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What is a QME Evaluation?
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A QME examination / evaluation is
performed by a
"Qualified Medical Evaluator". The QME
is is a physician licensed in California who has
passed all requirements set forth by the
California
Workers' Compensation Medical Unit.
A QME may be a M.D., D.C., D.O., D.D.S., D.P.M., or
Ph.D.
also see:
The Division of
Workers' Compensation
Frequently Asked Questions
California State
Law provides for the regulation and resolution of disputes
regarding work related injuries. If
you have been injured at work, your employer or their
insurance carrier may dispute your injury, or you may disagree
with the findings of your medical provider. In either
event, California Law provides for either side to receive an
unbiased medical examination by a QME to help determine the
facts of the case. You may also request a QME examination if
your employer or their insurance carrier have denied your claim
of injury.
Either
party may contest the findings of your treating doctor.
Here are two examples
of a possible dispute leading to a QME examination:
1) If
your injury has resulted in a permanent loss of
your work capacity your
employer/insurer may dispute the disability findings
of your treating doctor. You may then be asked to submit to a QME examination.
2) If YOU disagree with the findings of your treating physicians
permanent and stationary report, you may request a QME
examination from the
California
Workers' Compensation Medical Unit.
You may also request a new QME if you disagree with the findings
of a QME which the insurance carrier had you undergo.
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What to Expect during
your QME Examination?
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The examining physician should
not show any bias toward you or the insurance carrier.
Because of this you may feel that the QME is being a little
distant with you. Understand that this appearance of
distance is needed in order to protect the unbiased nature of
the examination.
Don't be surprised if the doctor spends a
great deal of time with you in taking the history. Often
the entire case and your current condition can only be assessed
by a very thorough history. There may be details in
particular of which the doctor has been asked to address.
Do your best to take your time and answer any questions as
honestly as you can remember. Words means a great deal
during
the history. Try to stay calm and remember that the doctor is
merely trying to establish the facts as best as possible.
The physical examination may also
be somewhat lengthy. Measurement of range of motion,
strength, orthopedic tests and neurologic tests will probably be
performed. New laws enacted in 2004 will require that QME
physicians use some additional methods to evaluate your
condition. These new
methods will no doubt increase the time spent during the
evaluation. In some cases special tests may need to be
ordered like MRI's, CT Scans and additional tests. Such
additional tests will only be required if the doctor is unable
to render an opinion unless such tests are obtained.
Remember; the QME examination and
the system which regulates the QME process is intended to
protect all parties from biased or unfair treatment. I
think it is fair to say that the majority of QME doctors try
their best to be unbiased and to render opinions based on the
facts presented.
Before and after the QME examination, you
or the insurance carrier should not contact the QME, unless
doing so by mail with each party of the case receiving a copy of
the communication. Again, this is intended to protect the
unbiased nature of the report. If the QME must contact you
regarding any missing case information, he/she will have his/her
office contact you.
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