If your QME was yesterday, then your QME examiner has 30 calendar days to issue the results to you, the claims adjuster, and all attorneys involved in your claim. However, 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.
What Happens Once You Get Your QME Results?
If you do not have an attorney and your dispute does not involve a permanent disability, the QME will send a copy of the report to you, the insurance claims adjuster, and the Disability Evaluation Unit (DEU). The DEU will issue a rating within 20 days. Once a rating is given, you may begin discussing a settlement for your case with the claims adjuster. If you have a Workers’ Compensation Attorney, the QME will send them a copy as well and your attorney will advise you about all the next steps based on the evaluation you were given.
How is a Disability Rating Determined?
A disability rating will determine permanent disability based on a medical evaluation of an injured person’s physical and mental impairment. Disability rating determinations are used by:
- Workers’ compensation administrations
- Injured workers
- Personal injury lawsuits
- Insurance claims
A disability rating can be given in the following scenarios:
- At the request of a workers’ compensation judge
- By request of an attorney or DWC information and assistance officer
- At the request of a claims administrator or injured worker for non-litigated cases
Your disability rating will reflect your percentage of disability. The permanent disability rating is determined by several factors, which include:
- Medical evaluation: an agreed-upon medical evaluator (AME) or a QME will provide a medical assessment of the disability.
- Impairment guides: an evaluation of a disability uses the American Medical Association Guides to the Evaluation of Permanent Impairment.
- Work restrictions: an injured employee’s limitations and restrictions.
- Age and occupation: the age and occupation will be taken into consideration, especially when a person’s line of work is no longer possible due to their disability.
What if I Disagree with My Disability Rating?
If either you or your claims adjuster disagree with your disability rating, you can send a “Request for Reconsideration of the Summary Rating.” Your request must be sent to the DWC administrative director using this form within 30 days of your QME. The following are reasons you can request reconsideration:
- The QME failed to address all your issues
- The QME failed to completely address your issues
- The DWC Medical Unit’s procedure was not followed by the QME
- The rating was incorrectly calculated
If you need assistance with receiving permanent or temporary disability benefits, it is recommended to consult with a Workers’ Compensation Attorney about your situation.
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 the security of your job, or the adequacy of your benefits, the 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.
