Results of Medical Evaluations Are Very Important to your Workers’ Compensation Case

A worker who has a work-related injury or illness and who has applied for Workers’ Compensation (WC) will be treated by his or her own doctor. That physician treats the worker and makes evaluations as to when to return to work and what the extent of any permanent disability is.

However, if the employer’s insurance company disputes any medically-related information about your WC case or if there are questions about what benefits you will receive, you will be asked to go through a medical evaluation with another doctor. There are 2 options for this review:

• If you are represented by an attorney for your WC case, you (along with your attorney and the WC claims administrator) may agree on a physician to use to evaluate your injury. This process, called an agreed medical evaluation (AME), would choose a doctor who hopefully is trustworthy, competent, and unbiased so that your injury or illness will be fairly evaluated; OR
• If you do not agree and choose an AME, then you must choose a doctor from a panel of 3 physicians selected by the California Division of Workers’ Compensation. The physician that you select becomes the panel qualified medical evaluator (QME).

Upon receiving your request form for a QME, the Division of Workers’ Compensation will issue 3 randomly-selected doctors to your case. You will have 10 days from the issue date to select a QME from this panel. If you do not make your selection by the deadline, your WC claims administrator may appoint the QME for you.

What Happens During the AME or QME Examination?

Your medical records and any other relevant documents will be sent to the evaluating doctor. This physician may review this material either before or after the exam. The insurance company will communicate with the doctor to explain your injury, describe your treatment and ask specific medical questions.

Review your notes about your accident and all relevant medical treatments before your appointment. It’s important to be truthful during the examination and answer questions fully – but do not exaggerate any aspect of your medical condition. Inform the doctor of your current pain levels and activity limitations as well as any prior accidents or injuries that you have experienced.

After the evaluation, the examining physician will send copies of their report to you, your attorney, and the claims administrator, as well as the Division of Workers’ Compensation which should issue your injury rating within 20 days. This rating may affect the WC settlement that you receive.

Let Us Help with Your Workers’ Compensation Medical Evaluation

If you or a loved one has been denied Worker’s Compensation or Social Security Disability (SSD) benefits, contact an attorney experienced in these types of cases immediately. Call The Kenton Koszdin Law Office in Van Nuys, CA at 800.438.7734 for your initial free consultation with Social Security attorney Kenton Koszdin. He can help you navigate the application process for the best possible outcome for you and your family.