Dr. Daniel Buch, BS, DC, QME - QME and AME Information

Short Answers to Complex California Workers' Compensation QME Questions

What is a QME Evaluation?
What to Expect during your QME Examination
Before your QME Examination
About Scheduling your QME Examination
QME FAQ
California Workers Compensation References

About Dr. Buch - Specializes in performance enhancement and the treatment of musculoskeletal injury. He received his Degree in Kinesiological Studies from California State University, Hayward and his Chiropractic degree from Life West Chiropractic College. Co-authored a cervical spine range of motion study which was published in the Journal "Spine".
Dr.Buch's Curriculum Vitae View abstract from the Journal Spine, Co-Authored by Dr. Buch, 1999 Email Daniel Buch

Dr. Buch has been California State Appointed Qualified Medical Evaluator since 2001 and performs medical legal examinations in the San Francisco East Bay Area. Dr. Buch is also a California DWC Medical Unit approved provider of QME continuing education, and is the course administrator for QMECEU.com.

If you have received a QME panel list from the State of California which includes Dr. Buch, please call . Our Office Manager Maggie Tan will be happy to assist you in scheduling your appointment.

This page presents background information regarding California Workers' Compensation and is not intended as a substitute for legal counsel. If you require further information contact either the California Workers' Compensation Office of Assistance, or seek assistance from a Workers' Compensation Attorney.

NOTICE:
Making a false or fraudulent workers' compensation claim is a felony subject to up to 5 years in prison or a fine up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.

What is a QME Evaluation?

A QME examination / evaluation is performed by a "Qualified Medical Evaluator". The QME 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 Medical Doctor, Doctor of Chiropractic, Doctor of Osteopathy, Dentist, Doctor of Podiatry, or a Psychologist (PhD). Under California law, an Acupuncturist (LAc) may also serve as a QME in a limited role. 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. For example; if you have been injured at work you may disagree with the findings of your medical provider, or you may feel that the insurance company is unfairly denying you medical care. In this case you may request a QME Evaluation from the California DWC Medical Unit. see: California DWC Information and Assistance Unit

Likewise, the Insurance company or your employer may dispute your injury. The insurance company may also request a QME evaluation.

In either event, California State law provides for either party to receive an unbiased medical examination by a State appointed QME to help determine the facts of the case and prepare a formal report of the evaluation. A QME does not work for the insurance company, nor does the QME work for the injured work or any attorneys involved in the case.

The injured worker or the workers' compensation insurance carrier may have disagreements regarding several issues in a case. There are many possible medical legal disagreement which can give rise to the need for a QME or AME examination, some possible disputes include;

- Disputes involving whether an on the job injury actually occurred.
- Disputes over the level of physical impairment resulting from the work injury.
- Disputes over the work restrictions required.
- Disputes regarding the need for future or current medical care.
- Disputes over apportionment of impairment to previous injury or illness.

An Agreed Medical Evaluator or AME, may be used when you are represented by an attorney. In this case, your attorney may agree with the defense attorney to utilize a specific evaluator. This is why it is called an Agreed Medical Evaluator. An AME is NOT certified or regulated by the California DWC. A QME may serve as an AME.

What to Expect during your QME Examination

During a QME or AME evaluation, the examining doctor should not show any overt bias toward you or the insurance carrier. I believe that the injured worker should be evaluated with care and respect. In my experience, I have found that most QME physicians conduct evaluations in a caring and responsible manner.

Do not be surprised if the doctor spends a great deal of time with you in taking the history. The QME will not be entirely familiar with your case as he or she has not been involved in your treatment, so the history and your answers are of great importance. Often your case and your current condition can only be assessed by a very thorough history. There may be particular details which the doctor has been asked to address by the insurance carrier or the attorneys involved. Take your time and answer any questions as honestly and completely as you can remember. Try to stay calm and remember that the doctor is merely trying to establish the facts as best as possible. A complete evaluation report is far better than an incomplete or speculative report.

The physical examination may also be somewhat lengthy. Measurement of range of motion, strength, orthopedic tests and neurologic tests will probably be performed. California Laws enacted in 2004 require that QME physicians use specific methods to evaluate your condition. These methods have generally increased 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 evaluation 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.

After you have scheduled your QME appointment you or or any parties involved in the case (attorneys, claims adjusters, employers) 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. You may of course contact the QME office for location directions and other minor logistical questions. The key here is that no parties involved should discuss your case with the QME unless each party receives this communication in writing.

Before your QME Examination

After scheduling your QME examination, your examining QME doctor may send you a questionnaire for you to complete regarding your history, treatment and current status. Please complete this and any other paperwork as completely and accurately as possible, PRIOR to your visit. Do not wait until the day of the examination to do this, as often the questionnaire is quite long. Don't let your exam be determined by partial fact and brief answers.

As a QME for many years, I try to address all relevant issues concerning your case in my reports. Your history questionnaire helps me fully consider the questions raised in your case. To the best of your ability, make sure you give complete answers to all questions. You may be the only source of information regarding certain aspects of your case. You should also have received a DEU form 100 "Employees' Disability Questionnaire". Make sure to fill this out and bring it with you to your examination.

About Scheduling your QME Evaluation

After you have requested a QME examination from the State of California DWC, you will be sent a form on which you will specify which specialty you wish to have examine you. This may be a chiropractor, and orthopedic surgeon etc. Select which specialty you prefer.
You may ask your treating physician for his or her advise on which specialty to select. The specialty you choose is often of importance.

A 2010 Report from The California Commission on Health and Safety and Workers’ Compensation includes some interesting information regarding the current status of QME panel specialty requests. http://www.dir.ca.gov/chswc/reports/2010/qmestudy.pdf

After you file this form with the Dept. of Workers' Compensation, they will then send you a list of either 3 QME's in your area, or (depending on your case) a list of many QME's in your area.
You may ask your treating physician for advice on which QME you select.

QME FAQ
Also see: Division of Workers' Compensation Frequently Asked Questions

1) Do I Need an Attorney to Handle my Workers' Comp Case?

A. You do not need an attorney in order to secure a QME examination or to protect your rights under the California Workers Compensation system; however, depending on your case, the severity of the injury, the duration of the case, extenuating circumstances and other factors which may make your case difficult to handle by yourself, you may benefit from having a workers' compensation attorney representing you. Personally, as a treating chiropractor and QME, I have found that if my patients are overly worried about legal issues, loss of income etc., they may neglect the primary concern which is restoration of health, decreased pain and increased function. In such circumstances, I recommend that the patient seek legal representation. see: California DWC Information and Assistance Unit

2) Do QME's Work for the Insurance Company?

A. QME's DO NOT work for or represent the insurance companies. QME's are duty bound to act in a professional and unbiased manner. The California Workers' Compensation Medical Unit, which oversees the conduct of QME physicians, has strict guidelines which help ensure that QME's remain unbiased. If you feel there is evidence to suggest that the physician behaved in a biased manner, you should report the incident to the DWC Medical Unit. Bear in mind that your QME may render an opinion that differs from what you expected, that does not necessarily mean that the QME was biased or that the QME acted in an unprofessional manner.

3) I told the QME doctor that I was hurting all the time, and that I was in severe pain, but the report says I do not hurt that badly. Why did the QME not write what I told him/her?

A. California laws enacted in 2004 changed many of the methods used by AME's and QME's in the determination of physical impairment. Under the the law, your description of your pain is no longer the primary factor used to determine your level of impairment. California law requires that AME and QME physicians use the methods described in the "AMA Guides to the Evaluation of Impairment, 5th Edition" to determine your impairment status. Your AME or QME MUST utilize these methods when conducting first time medical legal evaluations after January 1, 2005. For this reason, it is important that the QME fully understands and applies the AMA Guides methods fully and fairly.

Workers Compensation References

California DWC Information and Assistance Unit

Division of Workers' Compensation Medical Unit

The Division of Workers' Compensation Frequently Asked Questions

Division of Workers' Compensation (DWC)

Workers' Compensation Appeals Board (WCAB)

Notice:
Making a fault or fraudulent workers' compensation claim is a felony subject to up to 5 years in prison or a fine up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.

QME and AME Information

Dr. Daniel Buch, BS, DC, QME 4400 Keller Avenue, Suite 250 Oakland, CA 94605 Oakland Office: QME and AME Scheduling:

Dr. Daniel Buch, BS, DC, QME
4400 Keller Avenue, Suite 250
Oakland, CA 94605
Oakland Office:
QME and AME Scheduling: