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Is There Anything I Can Do If I Disagree With What The QME Reports In The California Workers’ Compensation Process?
Everyone must earn a living, and workers in California are no exception. Unfortunately, sometimes on the job, injuries happen. Someone who suffers an injury at work may be entitled to workers’ compensation benefits. However, as part of the claims process, you need to submit to a physical examination given by a Qualified Medical Examiner (QME).
The Workers’ Compensation Bureau values the opinion of the QME. So, what happens if you disagree with their opinion? You may wonder if there is anything you can do. Qualified workers’ compensation attorneys can help you understand your rights and identify appropriate steps to take after an unfavorable QME report.
Our injury attorneys at Arash Law have represented injured workers across California for decades. We are here to help you, too. If you have suffered a workplace injury, contact our office at (888) 488-1391 or through our online chat feature.
Who Serves As A Qualified Medical Examiner?
This exam aims to mitigate a dispute between the workers’ compensation adjuster and the injured employee regarding the cause of a workplace injury. A Qualified Medical Examiner is a licensed physician qualified to render an expert opinion regarding workplace injuries.
The QME must be board-certified in a medical specialty and certified by the California Division of Workers’ Compensation Medical Unit. A QME must be qualified to give a disability rating, a percentage assigned to an injured worker that reflects their likelihood of returning to gainful employment.
California keeps a list of QMEs. Each accident victim can choose from the list provided. The details of how QMEs get assigned to a claim are below.
Why Do I Need A QME Doctor?
A QME doctor evaluates an employee’s injuries and determines if they happened. Unfortunately, the injured employee must submit to the QME’s physical examination to proceed with their claim. Their examination results can create a hurdle for the injured employee to overcome.
A workers’ compensation attorney can help you understand the QME process, prepare thoroughly for your examination, and navigate the complex legal requirements involved in workers’ compensation claims.
What Should I Expect During A QME Evaluation?
During your QME exam, a doctor working for the Division of Workers’ Compensation Medical Unit will conduct a physical examination. The doctor will evaluate your condition and understand the extent of your work-related injuries.
The doctor will assess you for any underlying conditions. If there is another cause of your injuries, it may help employers challenge the extent of their responsibility in compensation claims.
By the end of the visit, the QME doctor will have an opinion on the following:
- Whether you have a permanent disability.
- The severity of your injuries.
- A treatment plan.
How Do I Prepare For A QME?
Properly preparing for a QME is critical. The QME evaluation is a crucial step in the workers’ compensation process. Being well-prepared allows you to provide complete and accurate information about your injuries and their impact on your daily life.
An injured employee may choose from a list of three QMEs. They must decide on a doctor, schedule an appointment, and inform their employer within ten days of receiving the list. If you fail to choose a QME, the insurance company will choose one. If you don’t choose a QME from the provided list, the insurance company will select one for you, which removes your ability to research and choose an examiner whose background aligns with your specific injury type.
This is why it’s important to spend time preparing before your appointment. Some steps you can take to communicate clearly during your evaluation include:
- Providing a timeline of your injury, detailing the events from when the harm occurred to the present.
- Making a list of your injuries.
- Highlighting the intensity of the injuries and discussing them with the doctor.
- Listing secondary symptoms of the injuries that you suffered in the accident, like anxiety, depression, panic attacks, and sleep disturbances.
- Keeping a journal of your feelings since the accident and letting the QME know how your injuries have affected your emotional well-being.
- Rating your injuries on a scale from 1 to 10.
Writing down your thoughts can help you with the nerves and frustration you may feel during your appointment, and you will get your point across more effectively.
Researching your QME is also productive. QMEs should be unbiased and render a neutral opinion, but they are human and have biases. Being well-prepared allows you to communicate effectively with the QME about your injuries, symptoms, and how they affect your daily activities. The QME needs the following information:
- Your current symptoms.
- Details about your injuries, including when and where the accident happened, and if the accident involved company equipment.
- Details about any previous injuries or medical conditions.
- Any medications you currently take, including pain and anxiety medications, especially medications you began taking after the accident.
- Your pain levels.
- Whether the injuries have limited your ability to participate in work-related or leisure activities.
Bringing a family member or friend to the appointment can also be helpful if you have someone familiar with your injuries and your abilities before and after the accident. They can help support your position with the QME. They can provide additional perspective on your condition and help corroborate details about how your injuries have affected your abilities before and after the accident.
When Will I Get My QME Report Results?
Waiting for the results of a QME report is nerve-wracking. The QME must issue their report to you, your employer, and their insurance carrier within 30 days of the examination.
Sometimes, the QME may request a 15-day extension to present the report. Those circumstances include:
- The QME consulted another practitioner regarding a medical opinion, and they are waiting to receive that opinion.
- The QME is waiting for test results and has yet to hear back from the lab.
- The QME provides another reasonable excuse for the delay, such as a death in their family or an illness.
What Do I Do If I Get An Unfavorable QME Report?
Your QME results may be unfavorable. If that happens, then your workers’ compensation claim may be unsuccessful. After an unfavorable QME result, an experienced workers’ compensation attorney can be helpful.
Why Did The QME Render An Unfavorable Report?
A QME renders an unfavorable result mainly because they believe workers’ compensation does not cover your injuries.
The Workers’ Compensation Bureau hires a QME to render an expert opinion on employees’ injuries to determine the cause of their harm. The QME reviews your medical records related to the accident, learns about your medical history, and conducts a physical examination to understand the severity of your injuries and the treatments you may need.
A QME may decide that the employer’s negligence did not cause the employee’s injuries. If the injured employee receives an unfavorable report, they may feel hopeless and confused about what steps to take next.
Fortunately, QME reports may be appealable. However, the appellate process can unfortunately be complicated. If you suffered an injury at work and received an unfavorable QME report, an experienced workers’ compensation lawyer can help you appeal the report.
How Can A Workers’ Compensation Attorney Help Me Appeal A QME Report?
Your injury lawyer will help you file an appeal for another QME examination. The appellate process is complex but generally includes the following steps:
File An Appeal
The first step is filing the appeal with the Division of Workers’ Compensation (DWC). The DWC will send a confirmation letter with your case number, and your attorney will handle all correspondence between you and the office so you do not miss any deadlines.
Get A Hearing Date
Your attorney will schedule a hearing for you. At the hearing, your workplace injury lawyer and the workers’ compensation adjuster will appear before the judge. Each side will present its side of the case. The judge’s role at the hearing is to attempt to settle the dispute. If the parties cannot settle, the case proceeds to trial.
A trial will likely occur within 30 to 90 days of the hearing. At the trial, each side will present its evidence. An experienced workers’ compensation attorney can present the facts of your case to pursue compensation for your injuries and losses. The judge will then make a decision.
If you or the workers’ compensation adjuster disagrees with the judge’s decision, either party may file a Petition to Reconsider. Your workplace accident attorney will handle this petition for you, if applicable.
Talk To Workers’ Compensation Attorneys To Learn More About Your Rights
Many injured workers may be eligible to recover workers’ compensation benefits. Unfortunately, insurance adjusters are not forthcoming with payments after a workplace injury. When that happens, injured employees need an injury attorney.
Managed by Arash Khorsandi, Esq., our legal team at Arash Law is ready to help you seek fair compensation after a job-related injury. We have decades of experience helping injured California workers pursue benefits after an accident.
Contact our office at (888) 488-1391, or chat with us to schedule a free, no-obligation case review. We’re experienced in representing clients who suffered severe work-related head and bodily injuries.
