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How a QME can help move forward a stalled compensation claim

Most workers who need workers’ compensation benefits in California will find that the process is relatively straightforward if they have the right help. However, for some workers applying for workers’ compensation benefits after an injury on the job or a diagnosis with a work-acquired illness, getting benefits can prove to be harder than they initially expected.

Your employer could try to undermine your version of events that makes them, and their workers’ compensation insurer, responsible for your care. Perhaps no one denies that the medical issue is because of your work, but there is a disagreement about what kind of treatment you need.

For those dealing with a denied claim or a dispute about the necessity of certain treatments, a qualified medical examiner (QME) could help them get the benefits they need.

What does a QME do?

A QME is a medical provider who meets certain criteria set by the state and who has undergone specialized training for workers’ compensation issues in addition to having their medical license. A QME can perform a physical examination, complete an analysis of the suggested plans of care and provide help with determining if a specific medical treatments are necessary.

Is a QME different than an AME?

There’s a lot of jargon associated with workers’ compensation. It’s easy to confuse terms, especially when they are very similar. An Agreed Medical Evaluator (AME) is a doctor whom your workers’ comp claims administrator and your attorney can agree on.

Only people who have an attorney representing them can see an AME. They don’t have to be approved by the state as workers’ comp evaluators, as QMEs do. You can see an AME after a QME, but once you start seeing an AME, you can’t ask to see a QME.

Contested claims often require extra assistance

Whether your employer denied your initial claim or there is a dispute about the kind of care you should receive based on your diagnosis, contested workers’ compensation claims might mean delays in treatment and in getting other benefits.

Having help during your application and your appeal, as well as when interacting with workers’ compensation representatives, can help you secure a positive outcome to your claim.