You went to the QME. You sat through the exam and went home. Now you are waiting, and no one really explained what happens next. The QME, short for Qualified Medical Evaluator, is one of the most important steps in a California workers’ comp case. The report that doctor writes can shape your benefits, your settlement, and whether your claim moves forward at all. Here is what happens after that exam.
The report is where your case takes shape
After the exam, the QME doctor writes a formal report. It usually takes a few weeks. That report is more than a note. It answers the questions your case turns on. Is your injury work-related? Have you reached what is called maximum medical improvement, meaning you are as healed as you are going to get? And how much permanent damage are you left with?
The insurance company reads that report closely, and so should you. Much of what happens next flows from what the QME wrote.
Your injury gets turned into a number
California does something that surprises people. It turns your injury into a percentage. Based on the QME report, you are given a permanent disability rating, written as a percent. A higher percent means a more serious permanent injury, and more money.
That number is not random. It comes from the doctor’s findings, run through a state formula that factors in your age and your job. A back injury that ends a warehouse worker’s career can rate very differently from the same injury in a desk job. This rating is often the single biggest factor in what your case is worth.
You do not have to accept the report as final
Here is what a lot of injured workers never hear. The QME report is powerful, but it is not always the last word. If the rating seems too low, or the doctor missed part of your injury, there are ways to challenge it. Your side can ask the doctor written follow-up questions, or in some cases seek a new evaluation. Insurance companies know most workers will not push back, which is exactly why pushing back can matter so much.
What comes after the rating
Once the rating is set, your case moves toward resolution. That usually takes one of two forms. A stipulation keeps your medical care open and pays your permanent disability over time. A compromise and release settles everything for a single lump sum, and usually closes future medical care. Which one fits depends on your injury and your future needs. It is a decision worth real thought, because it is hard to undo.
A workers’ comp judge at the WCAB has to approve any settlement, to make sure it is fair. That is a protection for you, not a formality to rush past.
Do not guess your way through it
The stretch after a QME is where a lot of value is won or lost, and where the insurance company is most active. A low rating accepted without question, or a settlement signed too fast, can cost you care and money you cannot get back.
If you have had your QME, or have one coming, find out what your report really means before you agree to anything. Koszdin, Fields & Sherry has guided injured workers across Los Angeles and the Valley through this process since 1955. Call 818-781-1503 for a free look at where your case stands.
