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

Updated: Mar 28


Updated: 03-28-2024 A work injury can disrupt your life in many ways, and navigating the workers' compensation process can feel overwhelming.  One important step you may encounter is a Qualified Medical Examiner (QME) evaluation. This evaluation plays a significant role in determining the benefits you receive. Here's a breakdown of what a QME is, how to prepare, and why it's important.

What is a Qualified Medical Examiner (QME)?

A QME is a doctor certified by the state's Division of Workers' Compensation (DWC).  These doctors specialize in evaluating work-related injuries and providing impartial opinions on their severity and long-term effects.

How Do You Request a QME?

If there's a disagreement regarding your workers' compensation benefits, such as the extent of your injury or the need for ongoing medical care, you or your employer's insurance carrier can request a QME evaluation. You can request a QME by filling out this form from the DWC website. The DWC will then send you a list of three randomly chosen QMEs in your area with expertise relevant to your injury type.

What is the Purpose of a QME Evaluation?

The QME  conducts a comprehensive medical examination, reviewing your medical history and discussing your injury in detail. Based on this evaluation, the QME issues a report that addresses several key questions:

  • Does your injury stem from the work incident?

  • Do you have any permanent limitations or disabilities as a result of the injury?

  • What future medical treatment might be necessary?

This report significantly impacts your workers' compensation benefits,  including the duration and amount of disability payments you receive and any necessary vocational rehabilitation.  This could be the difference between thousands or even millions of dollars.

Being prepared for your QME evaluation can significantly strengthen your case:

  • Research and Select a QME: While the DWC randomly selects three potential doctors, you have the right to choose one from that list within 10 days. Research their experience in treating your specific injury type to maximize the effectiveness of the evaluation.

  • Gather Documentation: Compile all relevant medical records related to your injury, including doctor's reports, radiology results, and a detailed log of your pain levels, symptoms, and medications.

  • Prepare a Timeline: Create a clear timeline outlining the incident, including the date, time, location, and how it occurred.

  • Be Clear and Concise: During the evaluation, clearly articulate your limitations and how the injury affects your daily life.

The QME's report heavily influences your workers' compensation benefits. By coming prepared with thorough documentation, a clear timeline, and a strong understanding of your limitations, you can ensure the QME has a complete picture of your situation. This comprehensive picture allows the QME to make a more accurate assessment of your injury and its impact, potentially leading to a more favorable outcome in your claim. What happens if you receive an unfavorable report? In that case, your best option is to hire a workers’ compensation attorney to represent you.

While the QMEs are all state-certified, some may have more experience with specific types of injuries. Researching and strategically selecting a QME from the DWC Medical Unit’s panel with relevant expertise can potentially benefit your case.

The QME will want a comprehensive picture of your situation. Here's what they typically need to know:

  • When, where, and how your injury occurred

  • Whether company equipment was involved

  • Details of your injury, including affected body parts and pain levels

  • Medications you've taken since the injury

  • Current symptoms you're experiencing

  • How the injury impacts your work and daily activities

By being prepared and providing the QME with all the necessary information, you can ensure a more accurate and favorable evaluation, ultimately aiding you in receiving the workers' compensation benefits you deserve.

Coming fully prepared to your QME evaluation is crucial for several reasons. First, it demonstrates your commitment to your recovery process. The QME will see your organized documentation and clear recollection of details as evidence that you're taking your injury seriously. Additionally, thorough preparation ensures the QME has a complete picture of your situation. This allows them to make a more accurate assessment, potentially leading to a more favorable outcome for your claim.




It’s beneficial to use a lawyer if the QME report is unfavorable.

Understanding the System and Challenging the Report:

  • Expertise in Workers' Compensation: Workers' compensation laws are complex and nuanced. A lawyer specializing in this area understands the QME process inside and out. They can identify potential flaws in the QME report, such as inconsistencies with your medical history or a lack of consideration for certain aspects of your injury.

  • Experience Challenging Reports: Lawyers have experience contesting unfavorable QME reports. They know the legal strategies for filing an appeal and can navigate the appeals process on your behalf.

Advocacy and Representation:

  • Leveling the Playing Field: Insurance companies often have their own legal teams representing their interests. A lawyer can ensure you have competent legal representation throughout the process, giving you a stronger voice in negotiations and hearings related to your claim.

  • Gathering Evidence and Building Your Case: Lawyers can gather additional medical evidence to support your claim, potentially including reports from specialists or independent medical examiners. They can also help you document the impact of your injury on your daily life, strengthening your case for fair compensation.

  • Negotiation Skills: Lawyers are skilled negotiators and can advocate for the maximum compensation you deserve based on the severity of your injury.

Emotional and Practical Support:

  • Mitigating Stress: The workers' compensation process can be stressful and time-consuming. A lawyer can handle the legal complexities, allowing you to focus on your recovery.

  • Peace of Mind: Knowing you have a legal expert by your side can provide peace of mind and ensure your rights are protected throughout the process.

A lawyer can help you with the next step if you’ve received a less than favorable report from a QME. 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 1-877-299-1555 or info@barsoumlaw.com to schedule a consultation with a member of our team.  Also, visit workercompla.com for more information.


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