WORKERS’ COMPENSATION QME EVALUATION
The workers’ compensation process can be puzzling and tricky, to say the least. At The Law Office of Matthew Russell in San Diego, CA, we frequently receive calls from injured workers asking about Qualified Medical Evaluators (QMEs) and the role they play in the workers’ compensation process. We like to say those callers were smart to contact us. When it comes to doctors, employers, claims administrators, and medical evaluations, it’s important to navigate carefully.
Our brief description below should answer most of your basic questions about QMEs. If you would like to discuss your specific circumstances further, please give us a call. Our team is dedicated to helping injured workers sort through the confusion of the workers’ compensation process and fight for what they deserve.
WHAT IS A QME DOCTOR?
Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers’ Compensation Medical Unit and are licensed to practice in California. This certification includes an administrative exam and a 12-hour report-writing program. Upon completion of these requirements, providers become listed as available for performing QME exams in their medical board specialty (medical doctor, osteopath, chiropractor, psychologist, dentist, optometrist, acupuncturist, etc.). Providers must also participate in ongoing education in the workers’ compensation evaluation process in order to maintain their certification as QMEs.
WHY DO I NEED TO SEE A QUALIFIED MEDICAL EVALUATOR IN SAN DIEGO?
Following a workers’ compensation claim, if your treating doctor gives you a permanent disability rating or if there are any objections to the treating doctor’s findings, a different doctor – either a QME or an AME – must perform an exam to confirm the permanent disability rating or address any one of the following objections:
- Whether or not the injury was caused by your work.
- Whether or not you need treatment for your injury.
- Whether or not you need to stay home to recover from your injury.
- Whether or not your condition is permanent and stationary.
- Whether you have a new and further disability.
See here for the DWC Medical Unit QME Database and list of QME Doctors in San Diego, California.
WHAT IS AN AGREED MEDICAL EVALUATOR (AME), AND CAN I USE ONE INSTEAD?
An Agreed Medical Evaluator (AME) is a physician selected by agreement between the parties to perform the medical/legal evaluation in a workers’ compensation case. An AME will only be used if you have an attorney. If you/your lawyer and your employer/claims administrator cannot agree on the evaluating physician, you will need to be evaluated by a QME.
If you do not have an attorney, the insurance adjuster will notify the state that you need a QME.
HOW DOES AN EXAMINATION BY A QME WORK IN CALIFORNIA?
In the event that you require examination by a QME, the state will generate a list of three QMEs in your area who practice in the field that you need. The party that requests the QME exam (you, your employer, or your claims administrator) chooses the specialty of the doctor who will perform it. The list of three QMEs is called a QME panel. You choose from this list and make an appointment for your exam.
The QME process was designed to eliminate favoritism between doctors and insurance carriers. But that doesn’t mean the randomly generated panels are always going to contain three doctors that are equally fair and knowledgeable in workers’ compensation law. Doctors are human. Some will lean in favor of employers. Others will orientate more toward injured workers.
At The Law Office of Matthew Russell, we can help you navigate the QME process and advise you as to your options. Our lawyers may be able to help you choose the best QME panel or even win you the freedom to use an AME instead.
CONTACT US FOR HELP WITH QME & WORKERS’ COMPENSATION IN SAN DIEGO, CA
We understand how tricky the workers’ compensation system can seem, and we’re serious about helping injured workers navigate the process and enforce their rights. Call us at (619) 544-1506 We’ll help you fight for the compensation you’re entitled to.