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The Medical Examination

A Qualified Medical Evaluator (QME) is usually the first medical professional to review your California workers’ compensation claim file. QMEs are medical doctors certified by the state as having special expertise in the area of workplace injuries. 

When a worker files a compensation claim, the Division of Workers’ Compensation prepares a QME Panel — a randomly-generated list of three QMEs who are close to the worker’s home zip code. The worker may choose one name off the list. If the worker has engaged a Los Angeles workers’ compensation attorney, the process is a bit more specific: 

  • Strike Panel: The worker’s attorney may strike one name, the adjuster may strike a name, and the remaining name is designated as the QME.
  • Agreed Panel: The worker’s attorney and insurance adjuster may agree on a QME, thus eliminating the other two names.

New method

For injuries occurring after January 1, 2013, the process is different. The state utilizes an Independent Medical Examiner (IME) to resolve disputes about medical treatment in a summary fashion — usually in 40 days or less. The IME may only review the medical necessity of the proposed QME treatment. 

Once the QME has gathered sufficient data, which is usually after one or two visits, the QME prepares a written report reviewed by the Claims Administrator in charge of the case. The Claims Administrator uses the QME in rendering a decision as to whether or not the employee’s claim is valid. 

  • Physical injury: A physical injury can either be a workplace trauma event or an occupational disease, such as repetitive stress disorder.
  • Psyche injury: A psychological injury may be caused by either workplace stress or the effects of a physical injury. 

At The Tous Law Group, we accept new cases on a contingency fee basis. In other words, you do not owe any legal fees unless and until you obtain benefits.

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