If you recently suffered a workplace injury and plan to file a workers’ compensation claim, your road to recovery will include numerous encounters with doctors. From your initial trip to the emergency room, to follow up visits with your treating physician, to physical therapy and rehabilitation, you’re about to become very familiar with San Diego’s healthcare professionals.
One of the individuals you may meet throughout the workers’ compensation process is a qualified medical examiner (QME). A qualified medical examiner is a healthcare provider who is licensed to practice in the state of California and who is certified by the Division of Workers’ Compensation Medical Unit in his or her area of expertise. The role of a qualified medical examiner is to perform an exam and provide an unbiased opinion of your proposed disability rating or treatment plan should the insurance company object to your physician’s findings.
As with any healthcare provider, the qualified medical examiner you see can influence the outcome of your case. At the Law Office of Gerald Brody & Associates, our attorneys can guide you through the process of choosing a qualified medical examiner and help you prepare for what to expect during your exam.
When you need to see a qualified medical examiner
There are two reasons you may need to see a qualified medical examiner during the workers’ compensation process:
- Your treating physician has given you a permanent disability rating.
- The insurance company has challenged your treating doctor’s findings.
If you need to see a qualified medical examiner, the state will provide you with a list of three QMEs in your area based on the medical specialty requested. You are then tasked with choosing a physician from this list and making an appointment. Because this is a legal medical evaluation, your meeting with a qualified medical examiner will be a bit different than a typical physician-patient relationship.
Preparing to meet a qualified medical examiner
Prior to your appointment, your QME will have received a copy of your medical records and other documents related to your workplace injury. What’s more, the insurance company will write a letter to your QME summarizing the treatment you’ve received thus far along with specific questions they have about your condition. In other words, your doctor will know the facts about your injury and objections about your treatment plan before you arrive at his or her office, so it’s important to be ready to tell your side of the story.
To prepare, write down every body part affected by your injury, how your injury impacts daily living, what activities make your pain worse, and a detailed timeline of what happened between your accident and your examination. Having this information available at your appointment will show that you’re serious about recovering and getting back to work as soon as possible.
What to expect when meeting a qualified medical examiner
During your appointment, the doctor will likely start by asking about how your injury occurred and treatment you’ve received from other doctors. It’s important to tell the truth and not exaggerate your symptoms. Unlike a checkup with your primary care physician, nothing you say to your qualified medical examiner is private or protected. Any statements or behaviors that conflict with your medical records may be used against you in your workers’ compensation case and could delay or even reduce your benefits.
In addition to asking questions about your medical history and workplace injury, the doctor will perform a physical exam and fill out a report with his or her findings. Use this time to ask questions about your condition and treatment options, and be sure to tell the doctor about any areas of your body that are still in pain and activities you have difficulty performing. The more information you can provide the better, as this appointment will determine the next steps in your workers’ compensation claim.
Need assistance choosing a qualified medical examiner? We can help.
Seeing a qualified medical examiner is supposed to eliminate favoritism between insurance companies and doctors, but not all QMEs are equally knowledgeable in workers’ compensation. At the Law Office of Gerald Brody & Associates, our attorneys are very experienced with the QME process and can help you select the best physician available. Working with a lawyer also grants you the opportunity to see an agreed medical evaluator (AME) where all parties agree on an evaluating physician instead of leaving such a personal decision to the state.
Call our office today at (619) 345-5317 to schedule your free consultation.