What is a QME?

If you’ve been injured on the job, or if you’re injured as a result of your working conditions, chances are you are filing a Workers’ Compensation claim. A workers’ compensation claim is an insurance claim that holds the employer liable for the cost of treatment for workers’ compensation injuries. However, receiving benefits from a claim isn’t as simple as reporting an injury to your employer — throughout the course of this claim, there are various deadlines, exams, and testimonies that need to occur in order to get proper treatment for your injuries, one being a QME.

Why are QMEs performed?

One aspect of a workers’ compensation claim is the QME, or Qualified Medical Exam. A QME is a medical-legal evaluation performed by a non-biased expert doctor in connection with a workers’ compensation case. If there is a dispute between the patient and employer regarding treatment, a QME may be performed to come to a resolution. The examining physician must be familiar with and apply the descriptions and measurements of the American Medical Association’s (AMA) guides.  During this exam, QME doctors review the history of the injury and examine the affected body parts, thus determining the type of treatment needed and to be paid for by the employer.

A QME is usually a long, detailed examination. Prior to the exam, QME doctors will review any medical records pertaining to the reported injuries, as well as any prior medical illnesses or injuries. It is required that these doctors write a comprehensive medical-legal report that adheres to the AMA’s standards. QMEs differ from regular appointments in how thorough they are – typical exams do not require as extensive a review of the patient’s prior injuries or illnesses.

People about to receive a QME are asked to notify the QME doctor in advance of what body parts, body functions, and organ systems are purported to be impaired as a result of the workers’ compensation injury. It is also recommended that the patient inform the QME doctor of which claims have been accepted by the claims administrator and which haven’t. In turn, QME doctors should be aware of the type of injuries they will be reviewing, and whether or not the claimed medical conditions are outside their medical specialty.

How are QME doctors chosen?

A worker’s compensation adjuster may request a QME for a patient if there are any questions pertaining to the nature of the injuries, such as the cost, severity of injury, or extent of any disability. QME doctors are on a specific list maintained by the state of California. Once the patient receives a short-list of three of these doctors, they have 10 days to select a provider, make an appointment, and notify their employer. QME doctors can include medical doctors, dentists, psychologists, or other qualified medical professionals. If the patient doesn’t make a selection, a qualified medical examiner will be chosen for them. The QME physician will perform the evaluation, and either agree or disagree with the original treating physician.

At Healthpointe, we have decades of experience in qualified medical examinations. Our Qualified Medical Examiners are certified by the Division of Workers’ Compensation Medical Unit, to accurately evaluate work injury claims, as well as complete medical-legal reports.

If you are an attorney looking to make a decision for your client, call us today at (800) 956-2663.