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What to do if you get a less than favorable report from a State Panel QME?

QME stands for Qualified Medical Examiner—a.k.a. a certified doctor from the Division of Workers’ Compensation (DWC) Medical Unit. When there’s a dispute over what benefits an employee is entitled to after injury, a QME evaluation occurs. You can request a QME by filling out this form from the DWC website. Once a QME evaluation is requested, the DWC will randomly generate a panel of possible QMEs to determine the extent of the work-related injury.

The purpose is to decide whether you have any permanent or long-term disabilities as a result of your injury, and what future medications you may need. A QME does this by examining you and your medical history. And their report ultimately decides what compensation an employee should receive. This could be the difference between thousands or even millions of dollars.

But what happens if you receive a less than favorable report? Essentially you have two main options: either ensure you never receive a bad report in the first place. Or hire a workers’ compensation attorney to represent your case.

Plan in advance

In theory, the QME evaluation is neutral, but in practice, they can be either biased towards your employer or may simply not have your best interests in mind. That’s why one of the most important yet most overlooked steps during the entire process is to research and select your QME from the DWC Medical Unit’s panel.

They will generate a panel of three approved examiners. And you then have 10 days to select one of the doctors on their list and inform the insurance company of your selection. After that deadline, the insurance company has the right to choose one of the QMEs and make an appointment for you. And you run the risk of being examined by a physician belonging to the insurance company’s own medical provider network.

Another way of ensuring a favorable QME report is by showing up to your examination prepared. This means bringing ALL your medical records and documents, and having everything written down ahead of time.

Your QME will need to know:

  • How the injury happened (where exactly were you and what exactly were you doing)

  • Whether company equipment was involved

  • Previous or existing injuries

  • Details of the injury (affected body parts, size and coloring of the wound)

  • What is the level of pain currently and when the injury occurred (on a scale of 1 to 10)

  • What pain medications have you been taking since the injury

  • Current symptoms (bruising, sickness, soreness, pain)

  • What activities has your injury affected (both during and outside of work)

Either write everything with pen and paper, type it on a computer, or ask a friend to dictate. Coming prepared with all these details formally written shows the QME that you are serious about recovering from your injury and not simply trying to scam your employer. Plus, reading from a piece of paper is much easier than trying to remember all your work-related injury details on the day of the exam.

Note: It’s important your doctor receives ALL of your medical records because otherwise, even if you get a favorable report, your employer’s defense could argue that the examination was not complete.

Lastly, don’t be afraid to bring a friend or family member with you for support, especially if that person saw you get injured or have seen you deal with the injury. They add another layer of credibility to your case and can act as witnesses during your QME evaluation.

Lawyer up and appeal

Filing for and undergoing a QME evaluation is an overly complicated process. Realistically, there’s not much an individual can do after receiving an unfavorable settlement amount without being a legal expert.

If after all your careful planning and research the state panel QME still gives an unsatisfactory report, it’s best to hire an attorney and appeal. A workers’ compensation attorney will be very familiar and knowledgeable about the entire QME process. They can even help determine which doctors are more favorable to you.

Insurance companies get their own lawyers, so why shouldn’t you? If you’re unsure of where to start looking, we’ve compiled a list of the top 5 workers’ comp attorneys in L.A.

Choose Barsoum

Legal background or no, 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 the past 25 years. Contact us today at 877-299-1555 or to schedule a consultation with a member of our team.

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