Many workers’ compensation claims are straightforward. A workplace incident results in an injury, and a doctor recommends a reasonable treatment plan. Workers’ compensation covers the cost of medical care and can replace lost wages while the employee recovers.
Other times, there may be disagreements or concerns that complicate the workers’ compensation claims process. Employers may question the origins of a medical condition, or there may be uncertainty about the treatment that the employee requires. In such cases, a qualified medical evaluator (QME) could help resolve the dispute.
What does a QME do?
Physicians who meet strict training and licensing requirements can ask the state to acknowledge them as QMEs. Typically, QMEs have a specialization in a certain area of medicine. After they pass a test, they can then perform in-depth evaluations of individuals seeking workers’ compensation benefits.
The goal of such evaluations is to determine the origins of a medical condition, the impact it may have on job functions and the best course of treatment given the circumstances. Often, QME evaluations are the result of an employer raising questions about a benefits claim.
Workers can choose a QME from a panel established by random selection. The California Division of Workers’ Compensation generates a panel with three options when an in-depth evaluation is necessary. In some cases, travel may be necessary to see a QME. The report produced by the QME can influence the progression of the claims process.
Individuals facing complex workers’ compensation claims may need help securing the benefits they require. A QME can play an important role in validating the need for care. Having experienced legal guidance can also help you get the benefits you deserve.
