What Happens If a Party Doesn’t Show Up to a QME Evaluation?
Occasionally an injured worker—or, less often, a defense-requested witness—fails to appear for the scheduled Qualified Medical Evaluator examination. California regulations spell out exactly how to proceed, how to bill, and how to reschedule the evaluation so the claim can move forward.
1. No-Show vs. Late Cancellation
- No-show: The claimant arrives more than 30 minutes late or does not appear at all.
- Late cancellation: The appointment is cancelled with fewer than six business days’ notice.
Both scenarios trigger the same billing and rescheduling rules.
2. Bill ML203 for Missed Appointments
Under the Medical-Legal Fee Schedule, you may bill ML203:
- Flat fee: $503 (2024-25 schedule)
- No modifiers: Record-review and complexity add-ons do not apply.
Attach a brief Proof of Non-Attendance stating the date, time, and circumstances (e.g., “Claimant did not appear by 9:45 a.m.; phone and email attempts were unsuccessful”).
3. Payment Responsibility
The claims administrator (insurer or self-insured employer) must pay the ML203 invoice within 60 days. If payment is late, you may assess a 10 % penalty and interest under Labor Code §4622.
4. Rescheduling the Examination
- Notify all parties of the no-show and provide at least two new dates within the next 60 days—ideally sooner.
- The 60-day scheduling clock restarts from the date you offer new appointments.
- Keep proof of your rescheduling correspondence to defend against late-scheduling accusations.
5. Repeated No-Shows
If the claimant misses two consecutive appointments without good cause, a party may petition the Workers’ Compensation Appeals Board (WCAB) for sanctions or to compel attendance. Some judges will allow you to proceed based on records alone, but this is case-specific.
6. Best Practices for QMEs
- Send written reminder letters 14 and 3 days before the exam.
- Collect a working phone number and email; call on the morning of the evaluation if travel logistics are a concern.
- Document every contact attempt—email timestamps and voicemail logs strengthen your ML203 invoice.
For the official fee language and billing code definitions, see California’s Medical-Legal Fee Schedule (§ 9795).