A QME report is forty to eighty pages, and the attorney needs about ten facts from it before the MSC. This is the checklist a California workers’ comp paralegal uses to pull those facts out the same way every time, with the page number next to each one — so anyone who picks up the file can check the summary against the report in a minute.
Why the page number is the whole point
A summary that says “WPI 8% lumbar” is a claim. A summary that says “WPI 8% lumbar (p. 31)” is a fact anyone can verify in ten seconds. The habit of writing the page next to every finding is what separates a summary the attorney trusts from one she re-reads the report to confirm. Every line in the template below has a page column. Fill it in every time, even when it feels obvious.
The ten fields, in order
1. Evaluator, role and dates
Doctor’s name and specialty; whether the report is from a PQME (panel QME), an AME (agreed medical evaluator), or the primary treating physician; date of evaluation; date of the report; whether it is an initial, supplemental or re-evaluation report. The role matters: an AME’s opinion carries different weight at the Board than a panel QME’s, and a supplemental report answering the attorneys’ questions is often where the useful reasoning lives.
2. Body parts evaluated
List every body part the doctor addressed — and note any claimed body part the report does not address. A missing body part is the most common reason for a supplemental request, and catching it in the summary saves a month.
3. History and mechanism, as the doctor states it
Two sentences: how the doctor describes the injury (specific or cumulative trauma) and the dates of injury the doctor used. If the doctor’s DOI differs from the DWC-1 or the application, flag it here — an evaluator working from the wrong date produces a report that will be attacked.
4. Records reviewed
The doctor lists what she read. Copy the list, then compare it against what is actually in the file. Records the doctor never received (the MRI, the prior QME, the surgery report) are the basis for a supplemental report — and under Labor Code 4628 the report must state what was reviewed. This field is where most defects are found.
5. Diagnoses
Per body part, as stated. Note any diagnosis the treating physician made that the evaluator rejected or didn’t mention.
6. MMI / permanent and stationary status
Is the applicant MMI? As of what date? If not, when does the doctor expect it, and what treatment is pending? If the report finds P&S, the date is the anchor for temporary disability and for the rating.
7. Whole person impairment, by body part
For each body part: the WPI percentage, the AMA Guides (5th edition) method and table the doctor used, any add-on for pain, and whether the doctor invoked Almaraz/Guzman to depart from the strict rating and what reasoning she gave. Write the page number for each percentage. This is the field the rater needs verbatim.
8. Apportionment
The percentage attributed to the industrial injury and to other causes, and — this is the part that decides whether the apportionment survives — the doctor’s stated reasoning for how and why the non-industrial factors contribute (Escobedo). A bare “50% non-industrial due to degenerative changes” without explanation is a defect; note it. Also note whether the doctor addressed a prior award (Labor Code 4664) separately from pre-existing pathology (4663).
9. Work restrictions and future medical
Restrictions as stated (lifting, bending, sitting, standing), whether the applicant can return to the usual occupation, and the future medical care the doctor says is reasonably required. This feeds the vocational analysis and the settlement value.
10. Compliance and defects
Labor Code 4628 requires the report to state, among other things, the date and time spent, the records reviewed, the history, findings, diagnosis, and that the doctor personally performed the evaluation; 8 CCR 10682 sets the format. Check each. Then note anything in the report that a reasonable opposing counsel will attack: the missing MRI, the apportionment without reasoning, the body part not addressed, the DOI mismatch. This section is what turns a summary into a plan.
The one-page template
| Field | Finding | Page |
|---|---|---|
| Evaluator / role / dates | ||
| Body parts (and body parts not addressed) | ||
| History and DOI as stated | ||
| Records reviewed (vs. records in file) | ||
| Diagnoses | ||
| MMI / P&S date | ||
| WPI by body part (method, add-ons, A/G) | ||
| Apportionment (%, basis, 4663 vs 4664) | ||
| Restrictions / future medical | ||
| 4628 compliance / defects / next step |
How long it takes by hand
An experienced paralegal summarizes a single QME report in 45 to 90 minutes if the report is clean and the file is organized. A file with two QMEs, an AME and three PR-4s is most of a day, and the comparison across reports — which doctor gave what for the low back — is another hour with a spreadsheet.
What software changes
Voxium Legal reads the report and fills the ten fields above with a page cite behind each one, then puts every report in the file on one grid — doctor, date, body parts, MMI, WPI, apportionment, restrictions — and re-reads each cited page to confirm the number: a ✓ where it matched, a ? where you should look yourself. Ask it “did the QME review the 2023 MRI?” and it answers from the file with the page, or says “not in file.” The judgment in field 10 is still yours; the first nine fields take minutes. How the QME report summary works, or try it on a closed file free.
Written for California workers’ compensation paralegals. This article is general information for legal professionals, not legal advice.
Leave a Reply