According to the State of California Department of Industrial Relations, a claims administrator helps workers with advice about their rights and the steps needed to get medical care. A worker may also learn of other benefits they are entitled to under workers’ compensation laws in California.
A QME stands for qualified medical evaluator; this is a physician who does the evaluation and advises what benefits are available. The QME is trained in the workers’ compensation program and has been tested on their knowledge. With legal representation, the worker and their claims administrator might agree on a doctor to resolve any medical disputes.
If a worker is represented by an attorney, an AME or agreed medical evaluator can be used with the agreement of the doctor, attorney and claims administrator. This is instead of the QME.
A panel, or list, of QMEs is a list that is randomly generated and given to the worker. It contains the names of three qualified physicians when there is a question of whether the injury is work-related. A specialty field can be designated on the form for using appropriate doctors.
A person who needs to get workers’ compensation benefits while dealing with medical bills and insurance might want to consult an attorney. A knowledge of QMEs can be helpful in resolving issues that might prevent the resolution of an employee’s compensation claim. If the worker has been denied a claim, consultation with an attorney might result in an appeal and the payment of benefits.