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What Happens If There Is a Disagreement Over Benefits?

By Kenton Koszdin Law Office on January 22, 2013 | In Workers Compensation

During a workers’ compensation claim, you may find that you disagree with the claims administrator handling your case when it comes to what the doctor who treats you has to say about your injury or what you need to recover. What should you do when a disagreement occurs?

When you and the claims administrator disagree about whether your condition is covered by workers’ compensation and in what way, you may settle the issue with an examination by a qualified medical evaluator (QME). A QME is a physician with extra training in work-related injuries and workers’ compensation requirements.

If you are being represented by an experienced Los Angeles workers’ compensation attorney, your attorney and the claims administrator may choose a QME whom they both agree should review your case. When a QME is chosen by agreement, he or she is known as an “agreed medical evaluator,” or AME.

The Division of Workers’ Compensation allows you to request a QME or AME in one of two ways. You may request one yourself by filling out the Request for Qualified Medical Evaluator form and submitting it to the Division of Workers’ Compensation. Or your attorney may make the request for you.

If you do not request a QME and your attorney does not request one either, the claims administrator may make the request. Since the requesting party chooses the specialty of the QME or AME you’ll see, it’s often wise for you or your attorney to be the one who makes the request.

At the Kenton Koszdin Law Office, our dedicated southern California workers’ compensation attorneys strive to help each person we represent settle any disagreements promptly, so they receive the full amount of benefits to which they are entitled. For a free and confidential consultation, contact us today at (800) 438-7734 or fill out our online contact form.

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