Glossary: QME and AI terms
Short version: 27 terms, each defined for how it matters when a California QME or AME picks or uses an AI tool. Other pages on this site link here the first time they use a term.
Limits: We read each product's own pages and the DWC sources on 2026-11-12 and did not upload records to any product. Prices, plans and rules change, and nothing here is legal advice; ask your own counsel about Labor Code 4628.
California workers' comp terms
- QME (qualified medical evaluator)
- A physician certified by the California DWC to evaluate disputed medical issues in a workers' comp claim and write a medical-legal report. Bound by 8 CCR 41 and Labor Code 4628.
- AME (agreed medical evaluator)
- An evaluator the represented parties agree on instead of a panel. The ML fee schedule's -94 modifier raises an AME's evaluation fee by 1.35 times.
- Panel QME (PQME)
- A QME picked from a panel the DWC Medical Unit issues. The -95 modifier marks a panel QME evaluation on the bill and does not change the fee.
- Medical-legal report
- The report a QME or AME writes on the disputed issues. 8 CCR 10682 lists 15 elements it should include where they apply, and it must comply with Labor Code 4628.
- Labor Code 4628
- The statute on who prepares a medical-legal report. Only the signing physician takes the history, reviews and summarizes prior records, and drafts the conclusions; anyone else who does nonclerical work is named. Breaking it makes the report inadmissible and unpaid.
- 8 CCR 41
- The QME ethics regulation. 41(c)(2) requires a list and summary of every record reviewed; 41(c)(7) has the evaluator write every part that discusses medical issues and conclusions.
- DWC quality assurance checklist
- The California Medical-Legal Quality Assurance Checklist posted by the DWC, last updated 2026-10-10. Not a required format. Its AI paragraph suggests naming the AI tool and certifying that you verified every statement.
- Records declaration (page-count declaration)
- The penalty of perjury declaration a party sends with records under 8 CCR 9793(n), including the total page count. Records without it do not count as received. Separately, the QME verifies the total pages reviewed in the report.
- ML fee schedule (MLFS)
- The medical-legal fee schedule in 8 CCR 9795. Each fee is a relative value times $16.25, and includes the history and exam, record review, report preparation and overhead.
- ML-201
- The code for an initial medical-legal evaluation that is not a follow-up or supplemental: $2,015, including review of 200 pages of records.
- ML-203
- The supplemental report code: $650, including 50 pages. Not allowed for reviewing information you already had before the earlier report.
- Supplemental report
- A report written after a party's request or after new records arrive, billed as ML-203. 8 CCR 35(i) has you write one on request when late records come in.
- Apportionment
- Splitting permanent disability between industrial and other causes, under Labor Code 4663 and 4664. The DWC checklist asks for approximate percentages and a how-and-why explanation.
- WPI (whole person impairment)
- The impairment rating, as a percentage of the whole person, that a QME gives under the AMA Guides for the disability rating.
- AMA Guides
- The American Medical Association's Guides to the Evaluation of Permanent Impairment. California ratings use the Fifth Edition.
- WCAB
- The Workers' Compensation Appeals Board, which decides disputes, including whether a medical-legal report is admissible.
- Panel decision
- A WCAB decision by a panel of commissioners. It may be cited but does not bind other panels or judges the way an en banc decision does.
- EAMS
- The DWC's Electronic Adjudication Management System. Its case numbers start with ADJ and appear on cover letters and decisions, which makes them an identifier.
AI and privacy terms
- BAA (business associate agreement)
- The HIPAA contract between a covered entity and a vendor that handles PHI for it. For AI, it has to cover the exact product and plan you use.
- PHI (protected health information)
- Health information that identifies a person and is held by a covered entity or its business associate. Every page of a QME file, the cover letters and your draft report count.
- Consumer plan
- A free or personal paid AI plan, such as ChatGPT Plus, Claude Pro or Gemini on a personal account. None of those we read carries a BAA.
- Safe Harbor
- HIPAA's de-identification method that removes 18 identifier types, including every date element except the year and any unique identifying number.
- Page citation
- A link or reference from each line of AI output to the page of your upload it came from. It is what lets you do the excerpt review Labor Code 4628(c) requires.
- Chronology
- A dated list of events from the records: visits, imaging, procedures, work status, each with its source page.
- Hallucination
- A statement an AI produces that its source does not support, such as an MRI the file never held or a case that does not exist.
- Deduplication
- Removing repeated pages, such as the same report sent by both parties. Exact-match deduplication misses copies with a different fax header.
- OCR (optical character recognition)
- Turning scanned or faxed images into text. Errors in dates and doses on handwritten pages are the most common source of wrong AI output.