A Typical Day as a Qualified Medical Evaluator (QME): Responsibilities and Workflow
- Nisha Mehta, MD
- 2 days ago
- 7 min read
Becoming a Qualified Medical Evaluator (QME) can allow you to complete assessments of workers’ comp claims and benefits in states like California that require certification to evaluate these cases. While this can be a lucrative side gig and a way to add ancillary income to your private practice, becoming a QME in California requires passing a competency exam and completing training. Given the steps required, it can be helpful to understand what this side gig entails before starting the process to help ensure it’s a good fit. Below, we cover what a typical day as a Qualified Medical Evaluator (QME) looks like, from preparing for the evaluation to completing the QME report, as well as highlight who QME work is a good fit for.
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How QMEs are selected for cases
When a worker is injured, they usually obtain the services of an attorney. In the course of their legal case, a panel is produced with three potential QMEs to assess the worker with regards to their injury claim. These QMEs all have clinics listed nearby to where the injured worker lives. The applicant attorney reserves the right to ‘strike’ a QME. Then, the defense attorney will ‘strike’ a QME. If the QME cannot apply the AMA 5th Ed, does not answer the questions, or leans towards the defense or applicant side, they may be struck out.
Whichever QME remains will have the opportunity to evaluate the injured worker to provide a balanced and unbiased opinion.
Of note, you must be certified as a QME to be considered during this process. Learn more about the steps required to become a Qualified Medical Evaluator.
How QMEs schedule the workers’ compensation evaluations
As a Qualified Medical Evaluator (QME), you control your own schedule. You provide your available dates and times to your QME coordinator, who manages the appointment requests and books evaluations on your behalf. Appointments are often scheduled months in advance, sometimes up to 3 months out.
QMEs may list up to ten clinic locations with the state of California and can update or change those locations every 6 to 12 months if needed. Availability is entirely flexible. Some QMEs choose to see only 1 or 2 injured workers per session, while others may see 10-15 in a single day. The pace and structure of your schedule are up to you.
Many QMEs see injured workers in clinics they already use for their regular practice. Others travel to “pop-up clinics,” which are typically simple exam rooms with a desk and chairs. These clinics are usually located in areas with a high concentration of injured workers. With an experienced coordinator, applicants can often be scheduled back to back, minimizing downtime and keeping the day efficient.
Ways physicians integrate QME work into their schedules include:
Adding QME evaluations to their regular clinical schedule
Blocking off certain days of the week/month in their clinical schedule for QME work
Flying to a clinic location in the morning and returning in the evening for a day of evaluations
Traveling to a clinic location and staying for 2-3 days
Prepare for the evaluation as the Qualified Medical Evaluator
As the evaluation date approaches, you’ll review the medical records, attorney letters, and intake history. Occasionally, records may be incomplete or delayed. When materials are available in advance, you can outline key questions and begin preparing your report framework ahead of time.
Compared to a standard clinical visit, QME work is non-treating and requires more preparation. Physicians new to QME work should expect to spend up to half an hour reviewing records for a case. As you gain experience and become more familiar with the legal framework, this review process often becomes much faster, sometimes taking only a few minutes.
Complete the QME evaluation with the injured worker
The QME appointment itself is more of a structured interview than a traditional medical visit. Think of it as a detailed history-focused encounter, similar to early medical training, where you are a ‘gatherer’ of information.
You are answering specific medical-legal questions, including:
Is the condition work related?
If so, what exactly happened?
What treatment have they had to date?
Will the injured worker get meaningfully better in the next 12 months?
Is there permanent impairment? If so, what percentage is given per the AMA 5th Ed Guides?
Is future medical care required?
Did anything else cause this impairment? If so, what (i.e. previous injury, obesity)?
Unlike routine clinic visits that focus primarily on diagnosis and treatment, QME evaluations require deeper exploration of work activities, prior injuries, outside factors, and the overall medical record. This is the legal aspect of med-legal work!
Oftentimes, the QME will review the history taken, ask clarifying questions, and then perform a focused physical exam.
During the interview, you may take notes directly or use a scribe. If the applicant requires an interpreter, one will be provided for you.
A focused physical examination is then performed, and depending on your specialty, you may need to bring specific exam equipment.
The overall evaluation time varies by specialty and experience, but typically ranges from 20 to 60 minutes. Early on, evaluations tend to take longer as you refine your process.
Writing your QME report
After the injured worker leaves, you’ll need to write the QME report. (Experienced QMEs may be able to begin writing their report while talking to the patient.)
Reports follow a standardized structure and must address specific questions. In some cases, you may also need to respond to unique issues raised by the parties. The better you prepare before the case and the more key questions you ask during the case, the faster you will be able to write a high-quality report.
This initial QME report is due within 30 days (a California Law requirement).
If records are missing or additional clarification is required, then the initial report feels abbreviated. In this instance, you will ask for additional information and/or needed tests, and then are issued a supplemental report along with the information requested.
Supplemental reports do not require a face-to-face evaluation and are typically more focused than the original report. These are due within 60 days.
Following up after your QME report is complete
Any questions that an attorney has will be answered during a re-evaluation, supplemental report, or deposition.
After you send in the report, the billing department collects payment on your behalf. Each of these items (re-evaluation, deposition, etc.) is separately payable.
Depositions for QME work
In rare cases, discrepancies or contested issues may lead to a deposition. QMEs are compensated for record review, deposition time, and transcript review. When reports are thorough, clear, and well-reasoned, depositions are uncommon. If this does occur, it is usually via Zoom.
Is QME work the right side gig for you?
The most efficient and best QMEs understand both the applicant attorney and defense attorney arguments, know how to ‘work backwards’ from the AMA 5th Ed Guides to arrive at conclusions, and explain their thought process clearly and succinctly. They put in the time to learn and understand that sometimes records are incomplete or the injured worker cancels.
The deeper you understand the AMA 5th Ed Guides, the smoother the entire process will be for you. If you solely rely on your clinical knowledge, you aren’t likely to produce a high quality med-legal report.
To make the most of this side gig, it’s recommended that you set aside dedicated time months in advance to help assist with scheduling. A willingness to travel to areas with more demand for QMEs can also help maximize this side gig’s potential.
Conclusion
With the right preparation before the case, flexibility on the examination day, and focus on key topics, QME work can become a natural extension of your workflow. At its best QME work is not just an extension of clinical medicine - it is a respected, intellectually rewarding role that places you at the center of the workers’ compensation system. As a QME, your opinion carries real weight. For those willing to learn the process and do it well, becoming a QME offers an opportunity to practice medicine with autonomy, purpose, and lasting impact.
Related QME & side gig resources for physicians
If you’re interested in becoming a QME, sign up for our chart review matching database (physician only) for alerts on relevant opportunities and our PSG weekly newsletter, where we publish current and upcoming job and side gig opportunities.
Learn more about QME work:
Explore related side gigs: