Some California workers’ compensation claims are quick and straightforward. The employee has an obvious injury that directly relates to the job that they do, and their employer acknowledges that they need support. The worker will apply for and receive benefits, and they can trust that their employer will accommodate their work restrictions as they transition back to their job.
Other times, the employer might try to fight the worker. They may question whether the injury is serious enough to warrant accommodations and benefits and may even claim that the worker didn’t incur their injury on the job. Workers have the right to keep pushing for benefits, but such situations can become complicated very quickly.
In a situation where there is a dispute about the origin of an injury or its impact on a worker, the California Division of Workers’ Compensation may ask the worker to undergo a medical examination by a qualified medical evaluator (QME). What does that process entail?
There are multiple requirements for workers seeing a QME
When the state requests that you see a QME for an evaluation, you will need to comply if you hope to eventually get benefits or to keep receiving the benefits you currently have. Once there is a request for a QME, you should receive a letter from the claims administrator. You will have the right to request a QME with a particular medical specialty. If you fail to do so within 10 days, the claims administrator will make that selection on your behalf.
At that point, you will receive a list of QMEs, typically a panel of three to choose from. These professionals could all be located far away, as the creation of the list is random. You will need to select a QME from the panel within 10 days, or the claims administrator will choose one for you. You will set an appointment and undergo a thorough evaluation to help determine if your condition results from your work or not. There should be a final report from your visit within 30 days.
Understand your rights and options
The QME is a neutral party but it is important to understand what medical options you might have if you believe you have received an incorrect assessment or diagnosis. A workers’ compensation attorney can help you understand your next steps, including possibly disputing the QME’s findings.