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, despite deserving assistance, you must 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 the best steps to take after an unfavorable QME report.
Our award-winning injury attorneys at Arash Law, under the leadership of famous attorney Arash Khorsandi, Esq., 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 Qualified Medical Examiners?
Who Serves as Qualified Medical Examiners?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.
Hiring an experienced workers’ compensation attorney can help you avoid mistakes many injured workers make when encountering a QME. By avoiding common mistakes, you may avoid an unfavorable report and get closer to successfully resolving your accident claim.
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 interrogate you about any underlying conditions. Employers do not want to pay compensation claims, so if there is another potential cause of your injuries, that is beneficial for them.
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 success of your workers’ compensation claim depends mainly on the outcome of the QME, so the better prepared you are, the better the chances of workers’ compensation insurance covering your injuries and losses.
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. Letting the insurance company choose a QME leaves you vulnerable to seeing a biased doctor in favor of your employer.
Regardless of the QME, you will see, spend time preparing before your appointment. Some steps you can take to get the most out of your evaluation include:
- Creating a timeline of your injury: share the details of your injury from when you sustained the harm until the present
- Making a list of your injuries
- Highlighting the intensity of the injuries and discussing it 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. Preparedness helps reduce the chances of an unfavorable report. 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 also provide valuable information to help you avoid an unfavorable QME report.
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, like 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 gives 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 are appealable. Unfortunately, however, the appellate process is complicated. If you suffered an injury at work and received an unfavorable QME report, it is time to hire an experienced workers’ compensation lawyer.
How Can a Workers’ Compensation Attorney Help Me Appeal a QME Report?
Your attorney 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 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 happen within 30 to 90 days from the hearing. At the trial, each side will present its evidence. An experienced workers’ compensation attorney can effectively present your case to maximize your settlement amount. 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.
Contact Arash Law, Led by Arash Khorsandi, Esq., Today
Every injured worker is entitled to recover workers’ compensation benefits. Unfortunately, insurance adjusters are not forthcoming with payments after a workplace injury. When that happens, injured employees need an attorney.
Managed by Arash Khorsandi, Esq., our legal team at Arash Law is ready to help you get the financial recovery you deserve after a job-related injury. We have decades of experience helping injured California workers get benefits after an accident.
Contact our office today at (888) 488-1391, or chat with us to schedule a free no-obligation case evaluation today. We’re experienced in severe work-related head and bodily injuries.
