How to Prepare for a QME Evaluation Without a Lawyer
The workers’ compensation process can be long and tedious for an injured worker to undergo, and perhaps the most stressful step is the QME evaluation. When there are disputes between you and your insurance company as to what benefits you are entitled to after a work-related injury a Qualified Medical Examiner (QME) is assigned to settle it. Without a lawyer this process may seem overwhelming, but there are ways to prepare for QME evaluation on your own.
What is a QME Evaluation?
A QME is a medical professional that is assigned by the Division of Workers’ Compensation (DWC). The QME is picked at random by the DWC to evaluate your work-related injuries by completing a medical evaluation, and asking you questions to assess the nature of your injuries. Some of those questions will pertain to topics such as how the injury happened, whether company equipment was involved, previous or preexisting injuries, current symptoms, and current medications. While this may seem like a lot to process, there are many ways to prepare for a QME evaluation, even without a lawyer.
How to Prepare for a QME Evaluation
The first step is to request a QME evaluation from the (DWC). You can request a QME by filling out this form from the DWC website. Once completed, the DWC will send you a randomly generated panel of QMEs. Once you receive this list you will have 10 days to select one and inform the claims administrator of your selection, before a QME is selected for you.
Research the QME panel before making your selection. One of the most important parts of the QME evaluation process, is choosing the right QME. While the panel is randomly generated by the DWC, you are entitled to select the QME from that list. This choice is imperative, particularly because one or more of the QMEs on the panel could be a physician belonging to the insurance company’s own medical provider network. Researching the physicians on the panel is the best way to ensure you receive an impartial medical evaluation.
Gather ALL medical records and documents ahead of the evaluation. During your evaluation, the QME will go over your medical records including the work-related injury in question and any prior or preexisting injuries you may have had. While the selection process is random, the QME may be biased toward your insurance company, particularly if you did not make the selection on your own during the 10-day window.
Make sure ahead of time that the day and location of the evaluation work for you. The DWC is required by law to generate the panel of QMEs based on your residential zip code, but if you and your claims administrator agree to it, you may also have the panel randomly generated by the zip code of your workplace. The claims administrator will also pay for transportation to the evaluation, so let them know ahead of time if that’s something you will require.
Benefits of Legal Counsel During a QME Evaluation Process
If you have a lawyer, you may be able to use an Agreed Medical Evaluation (AME). An AME is very similar to a QME, the only difference is QME is done by a medical professional chosen through the state system, while an AME is done by a medical professional agreed upon by your lawyer and the claims administrator. The main benefit of an AME is that it eliminated the randomness of the QME process, although it is important to note that after you undergo an AME you are no longer entitled to a QME.
A workers’ compensation attorney will be familiar with QME process and answer any questions you have along the way. The QME process, while manageable to navigate on your own, is an overcomplicated process. Luckily, most lawyers have plenty of experience dealing with the QME process and all the parties involved. This experience is sure to be a reassuring presence during this long process.
Along with guiding you through the QME process, a lawyer would also represent you in trials, arbitrations, or other proceedings. Even if you do everything right to prepare, the QME may not rule in your favor. There are options in case that happens, but legal representation would only become more important. If you are able, seeking legal counsel early in the process is the best way to ensure a positive evaluation from the QME.
The QME process, while overcomplicated, is manageable to navigate on your own. Once you file your QME request, the most important thing to do is research the QME panel provided by the DWC. You must inform them of your selection within 10 days of receiving the panel. Also, be sure to prepare by gathering all relevant medical records to bring with you to the evaluation. Finally, make sure the date and location of the evaluation work for you, and utilize transportation provided by the claims administrator if you require it.
Legal background or not, any employee who suffers from a job-related injury or illness is entitled to benefits. And Barsoum Law is committed to help. We offer a personal focus and individualized care that large corporate firms do not. Our multilingual, multicultural team is dedicated to making sure you obtain the compensation you deserve.
If you have suffered a work-related injury or illness, Barsoum Law can and will help. We have represented thousands of injured workers throughout California for the past 25 years. Contact us today at 877-299-1555 or firstname.lastname@example.org to schedule a consultation with a member of our team. Also visit workercompla.com for more information.