Medical bills and missing work are ingredients for disaster, so you want all the help you can get from workers’ compensation. The insurance company might not want to hear what you and your doctor have to say, but a third party could step in and set things straight.

Workers’ compensation provided over $608 million to California workers last year. That money goes out to thousands of workers who need help covering costs after a workplace accident. But getting the money you need isn’t guaranteed when you apply, and the insurance company may need some convincing. This is where a qualified medical examiner (QME) may come into play, in the right situations.

Second opinions

There are a few scenarios which could put you before a QME:

  • Denied: A QME visit is on the table when the insurance company delays or denies your claim. The doctor will act as an informed and impartial party, chosen to resolve the dispute by rendering another medical opinion on the injury.
  • Developed: If you believe a doctor could bump your prognosis up a notch, it might be up to a QME. If the QME is a specialist, they could be in a better position to tell if your particular injury will lead to disability and what kind of future treatment you may need.
  • Disagreed: You may need to see a QME if you or the insurance company disagree with the initial assessment made by your doctor. The extent of your injuries or the process of rehabilitation could have you seeking a second opinion to verify the original diagnosis.

The benefits you get from workers’ compensation may be a drop in the bucket to the insurance company, but it can mean the world to you. Make sure you get what you deserve by knowing when you can ask a QME to step in and add some clarity to your claim.