In California, if you are injured at work and your employer has workers’ compensation insurance, you will generally be treated by a doctor chosen by your employer or a “QME” (Qualified Medical Evaluator). You may be wondering why it matters which doctor you see – can’t any doctor give you a note to get better? It turns out that the type of doctor you see impacts your case, and in this article, we will explain what a QME is and how they fit into the workers’ compensation system.
What Does QME Stand For?
A QME is a Qualified Medical Evaluator. They are doctors who the State has approved California to perform workers’ compensation evaluations.
QMEs are essential because they help injured workers get the necessary medical treatment. They also ensure that employers and insurance companies provide appropriate levels of care and benefits.
How Does a QME Work?
A Qualified Medical Evaluator (QME) is a physician appointed by the State of California to evaluate an injured worker to determine the extent of the worker’s disability. The QME process is used when there is a dispute between the injured worker and the employer/insurer over the extent of the disability.
The QME will review the injured worker’s medical records and may perform additional testing, such as a physical examination to determine the degree of disability. The QME will then issue a report detailing the findings and treatment recommendations.
Suppose you are an injured worker in California and are involved in a dispute with your employer/insurer over your disability. In that case, you may be required to undergo a workers’ comp QME evaluation. It is essential to understand how the QME process works and what your rights are during this process.
What is the Difference Between an AME and a QME?
If you’ve been injured at work, you’ve probably heard the terms “AME” and “QME” thrown around. But what exactly is the difference between these two types of doctors?
An AME, or authorized treating physician, is a doctor that your employer has chosen for you to see for your workers’ compensation injuries. An AME is typically someone who is familiar with workers’ compensation law and how work-related injuries are treated.
A QME, or qualified medical evaluator, is a doctor the State of California has designated to perform evaluations in cases with a disputed workers’ compensation claim. A QME workers’ comp will usually be an impartial doctor who will examine the injured worker and the employer’s insurance company to determine whether or not the claim is valid.
It’s important to note that you cannot choose your QME – either your employer or your workers’ compensation insurance carrier must do this. Once a QME workers’ comp has been selected, they will perform a comprehensive evaluation and issue a report that will be used to determine whether or not you are eligible for workers’ compensation benefits.
Who Decides if I Need a QME?
The answer to this question is a bit complicated. If you are an injured worker in California, you have the right to choose your treating physician. However, suppose you and your employer/insurer cannot agree on a particular physician. In that case, either party can request that the Workers’ Compensation Appeals Board (WCAB) appoint a Qualified Medical Evaluator (QME).
A QME is a physician who has been specifically trained and certified by the WCAB to perform medical evaluations in workers’ compensation cases. Once appointed, the QME will comprehensively examine the injured worker and prepare a written report detailing their findings. The WCAB will use this report to determine whether or not the injured worker is eligible for workers’ compensation benefits.
It is important to note that QMEs are neutral parties and are not affiliated with either the injured worker or the employer/insurer. As such, they can provide an unbiased opinion on the injured worker’s condition and whether or not they are eligible for benefits.
What if I Disagree With the QME’s Opinion?
If you disagree with the QME workers’ comp opinion, you have a few options. You can:
1. Request Reconsideration from the DWC medical director
2. Request an Appointment with a Qualified Medical Evaluator (AQME)
3. Request a panel of three QMEs
4. File a Petition for Independent Review with the DWC
5. Go to court
If you choose to go to court, the court will decide whether to accept the QME’s opinion. If the court agrees with the QME’s opinion, it becomes binding on you and your employer/insurer. If the court decides not to take the QME’s opinion, then you and your employer/insurer can each choose your doctor to give an idea on your case.
Conclusion In conclusion, a QME is a Qualified Medical Evaluator. They are essential because they are usually the final say in whether an injured worker receives benefits or not. QME reports can be critical in deciding the outcome of a claim, so it is essential to choose a QME carefully. If you need help finding a QME, browse our San Gabriel Valley Workers’ Compensation website for more information. Or you can give us a call at 626-602-9483.