Workers' Compensation Law Center receives many questions regarding Qualified Medical Evaluators (QME) than any other topic. Often there is a lot of confusion as to "when do I get a QME," "why I need a QME," and "do I have to go to the QME appointment."
First the basics of a QME. A QME is an independent doctor who is to evaluate you for your work comp claim. In California Workers' Compensation, a QME makes a determination on causation, nature and extent of injury, temporary disability, permanent impairment, current injury status and future care you will need. These QME appointments are key, and selecting the correct doctor is critical to your claim. Choose the right one and your claim will have success. Choose the wrong one and you could see your claim vanish in smoke.
A QME becomes necessary when your claim has been denied, your PTP has declared you permanent and stationary, or medical treatment is not being provided.
Unrepresented workers are often sent a panel to fill out and request a doctor. The first thing to do is to select a specialty. Why it may seem obvious, this area is quite confusing and can lead to difficulty later. For a spine injury, you may think to select “Spine,” however a better choice would be either “Chiropractic” if non-surgical or “Pain Medicine” for surgical. Generally, these to specialties right a better report than an orthopedist. For carpal tunnel, it may seem like an orthopedic surgeon (not Spine or Hand) would be the proper choice, however you would again be better served with choosing a Pain Medicine doctor. In fact, when in doubt, I recommend choosing a “Pain Medicine” doctor because they provide the most thorough reports available. Should you be having trouble filling out the request for a panel, please feel free to contact a Workers’ Comp Attorney for additional help.
There are many different reasons a party can object to a panel. Contact an Attorney for guidance in whether you should object to the panel.
Now you have chosen a specialty, be sure to fill out the proof of service, if improperly filled out; the DWC will kick back your panel.
Once you receive a panel, there will be three doctors on the panel. Knowing who to choose is an art form. There is no good answer. Work Comp Law Center could easily provide a list of doctors to choose, however if more than one were on the panel, it becomes a matter of which doctor is right for you. Contact your nearest Work Comp Law Center for additional details of selecting a QME.
Now you have your QME appointment, yes, you really need to attend. Twenty (20) days prior to the appointment, the insurance carrier and there defense attorney will forward all the medical records to the QME along with a letter outlining the issues as the insurance carrier sees it. Work Comp Law Center also provides a letter to the QME outlining your position in the claim.
Attendance at your appointment is critical. See our video tips of what to discuss with the QME during your appointment. Your QME has 30 days from the date of your appointment to serve you with a copy of the report. If you don’t receive it within 30 days, you can object and request a new QME.
For additional details on Qualified Medical Evaluators and their evaluations, please contact one of our offices so we can better serve you and answer questions specific to your claim. We offer a free consult to discuss your claim.