Qualified Medical Examiner (QME) Frequently Asked Questions
In a workers’ compensation case, it’s uncommon for all parties to agree throughout every step of the process. An employer may dispute your claim and argue that your injury wasn’t caused by your job. Or, perhaps your employer is trying to prove that you were intoxicated at the time of your injury to prevent you from collecting benefits. When the claims adjuster disagrees with your treating physician’s findings and proposed treatment plan, he or she will request a qualified medical examiner (QME) to provide an unbiased second opinion.
At the Law Office of Gerald Brody & Associates, we receive a lot of questions about the QME process and how to select a physician. If you have been injured at work and are planning to file a workers’ compensation claim, you’ll find many of the answers you’re looking for here.
What is a QME?
A QME, or qualified medical examiner, is a physician who evaluates injured workers when there are questions about their treatment plans or benefits. A QME must pass a test and receive ongoing education on the workers’ compensation system to provide an unbiased medical opinion.
What is the difference between a QME and an AME?
If you have a lawyer, your attorney and the claims administrator may agree on a doctor to provide a second opinion. This is called an AME, or agreed medical evaluator. If you are unrepresented or if your lawyer and the claims administrator cannot agree on a physician, you will choose a QME from a randomly generated list of doctors issued by the DWC Medical Unit. This list is called a QME panel and it contains three doctors of a specialty related to your injury.
I don’t like my options. Can I get a new QME panel?
Unfortunately, no. According to California workers’ compensation law, a QME panel must be generated randomly based on your home ZIP code. However, if one or more of your assigned QMEs is unable to see you within 60 days, the DWC Medical Unit will issue a new panel.
What should I bring to my appointment?
Your QME will have received a copy of your medical records and other documents related to your injury. Arrive prepared to tell your side of the story; tell the truth and do not exaggerate your symptoms. It might be a good idea to write down each body part affected by your injury, along with what activities make the pain worse and how your injury affects daily living.
I just had my QME evaluation. What happens next?
The QME has 30 days from your examination to issue a medical report. If you have an attorney, the QME will send a copy of the report to your lawyer and the claims administrator. From here, a disability rater from the DWC Disability Evaluation Unit will issue you a disability rating within 20 days, after which you and your attorney can begin discussing settlement of your case.
You don’t have to go through the QME process alone.
There are many factors that can influence the outcome of your workers’ compensation case, including the qualified medical examiner you select. The physician you choose will make important medical decisions about your future, including treatment plans and to what extent you are disabled. While it might be convenient to choose the doctor closest to you or a physician with a flexible schedule, it’s more important to see a QME who is regularly used in the workers’ compensation system.
At the Law Office of Gerald Brody & Associates, our attorneys are well versed in the QME process and can help you select a physician who will write a meaningful report for the workers’ comp judge. Your initial consultation with us is free, and there’s zero obligation for representation. Call us today to schedule your appointment at (619) 528-9800.