After your Qualified Medical Exam, the doctor has 30 days after the date of the exam to issue their report. Once the report is complete, it is sent to you, the insurance adjuster, and any legal counsel involved in your case. 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.
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
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.
Does a QME Determine Your Disability Rating?
Yes, a Qualified Medical Examiner (QME) will play a vital role in determining your disability rating after you’ve suffered an injury. A QME is a physician who evaluates you when questions arise about what medical benefits you are eligible to receive. Based on a QME’s evaluation, you will be assigned a percentage of permanent disability. Their rating takes into consideration the extent of your impairment, functional limitations, and the impact on your ability to perform your regular job duties and daily functions.
What if I Disagree with the QME’s Disability Rating?
If you do not agree with the QME evaluation of your disability, you can request a supplemental report or attempt to make a compromise with the claims administrator or defense attorney. Negotiations, however, are typically best left to attorneys as injured victims may not be fully aware of the benefits they’re entitled to or the value of their disability claim. An attorney will be able to handle negotiations on your behalf or file an appeal with the Workers’ Compensation Appeals Board. The appeals process involves presenting additional evidence, such as medical reports and testimony to support a more accurate assessment of your permanent disability.
FAQ
Q: I moved out of California and would like to settle my case. Do I still need to go through with the QME process?
A: If both you and your claims adjuster agree to the treating physician’s report, then there is no need to attend a QME evaluation.
Q: If I need another evaluation, should the original QME do it? What if the physician is no longer available for a QME?
A: A second evaluation should be done by the same QME. You can see a different physician only if the original physician is unavailable, the QME became your treating physician after the evaluation, or a workers’ compensation law judge decides you need a new evaluation with a different QME.
Q: Are my medical and non-medical records sent to the QME?
A: Yes, your records will give the QME a history of your injury. All test results and previous treatments will be sent to the QME.
Can a Lawyer Help with My QME?
Navigating the complexities of personal injury and workers’ compensation law can be exceptionally daunting without proper legal representation. At Maison Law, we specialize in personal injury law and provide expert analysis and legal support to ensure our clients receive the compensation they need for their injuries. Contact Maison Law today for a free consultation and case evaluation. There are no upfront charges or hidden fees for our services as you will only be charged if we win your case.
