My Workers’ Compensation Adjuster Requested A QME – What Does That Mean?

QUALIFIED MEDICAL EVALUATOR:

Often a workers’ compensation adjuster will request a Qualified Medical Evaluator (QME) to provide a final expert medical report. A QME is supposed to be unbiased.  We always recommend an injured worker seek legal counsel before getting involved in the QME process as some medical reports do not feel unbiased for the injured worker.  The reality is that some QMEs are more employer friendly, some are more employee friendly, and some are middle of the road often called Agreed Medical Evaluators (AME).  AMEs are only a possibility to those injured workers with legal representation.  What if I am already in the QME process and do not have legal representation?

QME LISTS:

There are many technicalities or procedural requirements for a QME to be valid. The parties receive a list of three QME doctors and one of those doctors is supposed to become the QME.   The reality is that many times the procedural requirements are not met and the adjuster may request another list of QMEs.  In fact, both parties usually have the right to request another list of QMEs due to procedural defects.  It is usually the party that does not like the QME chosen and wants a different QME.  The adjuster usually likes a more conservative/employer oriented QME and the injured worker appreciates a more employee friendly QME.  Most injured workers have no practical information about the QMEs.  On the other hand the adjuster usually has information on which QMEs they like or dislike.

REPLACEMENT QME PANELS:

There are several procedural violations that allow a party to obtain another list of QMEs. For example, the QME may not be available for evaluation in a timely fashion.  Doctors are very busy and cannot always evaluate everyone within the 60 days required. When a procedural violation occurs a party may order a new panel of QMEs.  When some of the doctors listed on the second panel of QMEs are the same as the first panel we have another violation.  For each violation another QME panel may be ordered.  This can cause undue delay and take several months to finally obtain a legitimate panel.  It is a vicious cycle with every procedural violation when the parties continue ordering new panels of QMEs.  The adjuster may manipulate this process until they are satisfied with the QME chosen.  If that is the case the injured worker may not be satisfied with the end result.

GET REPRESENTATION:

In short, if you are not represented by an attorney and find yourself in the vicious cycle of replacement QME panels you should find representation immediately. The wrong QME could sink your case and there is usually an underlying strategy why new panels are being requested.  The wrong QME may also limit your ability to obtain legal representation at a later date because of the expense involved in cleaning up the QME reporting.

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