A Qualified Medical Examiner, also known as a QME, is a physician who examines an employee for their workers’ compensation injury. QMEs help resolve disputes between the employee and their employers’ workers’ compensation insurance when there is an issue regarding the employee’s injury. The QME will typically review medical records, evaluate the injured worker, and issue a medical-legal report.
To request a panel QME, the employee, their attorney, or the insurance administrator has to complete the “Request for QME panel” form and submit it to the Medical Unit of the Division of Workers’ Compensation. It is important to note that whoever proposes the request for a panel QME will pick the specialty of the doctors for the exam. It becomes a race to determine the QME because the Medical Unit will issue one QME thing at the initial request.
Issues can arise when, for example, an employee is injured on the job and suffers trauma to their head and ankle. If the insurance company were to request a panel QME, then they have control over what specialty the employee sees. They could ask a panel QME with specialties in orthopedics even though the employee’s most significant injury was to their head. Thus, they should see a QME specializing in neurology.
After receiving the request, the Division of Workers’ Compensation will randomly assign a panel of 3 QMEs that an employee can choose. The panel will generally be sent within 30 calendar days of receiving the request. The employee has ten days to select one of the QMEs from the panel and has to make an appointment for the evaluation. However, the claims administrator has the right to choose the QME if the injured employee does not select the QME within ten days.
If you, your lawyer, and the claims administrator agree on a doctor, you will see an AME or an Agreed Medical Examiner. If you see an AME, you do not have to see a QME from the required panel.
After the evaluation, the QME or AME will create a report distributed to the employee, attorney, and claims administrator. The employee and the claims administrator have 30 days to decide whether the report is accurate or object to its contents.
Choosing the right QME or AME can be difficult, but our Sacramento Workers’ Compensation Attorneys are here to help. They can assist you when selecting from your panel QME or work with the insurance company so you can see an AME. Please don’t wait until it’s too late; contact one of our Sacramento workers’ compensation lawyers today.