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Leep, Tescher, Helfman and Zanze

Steps should you take if you can’t make your qualified medical examination

Countless Californians suffer injuries while on the job each year. The state requires almost every employer to have workers’ compensation coverage in case such an event occurs. It’s in situations where there are questions about how much in benefits you may be eligible to receive that state officials may schedule you to see a qualified medical evaluator (QME). Your participation in this examination could shape the outcome in your case. You must know what steps to take should you be unable to attend this critical appointment.

State officials randomly assign you to see a QME that has an office in select zip codes closest to your home. Your claim administrator may be willing to switch that assigned doctor out for one closer to your workplace, though. If you have can’t find or afford transportation to the QME appointment, then the claims administrator will pay for your trip there. Your case manager will also assign you to see a doctor closer to your new residence if you relocate out of the area before your QME examination.

There are instances in which the assigned QME may be unavailable to see you within 60 days. It’s in cases such as this that the medical unit may verify their unavailability and then set you up with an appointment with an alternate QME physician. If there’s any question that your illness or injury is work-related, then it’s unlikely that your claims administrator will want you to wait to see a QME doctor to make this determination.

The medical unit may also replace your assigned QME physician if you find they are no longer an active one.

Workers’ compensation claims administrators work much like any other insurance adjuster does. Their primary goal is to keep as much money in their accounts as possible. Many insurers will make you jump through hoops hoping that it will wear you down and then swoop in and deny liability. A QME attorney can advocate for you when your Redding employer’s workers’ compensation carrier doesn’t seem willing to give you the benefit of the doubt and fairly consider your California claim.