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Can any licensed doctor be the QME for your workers’ comp claim?

Some workers’ compensation claims are straightforward. It is obvious how the employee got hurt and what benefits they require. Other times, claims can cause lengthy disputes between workers and their employers.

When there are disagreements about the right treatments, the restrictions on a worker’s job performance or even if their injury is the result of their work, the worker and their employer may require the help of a qualified medical evaluator (QME) to resolve the disagreement. Can you go to your primary care physician and ask them to act as a QME for your claim?

Doctors must apply to become QMEs

Workers who need medical care after suffering an injury at work can sometimes seek care from their own physicians. If they predesignated their physician for care before their injury, if their doctor is part of their employer’s approved health care organization or if their treatment lasts more than 30 days, their personal doctor can provide care. Still, that doctor likely can’t provide the testing to settle disputes.

Although many doctors are able to meet the necessary requirements to participate in workers’ compensation claims, they have to file paperwork with the state to officially serve as a QME. They will need to meet certain standards and commit to continuing education on the program. When you need the support of a QME for your claim, the chances are good that the state will assign one or give you a list to shoes from rather than letting you select your own doctor.

Learning more about how workers’ compensation benefits work in California can help you get the necessary support during your recovery from a work-related medical issue.