- Legal
Before California’s QME Template Arrives, Fix the Record Set Behind It
The case for AB 1293 was easy to make. A panel QME issues a report that never addresses apportionment, or answers causation for the shoulder and says nothing about the cervical spine. Somebody requests a supplemental report, which the evaluator has 60 days to produce. Somebody else notices the deposition, which can be set as far out as 120 days. Months come off the claim, the per-page and per-report billing keeps running, and the underlying medical opinion has not moved.
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Labor Code section 4062.4, added by AB 1293, is the Legislature’s answer. Regulations are due by January 1, 2027. It is a reasonable answer as far as it goes, and where it stops is at the evaluator’s desk, which is one step downstream of where most of the damage happens.
What Section 4062.4 Actually Enacted
Governor Newsom signed the bill on October 3, 2025, and it became Chapter 298 of the 2025 statutes. The whole of section 4062.4 fits on a single page.
The Administrative Director has to develop and make available two things: a template QME report form containing all statutory and regulatory requirements for a QME report, and a medical evaluation request form for communicating with a panel QME under section 4062.3. The Division of Workers’ Compensation adopts implementing regulations through the standard rulemaking process, with an effective date no later than January 1, 2027.
Then there is the sentence most of the coverage skips. Subdivision (a)(2) provides that use of the template does not constitute prima facie evidence that a report is complete, accurate, or compliant. A report written on the state’s own form arrives carrying no presumption at all. If it is thin on apportionment reasoning, it is exactly as vulnerable as it was before, and either side challenges it the same way it always did.
The verb in both provisions is “make available.” Neither the evaluator nor the parties are required to use anything.
The Bill Was Rewritten Twice, and Each Pass Removed Teeth
This matters because a good deal of the published commentary describes bills that were amended before passage. AB 1293 was rewritten twice in the Assembly, and each pass removed something that people are still attributing to the law.
March 24, 2025: Mandatory Use and a Quality Scorecard
The version amended March 24, 2025 was considerably more aggressive. It added a new subdivision (m) to section 4062.3 requiring that, for medical-legal evaluation dates of service on or after January 1, 2027, parties communicate with and provide information to the panel QME in the manner prescribed by the Administrative Director. Mandatory use. It called for a joint request form to be used by all parties rather than a form merely made available. It directed the Administrative Director to establish a method for evaluating QME reporting quality, including collecting Appeals Board and judge findings that a report was incomplete or not substantial evidence on permanent disability or apportionment. And it described the template as containing the requirements for a complete report that constitutes substantial evidence.
April 9, 2025: Both Struck, a Complaint Process Added
The April 9, 2025 amendments struck the section 4062.3 changes in their entirety, taking the mandatory-use provision with them. They also deleted the reporting-quality method. In its place the bill turned to section 139.2, adding a requirement that the Administrative Director promulgate regulations by January 1, 2027 establishing a process for parties to submit allegedly inaccurate or incomplete medical-legal reports to the medical director, evaluate those reports annually, and publish the results on the division's website. Subdivision (a)(2), the no-prima-facie clause, first appears here.
October 3, 2025: Section 4062.4 and Nothing Else
The chaptered version signed in October does none of the section 139.2 work either. It adds section 4062.4 and nothing else.
| Provision | March 24, 2025 | April 9, 2025 | Chaptered |
|---|---|---|---|
| Mandatory manner of communication with panel QME | Yes, via 4062.3(m) | Struck | Absent |
| Joint request form all parties must use | Yes | Softened to a form made available | Absent |
| Method for evaluating QME reporting quality | Yes | Struck | Absent |
| Party process to flag inaccurate reports, annual evaluation, published results | No | Yes, via 139.2 | Absent |
| Template creates no presumption of compliance | No | Added | Yes |
| Template contains requirements for a report constituting substantial evidence | Yes | Yes | Softened to "a QME report" |
The Phrase the Legislature Declined Twice
The last row is the one worth sitting with. Two successive versions of this bill described the template as embodying what a report needs to constitute substantial evidence. The enacted text does not. It requires the form to include the statutory and regulatory requirements for a QME report, then says in the next breath that using it proves nothing about completeness, accuracy, or compliance. The Legislature had the stronger formulation in front of it twice and did not enact it.
So if you have read that AB 1293 creates compulsory templates, a quality scorecard for evaluators, or a complaint channel for inaccurate reports, each of those describes a real provision that was in a real version of this bill and is not in the law.
| Reached by the AB 1293 template | Not reached | |
|---|---|---|
| Report structure and required headings | Yes | |
| Whether every statutory element is prompted | Yes | |
| Whether the evaluator received the prior claim records | No | |
| Whether duplicates were removed before service | No | |
| Whether the cover letter named every disputed issue | No | |
| Whether the opinion holds up as substantial evidence | No | |
| Service timing and objection windows under 4062.3 | No |
A Compliant Report Can Still Answer the Wrong Question
A QME report is a function of two inputs: what the evaluator was asked, and what the evaluator was given. The template addresses neither. It governs how the answer is laid out on the page.
Consider what a compliant report looks like when the file behind it was poor. The evaluator addresses apportionment because the template prompts for apportionment, and writes that apportionment to prior injury cannot be determined because no prior treatment records were provided. Every heading is answered. The one issue that priced the claim is unresolved, and the cause sits in the records package.
That failure mode is not hypothetical, and the regulations anticipate it. Under 8 CCR section 35(i), where a party fails to provide relevant medical records within 10 days after the evaluation date and the evaluator cannot obtain them, the evaluator proceeds and serves the report anyway. Section 38 gives the evaluator 30 days from the examination to prepare and serve it. The same regulation contemplates the evaluation going forward without all relevant records while the parties are still fighting over what gets sent.
Evaluators have adapted in the most telling way possible. Published report templates circulated to California QMEs include standing language for exactly this situation: records were not received within 10 days after the evaluation per section 35(i), so if you want them reviewed, request a supplemental report. The boilerplate exists because the scenario is routine. And a supplemental report is the 60-day delay the template was meant to prevent.
RAND's 2026 Study Lands on Record Delivery
RAND reached the same place from the data side. In the 172-page study DWC released in May 2026, record delivery was one of ten core research questions, which is itself a signal about where the system’s problems sit.
Stakeholders across the process told RAND that determining which records are relevant is genuinely difficult, and that better organization and removal of duplicates would help. Frustration with record delivery turned up among the reasons QMEs give for leaving the system altogether. RAND’s recommendations include requiring records be delivered before the evaluation, adding report-writing time for cases carrying large record volumes, and collecting data on record delivery and completeness, which the state does not currently track.
There is a direct cost signal too. The 2021 fee schedule replaced time-and-complexity billing with flat fees plus $3 per page for record review beyond 200 pages. RAND found that average medical-legal payments in 2022 and 2023 ran 57 percent above the 2016 to 2020 average, more than double the 25 percent increase the regulation was designed to produce. Earlier CWCI analysis attributed most of that growth to per-page review of records over 200 pages.
Read that alongside the duplicate problem and the arithmetic is unpleasant. In a package that has already crossed 200 pages, a duplicated emergency department run bills at the same $3 per page as the orthopedic note that decides apportionment. Nobody is paying for insight there. They are paying for volume that a deduplication pass would have removed before service.
The arithmetic is easy to run against your own files rather than take on faith. A 1,400-page set bills 1,200 reviewable pages past the threshold, or $3,600. If a quarter of that set is duplication, which is not an unusual proportion in a multi-provider claim assembled from several retrieval sources, roughly $900 of the review fee is being spent on pages the evaluator has already read once. That figure buys nothing on causation, nothing on apportionment, and it recurs on every file assembled the same way. Run it on a package your team sent last month and see where it lands.
Nothing About Section 4062.3 Changes in 2027
Section 4062.3 does not change. Information a party proposes to send the evaluator is still served on the opposing party 20 days in advance, and the opposing party still has 10 days to object to nonmedical records. That cuts both ways: defense sends the records and the issue cover letter, applicant counsel may send an advocacy letter and records of their own, and each side’s service obligations are the same. Ex parte exposure is unchanged, and a communication that should have been served does not become compliant because it was typed onto a state form.
Nor does the substantial evidence standard move. A report that addresses every required heading can still fail as evidence when the reasoning behind the causation or apportionment opinion is absent. Facial completeness and evidentiary adequacy have never been the same test, and a template can only help with the first.
Timing does not improve on its own either. RAND’s data put the 2023 average at 118 days from panel assignment to exam date, with fewer than a quarter of exams happening inside 90 days. Whatever the template does for report structure, the calendar in front of it stays the same.
What Automation Can Do With a 4,000-Page Intake
It is worth saying plainly, because the question comes up whenever standardization and technology land in the same conversation.
Software is good at the parts of this problem that are mechanical. Splitting a 4,000-page intake, correcting page orientation, running OCR, classifying documents by provider and type, sorting chronologically, identifying and removing duplicate copies of the same record, and flagging where a treatment timeline has a gap. Those are pattern tasks at volume, and they are exactly the tasks that determine whether the record set reaching a QME is usable.
Software is not good at deciding whether a 2019 lumbar MRI is apportionment evidence or noise in this particular claim. That is a judgment about the case, made by someone who understands what each side has to prove. AB 1293 draws a version of the same line: subdivision (a)(2) refuses to let a completed form stand in for a sound opinion. Structure is not substance. That holds for a state template and it holds for an automated summary.
Preparation That Does Not Depend on the Regulations
It is worth saying plainly, because the question comes up whenever standardization and technology land in the same conversation.
Software is good at the parts of this problem that are mechanical. Splitting a 4,000-page intake, correcting page orientation, running OCR, classifying documents by provider and type, sorting chronologically, identifying and removing duplicate copies of the same record, and flagging where a treatment timeline has a gap. Those are pattern tasks at volume, and they are exactly the tasks that determine whether the record set reaching a QME is usable.
Software is not good at deciding whether a 2019 lumbar MRI is apportionment evidence or noise in this particular claim. That is a judgment about the case, made by someone who understands what each side has to prove. AB 1293 draws a version of the same line: subdivision (a)(2) refuses to let a completed form stand in for a sound opinion. Structure is not substance. That holds for a state template and it holds for an automated summary.
Read Your Last Three Cover Letters Against the Checklists
Take your last three panel cover letters and read them against the DWC quality assurance checklists. Every disputed issue has to be named, and named by body part. If the checklist prompts the evaluator to address something your letter never raised, the gap is in your practice rather than the evaluator's, and no template will close it.
Then Look at What Went Out With Them
Then look at what went out with those letters. Not the page count. Whether the prior claim records were in there at all, whether imaging reports accompanied the films, whether the treatment timeline has a hole nobody flagged, and how many times the same record appears. Past 200 pages you are paying $3 for each one, so a duplicate set is a billing problem as much as a reading problem. Our breakdowns of apportionment preparation on the defense side and QME and IME exam preparation for applicant attorneys both go deeper on what belongs in the set.
Build the Record of What You Sent, and Set Your Policy Now
Keep a service log with real dates. When templates arrive, format arguments recede and the fights move to what was sent, when, and to whom. Parties who can produce that record on demand will do better than parties reconstructing it from email threads.
For claims organizations the exposure is different in shape and larger in aggregate. A QME opinion that could not reach apportionment because the prior records were missing does not just delay one file, it prices it wrong, and the reserve consequences persist long after the supplemental report lands.
And decide your position on the forms before you need it. Because use is voluntary, every panel presents a choice: ask the evaluator to use the template, say nothing, or object when the other side asks. Settling that once as policy beats improvising it case by case in 2027.
Frequently Asked Questions
Does AB 1293 require QMEs to use the DWC template?
No. Labor Code secw 4062.4 directs the Administrative Director to develop and make the template available. It does not require an evaluator to write on it or a party to send the request form. An earlier version of the bill would have made the prescribed manner of communication mandatory for evaluation dates of service on or after January 1, 2027, and that language was removed before passage.
What is Labor Code section 4062.4?
It is the section AB 1293 added to the Labor Code, effective as Chapter 298 of the 2025 statutes. It requires DWC to create a template QME report form and a medical evaluation request form, states that using the template creates no presumption of compliance, preserves party rights under section 4062.3, and requires implementing regulations with an effective date no later than January 1, 2027.
When do the AB 1293 regulations take effect?
No later than January 1, 2027. DWC adopts them through the Administrative Procedure Act process, which includes a public comment period. Draft template forms had not been posted as of this writing.
Does using the QME template make a report substantial evidence?
No. Subdivision (a)(2) is explicit that use of the template does not constitute prima facie evidence that a report is complete, accurate, or compliant. A report on the state form can still be challenged as failing the substantial evidence standard if the reasoning behind the opinion is missing.
What happens if the QME does not receive the medical records before the evaluation?
Under 8 CCR section 35(i), where a party fails to provide relevant medical records within 10 days after the evaluation date and the evaluator is unable to obtain them, the evaluator completes and serves the report without them. Section 38 sets a 30-day window from the examination for that report. Questions left unanswered for lack of records then require a supplemental report, which the QME has 60 days to produce.
Does AB 1293 change the 20-day service rule under Labor Code 4062.3?
No. Information a party proposes to provide the evaluator must still be served on the opposing party 20 days beforehand, and the opposing party retains 10 days to object to nonmedical records. Section 4062.4 expressly preserves party rights under 4062.3.
How much does record review cost in a California medical-legal evaluation?
Under the 2021 medical-legal fee schedule, record review is reimbursed at $3 per page for records beyond 200 pages, on top of the flat evaluation and report fees. RAND and CWCI analyses both identified per-page review above that threshold as the main driver of medical-legal payment growth since the fee schedule changed.
Does AB 1293 create a way to report an inaccurate or incomplete QME report?
Not in the enacted law. A version amended April 9, 2025 would have required regulations establishing a process for parties to submit allegedly inaccurate or incomplete medical-legal reports to the medical director, an annual evaluation of those reports, and publication of the results. That language was in section 139.2 and does not appear in the chaptered bill. Existing review and reappointment mechanisms under section 139.2 are unchanged.
Does the AB 1293 template define what makes a report substantial evidence?
No, and the drafting history is deliberate on this point. Versions amended March 24 and April 9, 2025 both described the template as containing the requirements for a complete report constituting substantial evidence. The enacted text requires only that the form include the statutory and regulatory requirements for a QME report, and subdivision (a)(2) states that using it is not prima facie evidence of completeness, accuracy, or compliance.
Will the QME template reduce the number of supplemental reports?
It may reduce the ones caused by an evaluator overlooking a required element, which is what it was designed for. It cannot reduce the ones caused by records arriving late, arriving incomplete, or never arriving, since 8 CCR section 35(i) has the evaluator serve the report regardless.
Explore White AI
Rapid Care provides medical record review, chronologies, and summaries for personal injury, workers’ compensation, IME, and insurance defense teams, on both sides of the claim. Intake, deduplication, classification, and chronological sorting run before a human reviewer looks at the output. If the record sets reaching your evaluators are arriving unsorted and duplicated, that is worth fixing while there is still time
