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Why Did the Workers’ Compensation Adjuster Request a QME?

doctor having difficult meeting with patientIf your workers’ compensation adjuster disagrees with the doctor’s report on your permanent disability, he or she may request that you be examined by a qualified medical examiner (QME). However, you should be aware that the adjuster may try to manipulate this process to deny you the benefits you deserve.

Seeking qualified legal counsel in this situation is a good idea because an attorney can work to ensure your best interests are protected. We know how adjusters may try to rig the process and can protect your rights. Our Bakersfield workers’ compensation attorneys are here to help protect your rights and pursue the benefits you deserve. Schedule a free, no obligation consultation now.

What You Should Know About QMEs?

A QME is often requested by a workers’ compensation adjuster to create a final, expert medical report on your injury or illness.

QMEs are supposed to be unbiased but it does not always feel this way. Many times, workers’ compensation adjusters have information about the QMEs which helps them select one that is more friendly to employers rather than employees.

How are QMEs Chosen?

QMEs are selected from randomly generated lists of state-certified doctors issued by the Division of Workers’ Compensation (DWC). Both parties receive a list with three QME doctors, one of which is meant to serve as the QME.

You must select a QME from the list within 10 days of it being issued. If you do not, the workers’ compensation claims administrator has the right to choose the QME.

If you have legal representation, your attorney and the claims adjuster can work together to agree on a physician who will resolve medical disputes. This doctor is called an agreed medical evaluator (AME). An AME is only an option if you are working with a workers’ compensation attorney.

Replacing a QME

A QME may be replaced due to a variety of procedural violations:

  • A QME is unable to complete the expert medical report in a timely manner.
  • Two QMEs practice within the same office or medical group.
  • Physicians listed on the second QME list are the same as on the first QME list.

If there is a procedural violation, you may request a new list of QMEs. The adjuster can do this as well. In fact, the adjuster may try to find procedural violations to continue requesting a new list until he or she can find a QME that may be more favorable to your employer.

You can learn more about QMEs from this list of frequently asked questions about them.

Complaints About QMEs

If you wish to make a complaint about your QME, you must do so in writing. You may send your complaint to the DWC Medical Unit via the address below or make an anonymous report via the unit hotline at 1-800-999-1041. It is preferred that you give your name and contact information in the event the Medical Unit needs to reach you for questions.

DWC Medical Unit

Attn: Complaint Unit

P.O. Box 420603

San Francisco, CA 94142

You may file a Request for Reconsideration of the Summary Rating within 30 days of the summary date’s issuance if you disagree with the QME’s summary rating due to:

  • The QME’s failure to address all issues
  • The QME’s failure to address all issues completely
  • The QME not following Medical Unit procedures
  • Your rating being incorrectly calculated

Contact Our Attorneys for Trusted Legal Help

If you suffered a work-related injury or illness, our workers’ compensation attorneys can fight to secure the benefits you deserve for your medical bills and lost wages. We will review your case and inform you of your legal rights.

Request a free, no obligation consultation today. There are no upfront fees and payment is only due if we recover compensation for you.

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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