discussions of the issues presented. His opinions and conclusions were framed in terms of reasonable medical probability, were not speculative, and were based on pertinent facts and documents and on an adequate examination and history. Dr. Betancourt also thoroughly set forth his reasoning in support of his conclusions. Based thereon, Dr. Betancourt's opinions constitute substantial medical evidence upon which the Court can rely.

  The court found no good cause to disqualify Dr. Betancourt, as his opinions were based on reasonable medical probability and substantial evidence.

  Official decision · page 10 →
• ADJ20106865 · 2026-05-18 · Pomona District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.7Not only does the letter not explicitly refer to objection, it does not contain any objection whatsoever. Applicant is entitled to retain the control of the QME process and did nothing to lose that control. Thus, defendant waived its right to an objection.

  Defendant's strike letter did not contain any objection to the QME panel specialty, so defendant waived its right to object; applicant was entitled to choose the specialty and chiropractic was appropriate.

  Official decision · page 7 →