In most cases, injured workers are typically only entitled to one QME evaluation. However, there are situations where you may be able to get a second QME if you have “good cause” to have another QME re-evaluate your injury. Without a valid reason, you cannot simply request multiple QME evaluations.
Reasons You Can Have More Than One QME
The basic rule of QME evaluations is that you only get one. Also, your claims administrator is only required to pay for one QME evaluation. But there are situations in which you may be entitled to a second QME, which include:
- There is a dispute over a new medical issue, requiring a different medical specialty
- A Medical Director or law judge grants an additional QME based on “good cause”
It is important to note that you do have the option to get a second panel if one or more of your QMEs are unavailable for over 60 days after receiving the initial panel. It will be up to the Medical Unit to replace those QMEs and verify that the physicians on the original panel are not available within the 60-day limit.
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.
Timeline for QME Evaluation
A standard QME appointment typically goes as follows:
- Medical records will be reviewed by the evaluating QME physician
- The physician will interview the patient in person
- After visiting with the patient, the physician has 30 calendar days to issue a report
- The physician submits a QME report detailing the diagnosis, analysis, and conclusion
It is important to remember that the QME is an independent consultant in your case. Their medical opinion is not legally binding in the same way a court’s judgment would be. Accepting the diagnosis of a QME is voluntary unless a comprehensive hearing overturns their findings.
Reasons a QME Can Be Delayed
There are three reasons why your examiner may request an extension on delivering your results. They include:
- The physician requested medical tests and is awaiting results
- The physician requested consultation and is awaiting a report
- The physician has a medical emergency and must delay the final report
It is important to note that a physician may not request an extension if the insurance claims adjuster fails to provide them with your medical records or past treatments. If the report is going to be delayed, the physician must file a time frame request with the DWC Medical Unit, as well as send a copy of the extension request to you. This must be filed five days before the report is due, according to Title 8, California Code of Regulations, section 38.
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 evaluation, the Workers’ Compensation Attorneys at Maison Law can help. Our firm will help you navigate the complexities of your workers’ compensation claim and we’ll manage your case every step of the way until you reach a successful settlement or need to be represented in court. 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.
