Qualified Medical Evaluators (QME) in California Workers’ Comp Decreases

San Diego Qualified Medical Evaluators (QME) Workers’ Comp

When you get hurt or sick, you probably have a specific doctor you visit for a diagnosis and prescription. You might assume that you’d visit the same doctor following a work-related accident, but in California, that’s not always the case. Unless you predesignate a doctor with your employer before an accident occurs, you won’t be able to see him or her for your injuries. Instead, you will choose a doctor from your employer’s medical provider network (MPN) as your primary treating physician. Should this doctor give you a permanent disability rating or if the insurance company challenges your doctor’s findings, you may need to see a qualified medical evaluator (QME) who can resolve the dispute.

According to a California Workers’ Compensation Institute study, the number of qualified medical evaluators dropped 20 percent over a five year period at a time when the number of fatal and nonfatal workplace injuries held steady. With fewer trustworthy qualified medical evaluators available, hiring a workers’ compensation attorney is more important than ever.

What do qualified medical evaluators do?

A qualified medical evaluator is a physician who is certified by the Division of Workers’ Compensation (DWC) in his or her areas of expertise. These doctors have received special training to examine injured workers and provide unbiased opinions on workers’ disability ratings or treatment plans should an insurance company disagree with a treating physician’s findings. Basically, qualified medical evaluators are responsible for resolving disputes so injured workers can get the compensation they need to recover.

Qualified medical evaluators include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists, and acupuncturists. If you’re hurt at work and your employer or the insurance company disagrees with your doctor’s treatment plan, there’s a good chance you’ll need to see a QME. Click here for Qualified Medical Examiner FAQs.

What does the decline in QMEs mean for California workers’ compensation claims?

Fewer qualified medical examiners has made it increasingly difficult for injured workers to schedule timely legal medical evaluations, which in turn is drawing out the resolution of many workers’ compensation disputes. What’s more, access to qualified medical evaluators is greatly impacted by location and the requested speciality. Most workers’ compensation claims involved musculoskeletal injuries in 2012 and 2017, so orthopedists provided a majority of services. However, they only represented one in six qualified medical evaluators in both years. In contrast, one in five qualified medical evaluators were chiropractors, yet they only accounted for about five percent of services in 2012 and six percent of services in 2017.

So, not only has the quantity of qualified medical evaluators dropped, but there is also a disproportionate number of providers in the specialties with the highest demand.

Can’t I see an unqualified medical evaluator?

If you do not have an attorney, no. While not everyone is required to see a qualified medical evaluator to receive workers’ compensation benefits, those who are must select one from a pre-approved list. The DWC will send you a panel of three qualified medical evaluators in your area based on the speciality you select and your location. You have 10 days to select a QME, make an appointment, and notify your employer. If you don’t meet this deadline, the DWC will choose a QME for you. If you do have an attorney, you have more freedom in what physician you see. With fewer qualified medical evaluators available, working with a workers’ comp attorney can speed up the process so you can get the care you need as quickly as possible.

Contact The Law Office of Gerald D. Brody & Associates of San Diego

One of the benefits of working with a workers’ compensation attorney is that you do not have to wait to see a top-rated qualified medical evaluator. Rather, your attorney and the claims administrator may agree on a doctor called an agreed medical evaluator (AME) who does not have to be certified by the Division of Workers’ Compensation. At the Law Office of Gerald Brody & Associates, we’re extremely familiar with the physicians in San Diego and can help you get an appointment with one of the best. What’s more, we’ll stand by your side throughout the entire claims process so you’re never left in the dark when it comes to your benefits.

Give us a call today to schedule your free consultation at (619) 528-9800.