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 any 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 submits the request for a panel QME will pick the specialty of the doctors for the exam. It becomes a race to pick the QME because the Medical Unit will issue one QME specialty at the initial request.
Issues can arise when, for example, an employee who 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 request a panel QME whose specialties were in orthopedics even though the employee’s most significant injury was to their head and thus should see a QME whose specialty is in neurology.
After receiving the request, the Division of Workers’ Compensation will randomly assign a panel of 3 QME’s that an employee can choose. The panel will generally be sent within 30 calendar days of receiving the request. The employee has 10 days to choose 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 did not choose the QME within the 10 days.
If you, your lawyer, and the claims administrator agree on a doctor then you will see an AME or an Agreed Medical Examiner. If you see an AME then you do not have to see a QME from the panel required.
After the evaluation, the QME or AME will create a report that will be distributed to the employee, their attorney, and the claims administrator. The employee and the claims administrator has 30 days to decide if they believe the report is accurate, or if they 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 choosing from your panel QME or work with the insurance company so you can see an AME. Don’t wait until it’s too late, contact a Sacramento Workers’ Compensation Attorney today.