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Qualified Medical Evaluators

Dr. Z is a state-certified Qualified Medical Evaluator. She is thoroughly familiar with the requisite processes and regularly performs evaluations in disputed workers’ compensation cases. Her evaluations and reports are fair, thorough and timely.

The following information is presented as a highlight of what is involved in this service. For complete official descriptions, please click or tap here to access the California Division of Workers’ Compensation website.

Definition

Qualified medical evaluators (QMEs) are qualified physicians who are certified by the California Division of Workers’ Compensation (DWC) — Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker’s eligibility for workers’ compensation benefits. QMEs include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists and acupuncturists.

A QME evaluates you when there are questions about what benefits you should receive. A physician must meet educational and licensing requirements to qualify as a QME. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process.

Process

A randomly generated list of three QME physicians (“panel QME”) is issued to you when there is a question about whether or not your injury is work related, or if there is a medical dispute that has n0t been resolved by the treating physician’s report. Whoever fills out the form to request the panel QME chooses the specialty of the doctors on the panel. The law requires the Medical Unit to issue panels close to your residence. If you prefer, the DWC Medical Unit can issue a panel of QMEs using the ZIP code of your workplace if the claims administrator agrees to this request. A QME is then picked from this list of state-certified doctors.

QMEs have 30 calendar days from the date your exam begins to issue their report. There are three reasons a physician may request an extension:

  • The physician requested you have medical tests and is awaiting results
  • The physician requested a consultation and is awaiting the consultant’s report
  • The physician has a “good cause” for an extension (e.g., natural disaster, evaluator’s family medical emergency).

The physician may not request an extension because the claims administrator failed to provide your medical records or past medical tests. If the report is going to be late, the physician must file a time frame extension request with the DWC Medical Unit and send a copy to the claims administrator and to you.

Finally, in the case where you don’t have an attorney and permanent disability is the disputed issue, QMEs send a copy of their report to the claims administrator, to the Division of Workers’ Compensation Disability Evaluation Unit (DEU) and to you. The DEU should issue a rating within 20 days. Once a rating is obtained, you may begin discussing settlement of your case with the claims administrator.

If you do have an attorney and permanent disability is the disputed issue, the QME will send a copy of the report to both your attorney and the attorney for the claims administrator. If a permanent disability rating is required, a copy of the report will be sent to a disability rater by either your attorney or the attorney for the claims administrator. Your attorney should advise you about all the steps in the process.