What to do if you get a less than favorable report from a State Panel QME?
Updated: Jan 3
A Qualified Medical Examiner (QME) is a certified doctor from the Division of Workers’ Compensation (DWC) Medical Unit. A QME evaluation occurs when there’s a dispute over what benefits an employee is entitled to after injury. 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 of a QME evaluation 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.
Preparing for your evaluation can help you to receive a positive report from the QME, however, what happens if you receive an unfavorable report? In that case, your best option is to hire a workers’ compensation attorney to represent you.
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. They will generate a panel of three approved examiners, and then you will have 10 days to select one of the doctors on their list and inform the insurance company of your selection.
After that deadline, if you have not made your selection, the insurance company has the right to choose one of the QMEs and make an appointment for you. 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. Leaving this decision in the hands of your insurance company can 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)
It is very important to come prepared to your evaluation. Not only will it show the QME that you are serious about recovering from your injury but will also show you’re not simply trying to scam your employer. Either write everything with pen and paper, type it on a computer, or ask a friend to dictate.
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.
Lawyer up and appeal
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.
A lawyer can also answer any questions you have about the workers comp process as well as represent you in trials, depositions, arbitrations, and other proceedings. Furthermore, legal representation will aid you in the negotiation process at these proceedings.
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.
Insurance companies get their own lawyers, so why shouldn’t you? 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.
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 email@example.com to schedule a consultation with a member of our team.