If you have an attorney, you and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator AME. If you have an attorney, your attorney and the claims administrator may agree on a doctor without going through the state system used to pick a QME. The doctor your attorney and the claims administrator agree on is called an agreed medical evaluator AME.
QME lists are generated randomly. An AME can only be used if you are represented by an attorney. An AME may be used regardless of the year of injury. In this context, the word panel means a list. A panel QME is a randomly generated list of three QME physicians issued to you when there is a question about whether or not your injury is work related, or if there is a medical dispute that hasn't been resolved by the treating physician's report.
Whoever fills out the form to request the panel QME chooses the specialty of the doctors on the panel.
You will receive the panel request form from the claims administrator and are given the first chance to fill out and submit the form. If you do not submit the form within 10 days, the claims administrator will do it for you and will get to choose the specialty of the QME you'll see. I have two different problems from the same injury for instance, a psychiatric and an orthopedic problem.
May I request two panels, one psychiatric and one orthopedic? The basic rule is that you get one. The claims administrator is only required to pay for one QME evaluation. The selected QME can get a consultation from another physician if there is a need for input from more than one medical specialty. In those cases, a panel will be provided. The Medical Unit cannot replace physicians based on distance from your address and cannot simply choose the physicians closest to you.
The claims administrator will pay your transportation costs to see the QME. The QMEs on the panel you issued are close to my home. However, can you give me a panel closer to work?
The law requires the Medical Unit to issue panels close to your residence. Title 8, California Code of Regulations, section Can I get a second panel if one or more of the QMEs are unavailable for over 60 days?
The Medical Unit will verify that the physicians on the original list are not available before issuing a new panel.
The panel QME I want to see is unavailable for three months. Can I wait for three months to see this QME? Under most circumstances you can choose to wait.
However, if the claims administrator is sending you to a QME because they don't think your injury or illness was caused by work, you cannot wait. The panel is randomly selected through a computer program. I received a panel three weeks ago and didn't select a QME. The claims administrator selected a QME from the panel and made the appointment. Can they do that?
If you didn't select a QME from the panel within 10 days of its issue date, the claims administrator has the right to make the selection. I was issued a panel of orthopedists at the claims administrator's request. However, I want to see a chiropractor. Will you issue a new panel? Your support person could also be a witness to the examination.
If the doctor does not allow this, you might ask if you could tape-record the examination or possibly take notes. Also, anything you say at the exam can be brought up during your case and could affect the outcome.
Sometimes, depending on what is said, the insurance company may use your statements to harm your case. Also, if you are taking pain medication, let the doctor know what type it is, the dosage, how many times a day you are taking it and the time you last took it. Contact Invictus Law today. If your treating physician gives you a permanent disability rating, it is likely the insurance company will want your disability verified by a QME.
QMEs can include medical doctors, dentist, psychologists, or any other qualified medical professional. Some QMEs are known to be more friendly towards employers or towards employees. You need to visit a QME doctor for evaluation and to determine your work-related injuries actually happened as indicated in your claim statement.
QMEs are supposed to be selected randomly from a list of state-certified doctors. The Division of Workers Compensation usually issues the list. The adjuster may choose some of his doctor friends to perform the exam.
Invictus Law can help. We have physicians in all specialties and can assist you to find the doctor you need. To request a medical expert, click here. Douglas Stoddard.
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