Medical Evaluation (AME & QME)
If you have been injured on the job and have filed a workers’ compensation claim, you may be required to submit to an examination by a physician to determine the extent and cause of your injury. The results of the examination along with the physician’s opinion are very important to the outcome of your case. Neither you nor the insurance company may select the medical evaluator, but instead must either agree on a doctor or have the Division of Workers’ Compensation (DWC) Medical Unit assist with the selection.
The experienced Los Angeles attorneys at the Kenton Koszdin Law Office have represented countless clients in their workers’ compensation claim cases. If your claim is being disputed by the insurance company, please get in touch with us as soon as possible. We will work hard to ensure that you receive the compensation you deserve. If you have any specific inquiries regarding your claim case, please call us today at (800) 438-7734. Our firm offers free in-home consultations.
What is the Difference Between an AME and a QME?
You, your attorney, and the claims administrator may discuss what physician to use to evaluate your injury for the purpose of resolving any disputes surrounding it. Ideally, you would find a trustworthy, unbiased, and competent physician together and establish him or her as the agreed medical evaluation (AME). However, such agreements do not always pan out. Your other option is to turn to the DWC Medical Unit and have them provide you with a choice of three doctors. The selected doctor becomes the panel qualified medical evaluator (QME).
The QME Selection Process in Los Angeles
If you request to go with a QME instead of an AME, you should receive a panel request form from the claims administrator. You must fill out and submit the form within 10 days, or the claims administrator will do it in your place. If the latter occurs, you will lose the opportunity to select the specialty of the QME that’ll be presented to you. Once a request form is submitted, the DWC Medical Unit will issue three randomly selected QME physicians to your case. You will have 10 days from the issue date to select one QME from the panel. If this deadline is not met, your claims administrator may exercise his or her right to appoint the QME in your stead.
Generally, workers’ comp claim cases involve only one QME evaluation. Since panels are randomly generated, they may not be rejected by the claimant, even if he or she feels the selected physicians will not provide a fair report. You may get your QMEs replaced by the DWC Medical Unit if they are not able to see you within 60 days of the panel’s issuance date. Only the Workers’ Compensation Appeals Board has the authority to enforce deviations from these otherwise stringent regulations.
What Happens Once the QME Report is Completed?
The QME should send copies of the report to you, your attorney, the claims administrator, and the Division of Workers’ Compensation Disability Evaluation Unit (DEU). The DEU should issue a rating of your injury within 20 days. This rating may affect the settlement you receive through workers’ comp.
For complete information on AMEs and QMEs, visit the California Department of Industrial Relations website.
Ensuring Present and Future Security
After suffering a work accident injury, you may face exorbitant medical expenses, lose the ability to work for a significant period, and encounter much distress trying to deal with the financial fallout. You do not have to face your problems alone. Let the compassionate legal team at the Kenton Koszdin Law Office tackle your legal and financial matters so you can focus on recovery. Contact us today.