(707) 542-5132 [email protected]

Qualified Medical Evaluators

In disputed workers’ compensation cases in California, Agreed Medical Evaluators (AMEs) and Qualified Medical Evaluators (QMEs) are often used to help resolve disputes. If you have recently suffered a work-related injury in California, you should be familiar with these terms so that you understand the process used in the event you face a medical dispute in your work injury case.

The California workers’ compensation law firm Kneisler and Schondel can help you to understand the roles of AMEs and QMEs in connection with your workers’ compensation case. They will fight for the best path forward in the event your case involves a medical treatment dispute or any other disputes that may impact your case. Contact us today to set up a consultation to meet with us to discuss your potential workers’ compensation case.

What is A Qualified Medical Evaluator?

A Qualified Medical Evaluator is the term for a physician who conducts an evaluation of an injured worker when there is a dispute regarding workers’ compensation benefits an injured worker may be eligible to receive. In order to qualify as a QME, a physician must meet specific licensing and educational requirements. A potential QME physician is also required to pass a test and participate in ongoing education relating to the evaluation process for workers’ compensation claims.

A QME for a workers’ compensation case is chosen from a list of state-certified doctors that is issued by the Department of Workers’ Compensation Medical Unit. The lists of QMEs are generated randomly by computer and based on an injured workers’ zip code.

A Panel QME list is a list that is randomly generated and contains the names of three QME physicians. This Panel list will be issued to an injured worker when there is a medical issue in dispute which cannot be resolved by the parties informally. A Panel list of QMEs will also be issued if there is a medical dispute that has not been resolved by the treating physician’s report. The specialty of the doctors to be on the Panel will be chosen by the party who fills out the form to request the panel QME.

What is An Agreed Medical Evaluator?

An Agreed Medical Evaluator is the term for a physician that your attorney and the insurance company for your employer have agreed to use to conduct the “QME” examination. Typically, the agreement will be reached between your attorney and the insurance claims adjuster, or their attorney. If you do not have an attorney representing you for your workers’ compensation case, you will not be able to choose an AME, you will be required to be seen by a Panel QME.

In many cases, it is difficult for both sides of a workers’ compensation case to easily agree on a medical evaluator for the injured worker. For this reason, having an AME on your case is not the most common scenario. It is also worth noting that once you see an AME, you are not entitled to see a QME as well. Your attorney will be able to explain whether an AME is an option for your case.

How is a QME Assigned if I Have Multiple Work Injuries?

In some cases, an injured worker will have more than one body part or body system injured in a work accident. This may result in the need for more than one specialty of doctors to evaluate the injuries. For example, an injured worker may have a claim for an injury that should be evaluated by an orthopedic specialist, while also having a pending claim for a psychological component to that injury, such as post-traumatic stress disorder (PTSD). Generally, the injured worker is entitled to consult with as many QME’s, as is necessary to properly evaluate each body part or system affected by the injury. 

In cases requiring multiple QMEs, the selected QME may generally obtain or request consultations from other medical specialists, if there is found to be a need for input regarding other medical specialties. There are also circumstances that in which a workers’ compensation administrative law judge requests an additional QME. When this scenario occurs, the Panel will be provided.

If you are in a position where your workers’ compensation claim has any issues in dispute, a California workers’ compensation attorney can help. Contact the office of Kneisler and Schondel today to get started pursuing the benefits you deserve for your work injury.