CALIFORNIA WORKERS' COMPENSATION
Medical/Legal Evaluations
I Received A Letter Telling Me To Pick A “Panel QME,” Do I Have To Do This?
Either you or the insurance carrier can dispute the opinions of the treating physician, including the opinions on permanent disability, temporary disability, medical treatment, etc. If this occurs, either party can request a Medical/Legal evaluation by a Qualified Medical Examiner. A QME is a physician who has completed state requirements to obtain such a license. If you are not represented by an attorney, this QME is identified as a “Panel QME.” If you do not disagree with your doctor’s opinions, you should not select a Panel QME. However, the insurance carrier may still request that you go to a doctor they select for this evaluation that you must attend. The opinions of this doctor may or may not be considered for settlement of your case.
If you also disagree with your treating physician’s opinions, we suggest that you not select a “Panel QME” and immediately contact an attorney for possible representation. The reason for this is that once you have selected a “Panel QME” that doctor’s opinions then become binding on you for the remainder of the case even after you have retained an attorney. And many attorneys have a list of their own Medical/Legal evaluators they prefer to use.
What is the Difference Between an Agreed Medical Examinations and Qualified Medical Examinations?
Often times, your primary treating physician is excellent at providing treatment but because of the significant details required in writing final reports that are acceptable under Workers’ Compensation Guidelines. Other times, one or both parties may just disagree with the findings of your primary treating physician. In such cases, you will be required to attend a Medical/Legal evaluation. This evaluation can be determined two ways:
Agreed Medical Examination. This is where both your attorney and the defendants make an agreement on one doctor whose opinions would be binding on both parties. The benefit in using this evaluator is that it simplifies the examination and reporting process and usually allows for quicker settlement of your case. Your attorney will only use doctors that are regarded as being fair and impartial.
Qualified Medical Examination. One or both sides can proceed with an individual examination by their own expert doctor. This doctor’s opinions will then take the place of the opinions of your treating physician for whichever party requests the examination.
As both parties have the right to such examinations, you are required to attend any examination set up by your attorney and the defendants and you may be required to attend more than one examination with the QME selected.
If you were injured at work and you need the assistance of a certified specialist in Workers' Compensation call Attorney Bart L. Mehlhop at (916) 930-9675.
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