At the San Mateo, California law firm DuRard, McKenna & Borg, we are dedicated to helping injured workers throughout the San Francisco Bay Area navigate the confusing workers’ compensation process. Below, please find answers to some of the questions we receive most commonly about the Qualified Medical Evaluator (QME). If you have further questions or would like to discuss your case with an attorney, contact us for a free initial consultation.
Q: What is a QME panel?</strong
A: If your treating doctor has said you are permanent and stationary, or if you or the insurance adjuster has objected to the findings of the treating doctor, you will be offered a QME panel. You can use this process to obtain an independent medical-legal report if there is an objection to the treating doctor’s findings.
If you do not have an attorney and it is necessary to have an independent medical-legal evaluation, the insurance adjuster will notify the state that you need a QME panel. The state will generate a list of three doctors in your area who practice in the field that you need. When you receive the QME list, you will need to choose a doctor and make an appointment.
The QME process was designed to prevent the insurance company from sending you to a doctor with whom it has a special relationship. To the extent that the QME process is done at random, there may be less favoritism for insurance carriers. The problem with the QME panels is that the results are very variable. Some doctors are knowledgeable about workers’ compensation law and some are not. Some doctors are very employer-oriented and others are injured worker-oriented. We can help you navigate this system to ensure you can get the fairest QME report possible
The medical-legal process has been increasingly limited in recent years. Often, injured workers are entitled to only one medical-legal report at the insurance carrier’s expense. If you choose the wrong doctor, or if you obtain a medical-legal report prematurely, your options will be limited. We can advise you as to your options while they are still available. In many cases, we are familiar with the doctors in your area and the types of reports they typically write. As a result, we may be able to help you choose the best QME panel or give you the freedom to choose an Agreed Medical Examiner rather than be limited to the QME panel.
Q: What if I do not like the report the QME doctor writes?</strong
A: If your injury occurred before January 1, 1994 or after January 1, 2003, we can help you obtain another medical-legal evaluation at the insurance carrier’s expense. This gives us flexibility in attempting to correct any problems that you have with the QME report. In many cases, disputing a QME results in litigation, so it is important to consult with an experienced workers’ compensation attorney before proceeding.
Q: What happens after I get the QME report?</strong
A: The QME doctor writes the report and will send it to the insurance company and to the Disability Evaluation Unit (DEU). The DEU will rate your report by reviewing the language used by your doctor in describing your injury and applying a formula to determine the percentage of disability. This disability will then be adjusted for your age and occupation at the time of injury. The question of which rating schedule applies to your case is complex. When you consult with us, we can evaluate your particular circumstances.
Q: What happens once I get a permanent disability rating?</strong
A: Once the rater determines the rating from the doctor’s evaluation report, it is possible to determine the value of your permanent disability. While it is possible to argue about the various components that go into a rating, the value of your permanent disability award will be determined from a chart which states the amount of money payable and the number of weeks over which the money will be paid. In most cases, there is no negotiation over this amount, but sometimes it is possible to argue that a different rating would be more accurate in your case.