Agreed Medical Evaluator (AME)
An Agreed Medical Evaluator (AME) is a physician the injured worker’s attorney and the claims administrator agree on to resolve a disputed medical issue in a represented California workers’ compensation case. OrthoLegal coordinates orthopaedic AME workers’ comp evaluations across California, with scheduling, agreed records and report support for both sides. Read about the QME panel process, find an AME doctor near you in our directory, or request an evaluation.
What is an Agreed Medical Evaluator (AME)?
An Agreed Medical Evaluator (AME) is a licensed physician jointly selected by both the injured worker’s attorney and the claims administrator or defense attorney in a California workers’ compensation case to provide an independent medical-legal opinion regarding disputed issues in a claim. AME physicians are typically board-certified, have significant experience as QMEs, and a reputation for balanced, well-substantiated reports, which is why both sides are willing to entrust their case to a single evaluator. For many orthopaedic surgeons, AME work represents an advanced stage of medical-legal practice built upon prior QME experience.
How does the AME process work in California?
The AME process begins when applicant and defense counsel mutually agree on a single physician, bypassing the standard California QME panel selection process. The mutually selected physician, often a specialist such as an orthopaedic surgeon or psychologist, reviews the medical records, imaging, and prior treatment, performs a comprehensive examination, and issues a medical-legal report addressing diagnosis, causation, apportionment, work restrictions, future medical care, and permanent impairment. Because both parties agreed on the evaluator, the Workers’ Compensation Appeals Board (WCAB) gives an AME report substantial consideration in practice, although the Labor Code gives neither report added weight.
What types of cases does an Orthopaedic AME typically evaluate?
Orthopaedic AMEs evaluate complex musculoskeletal injuries where both sides want a single trusted expert, including cervical and lumbar spine disorders, shoulder pathology, knee and hip injuries, joint replacements, complex fractures, and post-surgical complications. They also handle multi-region cases involving contested apportionment between industrial injury, pre-existing conditions, and degenerative changes.
The Path to Agreed Medical Evaluator (AME) Status
In California, becoming an Agreed Medical Evaluator (AME) is a reputation-based achievement. Unlike the Qualified Medical Evaluator (QME) status, there is no state application; it requires a proven track record of unbiased reporting and mutual trust from both applicant and defense attorneys.
Earn QME Certification
Obtain California QME certification as the essential standard foundation for all future AME work.
Build a Specialized Track Record
Consistently produce balanced, thorough reports in high-demand subspecialties like spine, shoulder, or hip.
Reputation Over Application
AME status is earned through professional standing, not through a formal state filing process.
Gain Bi-Partisan Trust
AME viability depends on appearing simultaneously on trusted evaluator lists for both applicant and defense.
Mutual Party Selection
Both legal parties must mutually agree by name to use you as their single evaluator.
Substantial Consideration
The WCAB gives AME findings substantial consideration in practice.
looking to integrate AME work into your practice?
How much does an AME evaluation pay in California?
AME reports bill under the same Medical-Legal Fee Schedule as QME reports (Title 8, section 9795), with modifier -94, which applies a 1.35 multiplier to the evaluation codes. Fees rise with the number of body parts, the volume of records reviewed and the complexity of the case.
What makes an Orthopaedic surgeon a strong candidate for AME work?
Orthopaedic surgeons who are strong AME candidates are board-certified, experienced QMEs with a reputation for balanced, thorough reporting that both sides respect. Subspecialty expertise in spine, joint reconstruction, or sports medicine is particularly valued, as is a demonstrated command of the AMA Guides and a track record of clear, defensible reports. Surgeons who remain active in clinical practice carry the credibility and current clinical knowledge that AME work requires.
Can I do AME work alongside my clinical practice?
Yes, many orthopaedic AMEs maintain active clinical practices while taking on medical-legal work. AME evaluations are scheduled on a case-by-case basis, allowing you to flexibly integrate them into existing clinic days or dedicate separate half-days to evaluations and report work. Whether you are a full-time surgeon or transitioning toward a consultative role, AME work provides a rewarding professional pivot that leverages your years of clinical expertise.
How does working with a medical-legal management company help an AME physician?
Management companies range in support levels, but typically handle scheduling, records coordination, and administrative follow-up, allowing the AME physician to focus on the evaluation and report rather than practice management. OrthoLegal acts as an essential administrative engine, handling everything including referral development. By managing the heavy lifting of the total evaluation workflow and ensuring compliance with DWC timelines, we allow physicians across many specialties to focus exclusively on clinical analysis and high-quality report writing. Our infrastructure ensures your practice meets the rigorous turnaround expectations that California attorneys demand.
FREQUENTLY ASKED QUESTIONS
What is an AME in workers' comp?
In California workers’ comp, an Agreed Medical Evaluator (AME) is the physician the injured worker’s attorney and the claims administrator agree on to evaluate a disputed medical issue. AMEs are used only when the worker is represented (Labor Code section 4062.2). An unrepresented worker goes through a QME panel instead (section 4062.1).
How do I find an AME doctor near me?
Both sides have to agree on the AME, so the search usually starts with the evaluators the attorneys already trust in the right specialty and region. OrthoLegal’s physician directory lists orthopaedic surgeons who accept AME work and the California counties where each one evaluates, with an appointment request form on every profile.
What happens at a workers' comp AME evaluation?
The AME reviews the records the parties agreed to send under Labor Code section 4062.3, takes a history, examines the injured body parts and writes a report on the contested issues. The report addresses the questions in each party’s cover letter and is served on both sides, like any medical-legal report under Title 8.
Who pays for agreed medical evaluations?
The employer or its claims administrator pays for each reasonable and necessary medical-legal evaluation obtained under Labor Code sections 4060 to 4062, and that includes an AME evaluation (section 4064). Billing follows the Medical-Legal Fee Schedule in Title 8, section 9795, where an AME report carries modifier -94.
Does an AME report carry more weight than a QME report?
The Labor Code gives neither report added weight. In practice the Workers’ Compensation Appeals Board gives an AME report substantial consideration because both sides chose the physician, but every report must rest on substantial medical evidence and explain its reasoning. Our QME vs AME article compares the two routes in detail.
What is the difference between an AME and a QME?
Both AMEs and QMEs perform medical-legal evaluations under California workers’ compensation, but they are selected differently. A QME is selected through a state-issued three-physician panel and a strike process, while an AME is jointly chosen by both parties without going through the panel system. Since both sides agree on an AME, the WCAB gives that physician’s opinions substantial consideration in practice, although the Labor Code gives neither report added weight.
How is an AME selected in California workers’ compensation?
AME selection occurs by mutual agreement between applicant and defense attorneys, typically based on the physician’s specialty fit, board certification, clinical experience, reputation for evidence-based, balanced reporting, and experience with the AMA Guides. Many attorneys maintain internal lists of trusted AMEs across multiple specialties, including orthopaedic surgeons, for specific body parts and consult opposing counsel regarding mutually acceptable candidates. The goal is an evaluator both sides view as fair, qualified, and likely to produce a defensible report.
What does an AME evaluation include?
An orthopaedic AME evaluation includes a detailed history of the industrial injury, comprehensive review of medical records and diagnostic imaging, and a hands-on physical examination assessing range of motion, strength, joint stability, and neurological function. The AME then renders opinions on diagnosis, industrial causation, apportionment, maximum medical improvement, work restrictions, future medical care, and whole person impairment under the AMA Guides. The findings are compiled into a comprehensive medical-legal report admissible before the WCAB.
How long does an AME evaluation take?
For the physician, an AME generally involves 45 minutes to two hours of face-to-face examination depending on the number of body parts and complexity, plus substantial time for record review and report drafting. Multi-region or post-surgical cases typically require longer review and more extensive analysis. The complete medical-legal report follows the appointment, with timing governed by California regulations on medical-legal reporting.
When is an AME preferable to a QME for my client?
An AME is often preferable when both sides want a faster, more authoritative resolution and trust a particular Orthopaedic specialist’s clinical judgment. AMEs are especially valuable in complex cases involving multiple body parts, contested apportionment, prior surgeries, or significant permanent disability exposure, where a single agreed expert can streamline the process. The QME route is typically chosen when the parties cannot agree on an evaluator or want the procedural protection of the panel strike process.
How do I become an AME?
A separate license or examination beyond California QME certification is not required to become an Orthopaedic AME, but it does require a strong reputation for balanced, well-reasoned medical-legal reporting. Most AMEs are board-certified Orthopaedic surgeons with significant experience as QMEs, fluency in the AMA Guides, and a record of reports that withstand cross-examination. Attorneys on both sides tend to designate physicians who consistently produce thorough, neutral, and timely reports across many cases.
As an attorney, how do I select an AME for my client?
Attorneys typically evaluate prospective AMEs by reviewing the physician’s board certification, subspecialty fit (e.g., spine, shoulder, joint replacement), reputation for objective reporting, command of the AMA Guides, and history of deposition and trial testimony. Many firms keep internal rosters of trusted Orthopaedic AMEs for specific body parts and discuss mutually acceptable candidates with opposing counsel. The aim is an evaluator both sides view as fair and likely to produce a report that holds up at the WCAB.
How does the AME evaluation differ by medical specialty?
AME methodology varies by specialty: an Orthopaedic AME focuses on physical examination, imaging interpretation, joint and spine assessment, and AMA Guides impairment ratings, while psychiatric AMEs rely on clinical interview and psychometric testing. Orthopaedic AMEs primarily resolve disputes over fractures, joints, spine, and post-surgical conditions, whereas other specialties address internal medicine, neurology, or psychiatric issues. When an injury involves multiple systems, separate AMEs in each specialty may be designated to evaluate the relevant components.
How do I get started doing AME evaluations with OrthoLegal?
OrthoLegal works with board-certified Orthopaedic surgeons who are QME-certified or actively building their medical-legal practice and are interested in expanding into AME work. We handle case scheduling, records management, and attorney coordination so physicians can focus on high-quality evaluations and timely reporting. Contact OrthoLegal to learn about available AME opportunities and how we support physicians across California.
