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How can a QME panel help resolve your workers’ comp claim?

Workers and their employers often disagree about workers’ compensation claims. Although a company won’t pay out of pocket for an employee’s benefits, a major claim can increase the premium that they have to pay for workers’ compensation coverage in the future. Workers know that they need benefits, and employers have an interest in minimizing what workers receive.

You know that you got hurt at work or developed your medical condition because of your job responsibilities. Maybe you have a repetitive stress injury from typing or using the same machinery every day rather than an injury from a specific incident. Your employer wants to insist that you got hurt outside of work and therefore workers’ compensation should not apply to your medical needs or leave of absence.

As an employee in California, there are certain systems that can help you resolve this dispute. Specifically, you may need to request a panel QME from the Division of Workers’ Compensation.

What is a panel QME?

A QME is a qualified medical examiner. Physicians who meet certain state requirements and want to participate in the workers’ compensation program can become QMEs. A QME can help evaluate your condition and determine what kind of treatment is necessary to get you back to work.

When there is a dispute about the origin or nature of your injury, a QME can help then as well. The Division of Workers’ Compensation can provide you with a randomly-generated list of three QMEs who can evaluate your condition.

The random selection is important because it helps ensure neutrality. It reduces the likelihood that either the employee or the business has a pre-existing relationship with the physician.

What happens during a panel QME?

Once you choose one of the doctors on the list provided by the state, you will have to undergo an extensive evaluation by the QME. They will then take the information gleaned from that exam and use it to write a report.

Their determination will play a major role in whether or not you can receive workers’ compensation benefits. If they agree that your condition is the result of your job responsibilities, then you will potentially qualify for both medical benefits and disability benefits if you require a leave of absence from work.

Learning more about the California workers’ compensation program can help you get the support you need after a workplace injury.