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On behalf of Koszdin, Fields & Sherry posted in Medical Benefits on Sunday, October 08, 2017.

What is a qualified medical evaluator?

If you are a California worker who was injured at work but there are questions about what medical benefits you are entitled to receive under workers’ compensation, you may need to be seen by a qualified medical evaluator. The California Department of Industrial Relations explains that a QME is a state-approved doctor who evaluates you to determine if your injury was work-related and help resolve any other disputes pertaining to your injury. Should your workers’ compensation claim be denied, the QME’s written report is a medical opinion that can be entered into evidence if you appeal the denial to the Workers’ Compensation Appeals Board.

QMEs must be licensed to practice medicine in California and meet educational requirements, pass a test and receive ongoing training about the workers’ compensation evaluation process. Once certified by the Medical Unit of the Division of Workers’ Compensation, a QME is placed in the Medical Unit’s database and available for appointment to work comp cases where a QME is required.

QMEs versus AMEs

When you go through the state system to get a QME, your claims administrator generates a list of three from all the physicians in the database, which is called the QME panel. By California law, the selection process is completely random and is based on the doctors’ zip codes. You pick one of the three as your QME. Your claims administrator pays for your QME evaluation and also for your transportation costs to see him or her.

If you have an attorney, however, you may not need to go through the state QME selection process. Instead, your attorney and your claims administrator can agree on the doctor who evaluates you. Such a doctor is called an Agreed Medical Evaluator and he or she may or may not be a QME. If you choose to be evaluated by an AME, you are not entitled to see a QME. This information is provided for educational purposes, and should not be interpreted as legal advice.

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