Is a QME Result Final?

While a QME’s rating carries a lot of weight in your claim, the final result is not set in stone. If you’re given a disability rating after a QME, your attorney, your employer, the insurance company, or the defense attorney can all formally dispute a QME’s finding through the Workers’ Compensation Appeals Board.

The Board will examine all medical evidence and testimony given on the matter to determine if the QME’s opinion warrants being overturned. Having your disability rating overturned is possible if you believe it is inaccurate. An experienced Workers’ Compensation Attorney can help you with the appeals process, as well as negotiate a fair settlement on your behalf.

What Can Overturn a QME Rating?

If you received an unsatisfactory QME rating, there are certain scenarios where the rating can be overturned. The following are reasons why a QME determination can be reconsidered:

• New evidence emerges, altering the case’s medical findings
• Procedural irregularities occurred during the QME evaluation:
  • QME has a pattern of giving inaccurate ratings
  • A conflict of interest between the QME and those involved in the case
  • Failing to consider a person’s physical requirements during the evaluation
• The final report contained factual errors and inconsistencies
• The QME failed to conduct an adequate medical examination

Understanding the QME Process

A standard QME appointment typically involves the following steps:

1. Medical records will be reviewed by the evaluating QME physician
2. The physician will interview the patient in person
3. After visiting with the patient, the physician has 30 calendar days to issue a report
4. 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.

The Difference Between Total and Partial Disability Benefits

A QME disability rating, along with a WPI rating, will be used to calculate an injured person’s lost earning capacity. WPI stands for Whole Person Impairment. The WPI rating is a percentage that measures the degree of permanent damage caused by a workplace injury to an employee’s physical and psychological well-being.

The result of these ratings will be decided by a person’s age at the time of injury, their occupation, and the type of disability or impairment they’ve suffered. This rating will fall between 0% and 100%. Permanent total disability ratings of 100% are uncommon, but they can happen. A permanent total disability rating of 100% will be granted if a worker has been totally paralyzed, blinded in both eyes, lost the use of their hands, or suffered a mentally incapacitating brain injury. However, in most cases, a partial disability rating is given to those who have suffered less damaging injuries.

What Benefits Can I Receive for a Permanent Disability?

According to the Center for Disease Control, 7% of adults in the United States suffer from an independent, living disability that makes it difficult to do daily tasks without assistance. Fortunately, workers’ compensation provides permanent disability benefits to those who have sustained permanent limitations due to a work-related injury.

Unlike temporary disability benefits, which pay injured employees for the wages they lost while recovering from injuries, permanent disability benefits are for those who are not likely to make a full recovery from their injuries. Permanent disability benefits are intended to pay for loss of “future earning capacity,” which is calculated anywhere from 0% to 100%, depending on the victim’s ability to rejoin the workforce.

The minimum amount a person can receive for permanent disability in California is $203.44 per week, and the maximum is $1,356.31 per week. However, permanent disability payments will be two-thirds the amount of the victim’s weekly wage before they were disabled.

Factors that Affect Injury Settlement Amounts in California

Disability cases often settle for the highest figures amongst personal injury and workers’ compensation accident claims. Average settlement amounts vary widely based on the details of the accident, however, the following factors will greatly influence the settlement you can expect to receive:

• The severity of your injury
• Your characteristics:
  • Age
  • Occupation
  • Overall health
  • Education
• Insurance policy of the liable party
• Your percentage of liability (if any) in the accident

Contact a Disability Attorney in California

If you have suffered an injury that has left you disabled 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 for your disability. 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.