Yes, injured workers may request a replacement QME to the workers’ compensation panel. This decision will ultimately be made by the Medical Director. If the request is approved, the Medical Director will select a replacement at random. Requesting a new QME can become complicated, so it is recommended to consult with a Workers’ Compensation Attorney before making changes to your workers’ compensation claim.
Reason for Requesting a New QME
Requests for a replacement QME are typically granted if the following occurs:
- A QME on the panel does not practice in the especially requested by the injured party
- A QME on the panel cannot issue a scheduled examination within 90 days of the initial request for an appointment, or if the 90-day scheduling has been waived in accordance with California Code of Regulations Title 8 Section 31.3(e), and the examination cannot be scheduled within 120 days of the initial request for an appointment
- The injured worker has changed their address since the QME panel was issued and prior to the date of the initial evaluation of the injured worker
- The QME who previously reported in the case is no longer available
- The QME has failed to meet deadlines and is damaging the injured worker’s claim
- The QME has violated appointment notification and cancellation law as stated in California Code of Regulations Title 8
Can I Request a New QME After an Evaluation?
In general, the injured worker is not entitled to a new QME evaluation after an initial evaluation, or after partnering with a Workers’ Compensation Attorney. The rule is stated in Labor Code 4062.1 (e), which reads:
“If an employee has received a comprehensive medical-legal evaluation under this section, and he or she later becomes represented by an attorney, he or she shall not be entitled to an additional evaluation.”
An important thing to note about the language of this law is the “has received” part. An injured worker may receive a replacement QME after obtaining representation as long as they have never received a comprehensive medical-legal evaluation.
Can I Request a Replacement of the QME Panel?
Since QMEs play such a vital role in evaluating injured worker’s future medical treatment, their level of impairment, and other health issues, the people on the QME panel of your workers’ compensation claim can be just as important. In certain circumstances, you may find yourself having issue with getting medical treatment approved or seeing the QME of your choice if you are having difficulty working with your QME panel.
A QME panel is a group of certified medical professionals chosen by the California Division of Workers’ Compensation to assess the medical condition of an injured worker. They are essentially supposed to act as a neutral third party to resolve medical disputes in a workers’ compensation case. However, sometimes a replacement panel is needed if the following circumstances arise:
- The QME panel is part of the same practice group as another panel member
- Someone on the QME panel is already a treating physician of the injured worker
- The original QME panel is outside the injured worker’s region if the worker has relocated
- The QME panel has issued a late report or failed to send appointment notifications
- The QME panel did not provide a complete medical evaluation or is not deemed qualified to address the disputed issue
- The QME panel has a conflict of interest with the injured worker
Contact a Workers’ Compensation Lawyer in California
If you or a loved one has suffered an injury that has left you disabled or severely injured and you are concerned about your QME’s qualification or the treatment you are receiving, the Workers’ Compensation Attorneys at Maison Law can help. Our firm will help you navigate the complexities of legal and we’ll be with you every step of the way until you receive the compensation you are owed. Contact Maison Law today for a free consultation and case evaluation. No upfront money is required for our services and we don’t get paid unless we win your case.
