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What is a Workers’ Compensation Qualified Medical Evaluation?

Claims for benefits under your California employer’s workers’ compensation insurance plan aren’t always approved immediately. Sometimes, injured workers must attend a second round of examinations beyond those performed by their own treating physician, usually due to some dispute over what type of benefits the worker is entitled to receive and doubts on the part of the insurance administrator about those benefits. This examination is conducted by either an Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME). Read on to learn about the role of an AME or QME in your workers’ compensation case, and contact the experienced Los Angeles workers’ compensation lawyers at Joe, Southard & Yeoh for a free consultation at 424-325-2205.

What is a Qualified Medical Evaluator?

Some workers’ compensation claimants are able to rely exclusively on the report of their treating physician when applying for benefits. If, however, the workers’ compensation claim administrator has questions about what sorts of benefits you’re entitled to receive, or whether your injury arose out of and in the course of your employment, they may request that you receive an examination from an approved third-party physician. If you’re not represented by an attorney, the California Department of Workers Compensation Medical Unit will issue a panel of three qualified medical evaluators from which you can choose your QME. These physicians must meet rigorous qualifications imposed by the state to be included on the official roster of QMEs, including continuing education requirements, licensing requirements, and an examination. The panel of three potential QMEs will be sent to the employee first to allow them to choose the QME. If the employee doesn’t make a selection within ten days, then the insurance claim administrator will be allowed to choose. The insurer is charged for the examination.

What is an Agreed Medical Evaluator?

If you have an attorney for your workers’ compensation case, then your attorney and the claim administrator have the option of together selecting an examiner on whom they both agree (an AME). Workers’ compensation attorneys are very familiar with local physicians who specialize in fields related to common workplace injuries, making them able to select a physician who they believe will provide a fair evaluation for their client. The findings of an AME are binding on both the worker and employer. However, a QME’s findings are treated with the same weight as the findings of the employee’s primary treating physician. Only a claimant who is represented by an attorney can use an AME.

If you’ve been injured on the job in California and need help getting the benefits you deserve for those injuries, contact the experienced and professional Los Angeles workers’ compensation lawyers at Joe, Southard & Yeoh for a free consultation by contacting their offices at 424-325-2205.

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