Writing a QME report that survives the WCAB

The physician’s report, start to finish

Labor Code §4628(a) is the rule every QME report stands on: no one other than the physician who signs the report — apart from a nurse doing routine nursing tasks — may examine the injured worker or take part in the nonclerical preparation of the report, including taking a complete history, reviewing and summarizing prior medical records, and composing and drafting the conclusions.

Others may outline the history or excerpt prior records, but then the physician “shall review the excerpts and the entire outline” and make whatever further inquiries and examinations are needed (§4628(c)).

The consequence is severe: failure to comply “shall make the report inadmissible as evidence and shall eliminate any liability for payment” (§4628(e)), and a knowing failure carries a civil penalty of up to $1,000 per violation (§4628(f)).

What the report must disclose

When and where the evaluation was performed; that the signing physician actually performed it; whether the evaluation and the time spent complied with the Administrative Director’s guidelines — and, if not, why; and the name and qualifications of everyone who performed any non-clerical service in connection with the report (§4628(b)).

Every formal evaluation must identify all information received from the parties, all information reviewed in preparing the report, and all information relied on in forming the opinion (Lab. Code §4062.3(d)).

The declaration

The report must carry the physician’s declaration under penalty of perjury that its contents are true and correct to the best of the physician’s knowledge and belief, except as to information received from others — “dated and signed by the reporting physician” and indicating “the county wherein it was signed” (§4628(j)).

Records, objections and contact

For a panel QME, a party must serve the information it proposes to provide on the other side 20 days in advance; nonmedical records objected to within 10 days are not provided (§4062.3(b)).

Ex parte communication with a panel QME or an AME is prohibited; if it happens, the aggrieved party may elect to end the evaluation and seek a new one, or proceed (§4062.3(g)). Scheduling and the furnishing of records are not ex parte (§4062.3(f)).

On time

The report is due within 30 days after the evaluator has seen the employee (8 CCR §38(a)); extensions are requested on Form 112 at least five days before that period ends (§38(c)–(d)). A late report without an approved extension can be replaced, and neither party is liable for it unless both waive (§38(b)).

How ChironAI™ OM helps

Chiron organizes the records into an evaluator-scope chronology built only from admissible records, every entry citing its source, and prepares a working draft. The physician personally reviews the records, decides every conclusion, edits and signs. Before finalising, OM checks the report against the §4628 required elements, records what was received and relied on, tracks the §38 deadline, logs ex parte contacts, and will not finalise without the physician’s signed declaration and county of signing.