Getting a Second QME: When, Why & How
If you’re involved in a workers’ compensation case in California and have questions about getting a second Qualified Medical Evaluation (QME), you’re not alone. Many injured workers are surprised to learn just how much weight a QME report carries and are even more surprised when they disagree with the findings. Whether your QME didn’t fully evaluate your injuries or ignored a key part of your claim, there are times when getting a second QME may be necessary or even legally justified.
At Pacific Workers', The Lawyers for Injured Workers, we’ve helped thousands of injured workers throughout Northern California navigate the workers’ compensation system, including the complex rules around QMEs. In this blog, we’ll break down when and why a second QME might be appropriate, how the process works, and what you need to know to protect your rights.
Watch our co-founder, Attorney Bilal Kassem, explain this topic on YouTube.
When Is a Second QME Necessary?
In California, a QME is a neutral, state-certified doctor who evaluates medical disputes in a workers' compensation case. If you're unrepresented, the Division of Workers' Compensation (DWC) assigns a panel of QMEs for you to choose from. If you're represented by a lawyer, your attorney and the claims administrator can agree on an Agreed Medical Evaluator (AME), or else the panel process is used.
A second QME may be appropriate when:
- Your injuries involve multiple body systems or specialties (e.g., orthopedic and psychiatric components).
- The original QME lacks the qualifications to address a disputed medical issue.
- There's a separate legal dispute under Labor Code §4060 (injury AOE/COE), §4061 (permanent disability), or §4062 (medical treatment).
- The QME made a legal or factual error that requires a second opinion in another specialty.
Here’s an example: You injure your back at work and later develop depression as a result. If the QME is an orthopedic specialist, they aren’t qualified to assess psychiatric issues. In that case, a second QME in psychiatry may be necessary to properly evaluate your case.
Getting a Second QME vs. Replacing a QME: What’s the Difference?
It’s important to distinguish between getting a second QME and replacing the QME.
- Second QME: You’re asking for a new evaluation in a different specialty due to a dispute not covered by the current QME’s scope. This often requires either an agreement with the insurance company (which is rare) or a judge's order showing “good cause."
- Replacement QME: You’re trying to swap out the existing QME for a new one in the same specialty. This can happen if the doctor becomes unavailable, is biased, fails to issue a timely report, previously treated you, or isn’t competent to evaluate your injury. In some cases, both sides agree on the need for replacement and file a request under 8 CCR 31.5. If not, the dispute may go to court.
Either way, this is not a quick or easy process. Judges don’t approve additional or replacement QMEs just because you didn’t like your first report. You need evidence, proper legal procedures, and often, the help of an attorney.
Common Reasons for Getting a Second QME
- Multiple Injury Types: When your claim involves more than one medical specialty, like an orthopedic injury and a mental health condition.
- Unqualified Evaluator: When the original QME wasn’t legally or medically able to address certain disputed issues.
- Newly Disputed Issues: When new disputes arise after the original QME appointment.
- Biased or Incomplete Report: When the report is clearly one-sided or lacks adequate medical reasoning (though this alone may not be enough).
Legal Requirements for a Second QME
To obtain a second QME in a different specialty, you generally need:
- An existing dispute under Labor Code §4060, §4061, or §4062.
- Evidence that the new medical issue falls outside the original QME’s expertise.
- A written request or motion before the Workers’ Compensation Appeals Board (WCAB) if the insurer won’t agree.
Without meeting these standards, your request is likely to be denied. That’s why getting legal help early in the process is so important.
Can I Request a Second QME Just Because I Disagree With the First One?
Generally, no. Disagreeing with a QME’s opinion is not alone enough to get a second QME. However, your attorney may be able to challenge the findings, cross-examine the QME, or request a supplemental report. In rare cases, a second QME may still be warranted, but it must be based on procedural or legal grounds.
What to Do If You Think You Need a Second QME
If you believe the QME didn’t address a key part of your injury or issued an unfair report:
- Talk to an experienced workers' comp lawyer immediately.
- Review the QME report carefully and note any omissions or incorrect information.
- Consider whether the issue is specialty-related or procedural.
- File the appropriate request (with supporting evidence) if you’re pursuing a second panel or replacement QME.
Why Legal Guidance Matters
Trying to navigate this part of the workers' comp process alone can be frustrating and costly. A lawyer can:
- Help you avoid mistakes when selecting a QME panel.
- Determine whether you have grounds for a second QME.
- Gather evidence and file a motion if necessary.
- Represent you in front of a judge if the insurer disputes your request.
Bottom Line: Know Your Rights
Qualified Medical Evaluators play a huge role in the outcome of California workers' compensation cases. If the doctor evaluating you isn’t qualified to address the full scope of your injuries or makes errors that put your claim at risk, you may be entitled to a second QME. But the process is complicated and tightly regulated. If you’re unsure what to do next, get experienced legal help as soon as possible.
At Pacific Workers', The Lawyers for Injured Workers, we’ve handled thousands of workers’ comp cases and helped many injured workers fight back against bad QME reports. Call us for a free consultation, and let’s talk about how we can protect your rights.
Need help with your QME dispute? Call (888) 740-6434 or contact us online for a free case evaluation.