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What is a QME, and when do I need to see one?

On Behalf of | Jul 26, 2022 | QMEs |

If you are injured at work and make a claim to obtain workers’ compensation, there is a chance that you will need to see a medical professional for a qualified medical evaluation. This evaluation can be requested when your claim is denied or delayed and you’d like a medical evaluation to determine if the claim should be payable. Additionally, you can ask for the evaluation by a qualified medical evaluator, or QME, if you disagree with your current treating physician’s thoughts on your condition or if you want to find out if you are permanently disabled and may need future medical treatment.

In California, you are able to see a list of QMEs to choose from, so you can select someone to take a look at your health situation.

When will you be forced to go through a QME?

Generally speaking, many people don’t need an evaluation by a QME if they get their claims approved. It’s when your claim is delayed or denied that it may be necessary to look into seeing a QME. If the insurance company wants you to see the QME, it will give you a form stating that you need to see one and give you 10 days to turn in the form to the Department of Workers’ Compensation Medical Unit. If you don’t send that form back within the timeframe, the insurance company can determine which doctor you’ll see.

That’s why it’s important to make sure you return the document as soon as you can. By doing so, you can maintain some control over who you see.

Do QMEs represent the insurance company?

No, they are third parties. The DWC Medical Unit sends three QME possibilities to your insurance company at random. You get to choose one of those people. If you don’t, then the insurance company will choose from the list.

If you think that you may want a QME or you have been asked to get one, it’s helpful to know your rights. You need to know where you stand with your case and what to do if you’ve faced an unfair rejection of your claim. You may still be able to get the compensation you need.