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A Qualified Medical Evaluator (QME) is a doctor who sees you after you’ve filed a workers’ comp claim. They provide a comprehensive medical and legal evaluation to determine various factors in your workers’ compensation case.
Selecting the right Qualified Medical Evaluator (QME) is a critical decision that can significantly impact the outcome of your workers’ compensation case. The QME plays a vital role in ensuring your injury is evaluated accurately, which directly influences the benefits and treatment you may receive.
Choosing the appropriate QME involves selecting a medical provider who specializes in the correct field for your specific injury. This choice might not always align with what you initially believe is necessary.
For instance, while an orthopedic surgeon might seem like the right choice if you have a back injury, a provider in another specialty—such as physical medicine, rehabilitation, pain management, or even chiropractic care—might be better equipped to give you an accurate evaluation.
Furthermore, general orthopedic specialists often handle a high volume of cases, which can sometimes lead to more generic evaluations. A QME who is not deeply familiar with the nuances of your specific type of injury may provide a cookie-cutter assessment that doesn’t fully capture the complexities of your condition. This can lead to an outcome that doesn’t reflect the true extent of your injury or the treatment you require.
Consulting with an experienced workers’ compensation attorney at this stage is essential. An attorney can help you choose a QME who is best suited to understand and evaluate your injury in detail, ensuring that the evaluation is tailored to your specific needs.
When you file a workers’ compensation claim in California, you will submit a claim form. The insurance company or claims adjuster must then decide whether to accept liability, delay the decision, or deny liability.
If the decision is delayed or denied, you have the right to fill out the QME form, even if the insurance adjuster hasn’t provided it. This form should be mailed to the Department of Workers’ Compensation’s Medical Unit in Oakland, CA.
If liability is admitted, a QME may not be immediately necessary. However, disputes often arise later over issues such as the length of time you should be off work, the payment of temporary disability benefits, or the evaluation of additional injuries not initially included in the claim. In these situations, a QME might become necessary later in the process.
Attorney Benjamin Helfman is a seasoned workers’ compensation attorney serving California. For over 30 years, he’s helped clients just like you navigate the QME selection process, getting qualified, helpful opinions on their case and the workers’ comp benefits they deserve.
Have questions about the QME selection process? Need guidance in choosing the right specialist? Get in touch with Leep Tescher Helfman and Zanze at (530) 287-6674 for a free initial consultation today!
After you receive a letter requesting a QME, you have only 10 days to fill out and submit the form to the Department of Workers’ Compensation’s Medical Unit.
This 10-day period starts from the date the letter is written, not when it is received in your mailbox. If you do not respond within this timeframe, the insurance carrier gains the right to choose the QME specialty, which might not be in your best interest.
Upon receiving a panel of three doctors, you have another 10-day deadline to select and schedule an appointment with one of them.
If you fail to act within this timeframe, the insurance adjuster gains the right to select the doctor. Consulting with an attorney at this stage is crucial, as they can provide guidance on which doctor might be more favorable to your case.
If you haven’t consulted an attorney by the time you receive the QME medical report, it’s still advisable to do so. An attorney can review the report and determine whether you need further legal representation or if you are likely to obtain a fair outcome on your own. Keep in mind that if you wait too long, it may be too late to obtain a second evaluation, which could impact your case.
If you’ve already been to a QME, you can file a request with the Department of Workers’ Compensations Medical Unit to replace that QME, though the basis for doing so is generally related to the original doctor retiring, passing away, or no longer being a Qualified Medical Evaluator.
It is usually quite difficult to change a QME after you’ve been to see one, which is why having an attorney help you at the initial stages of a QME application is so important. Without the right guidance and legal representation, you’re likely to be stuck with an insurance carrier’s choice and have little leverage.
Take all the documentation that you obtained from your initial, non-QME doctor’s visit. This includes medical records and imaging obtained from this visit. These are the only documents the QME is allowed to review, so be sure to bring those forms.
The workers’ comp carrier will also send you a copy of the documents, evidence, or video they plan to share with the QME, allowing you to object to any of that evidence and provide further medical records, or an MRI or X-ray.
Your attorney can be of help at this juncture, as well, helping protect your rights and interests as an injured worker, and pushing back fairly against any evidence the carrier may argue negates your claims to be injured.
It’s important to select the right QME for your injury type, not simply the QME who lives closest to your home. The best doctor may be at quite a distance, but seeing them for excellent care is better than seeing a less specialized physician in your own town.
Allowing an attorney to help you select a Qualified Medical Evaluator is always a better choice than simply going by reviews on Yelp. A doctor with poor bedside manner who gets negative, emotionally-driven reviews online may, in fact, be the most sophisticated and qualified specialist for your injury type.
To this end, an attorney can weigh in to determine whether a judge is likely to follow a certain QME opinion, assist in choosing the best doctor for your case, and help you obtain the workers’ compensation benefits you deserve.
For more information on Tips For Navigating The QME Selection Process In California, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (530) 287-6674 today.
Attorney Benjamin Helfman is a seasoned workers’ compensation attorney serving California. For over 30 years, he’s helped clients just like you navigate the QME selection process, getting qualified, helpful opinions on their case and the workers’ comp benefits they deserve.
Have questions about the QME selection process? Need guidance in choosing the right specialist? Get in touch with Leep Tescher Helfman and Zanze at (530) 287-6674 for a free initial consultation today!
