How to Choose a QME?

If you partner with a Workers’ Compensation Attorney after being injured at work, they can select a physician from a panel of Qualified Medical Examiners (QME). It is important to choose the physician who you, or your attorney, feel is best qualified to make many critical medical decisions on your behalf.

While you will have an opportunity to dispute some of the decisions made by a QME, ultimately, the agreed-upon QME’s diagnosis will largely influence the outcome of the benefits you are entitled to through your workers’ compensation claim. A QME will initially decide whether you currently need medical treatment, or in the future, as well as to the extent you are disabled. Disability will be diagnosed by your QME as temporary or permanent disability.

Types of Permanent Disability Benefits

California’s workers’ compensation system offers two types of permanent disability benefits. These benefits include:

• Permanent partial disability: people deemed partially disabled with a rating of below 100% are entitled to weekly payments at an established amount. The higher your disability rating, the more money you will be able to collect.
• Permanent total disability: if you become 100% disabled from a work-related accident, then you’re entitled to weekly payment for the rest of your life. You may also be able to receive a lifetime pension if your disability rating is between 70% and 90%.

How Do I Get Permanent Disability Benefits in California?

Permanent disability benefits cannot be considered until after temporary benefits have been exhausted by the injured victim. Once temporary benefits have been exhausted, the injured victim’s injuries will be evaluated by an approved physician to determine if they’ve reached Maximum Medical Improvement.

Once you’ve reached MMI, your ability will determine if you can return to work on a restrictive basis or if you’re ready to completely return to your regular duties. Also, your employer will consider your physical restrictions before deciding to offer you “modified work.” Modified work means you will only be required to do a portion of your usual duties. If modified work is unavailable for your specific job, then your employer may choose to offer you “alternative work.”

This equates to a different type of work with the same rate of pay and employment location. If you have reached MMI and you still have physical limitations due to your work-related injury, then you must prove the following to recover permanent disability benefits:

• Your injuries came from your job doing a work-related activity
• The nature and severity of your injuries or illness has resulted in permanent disabilities
• Your disability prevents you from returning to work

How to Choose a Good QME

A common mistake injured workers make when searching for a QME is choosing a doctor based on their immediate availability. If a physician has an open calendar, then there might be a reason why no one is making appointments with them. Good physicians and good QMEs are typically busy because people want to get the best treatment. So, it is important to not choose your QME based on availability alone.

Another mistake injured workers make when selecting a QME is choosing a physician because their office provides good customer service. While customer service is nice, it does not always translate to a good QME. It is recommended to put niceties aside and look for a physician who spends time discussing your situation with you and understanding your medical records. A physician who understands how this injury will impact your life will be able to write a meaningful report to the workers’ compensation insurance or a judge if your claim goes to trial. It is important to understand that this information is not legal advice, but a general idea of what you can expect when looking for your ideal QME.

The Process of Choosing a QME after Filing a Workers’ Compensation Claim

After a work-related injury, a list of Qualified Medical Evaluators will be sent to you in a letter. This list will have been requested by you, your attorney, or your claims administrator. If you do not have an attorney helping you with your claim, you will need to take the following steps to choose your QME:

1. Select a QME physician from the list provided to you within 10 days of the date the list was issued.
2. Call the QME’s office, which should be listed on the form, within 10 days of the date the QME list was sent to you and make an appointment.
3. Inform the physician’s staff if you will need assistance or an interpreter for your visit. The staff will ask you for the information listed on the top of the QME physician list you were provided to confirm your QME visit is official.

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.