What Is A QME? How It Affects My Claim?
Updated: August 13, 2022
In simple terms, a QME is a physician who is trained in the legal concepts in workers' compensation and writes reports in a legal fashion to evaluate all of the issues in your case. If you attend the wrong QME, then your entire case could be affected. It's a dreadful phone call we get often from unrepresented injured workers. They say "I went this QME doctor" and the doctor was terrible. What do I do?" There may not be a lot we can do if you have already gone through the QME process. So how do you avoid the mistakes that can be made?
Mistake #1: QME Request Form (QME Form 105)
Click here to open another internet window and go to our Mistake to Avoid page on our page and look at what this form looks like. Do you have it in your pile of papers? If the answer is "yes," then it may be time to contact an attorney.
If the insurance company sends you this form, and you don't take action, then in many cases they will fill out the form for you which is normally not to your advantage. What if you need to go to a Neurologist or a Pain Management physician and end up with an Orthopedic Surgeon. It's not a good match and could present problems in your claim.
You have the right to fill out the form on your own and request a QME List from the State of California. The QME list is another "land mine" in the workers' compensation system that we'll discuss below.
We recommend that if you don't have an attorney, that you contact an attorney that specializes in workers' compensation if you have this paperwork; at the very least, they may be able to give you some direction on how to fill out the form.
Mistake #2: QME List (QME Form 107
Click here to open another internet window and go to our Mistake to Avoid page on our page and look at what this form looks like. Do you have a form that looks like the QME List form?
If you already received a list from the State and you don't have an attorney, you don't want to pick a doctor without consulting with an attorney if that is possible.
The first problem with this list is that you have ten (10) days to pick a doctor; if you don't pick one, the insurance company will pick one for you. Second and an obvious problem is "who do you pick?" That's why calling an attorney now matters, because if you pick the wrong doctor, then as already discussed above, it could spell "trouble" for your claim.
Mistake #3: QME Appointment is Happening Soon
Let's say that you already got the QME List and a doctor was already selected...does that mean all is lost if you have the wrong doctor? Maybe not...before you go to the appointment, you should consult with an attorney. You may have ended up with a good doctor, and you can get that reassurance from an attorney who understands the work comp system. If you have a bad doctor, a lawyer still may be able to help.
Again, if you go to a doctor who isn't favorable to your claim, then you are most likely stuck with that physician. There are some legal steps an attorney can take if you already have been to QME appointment, but it can be an uphill battle that is often not won.
What should you take from this? If you get anything that has to do with a QME (a letter, a form, etc.), then we recommend you contact an attorney that specializes in workers' compensation; at the very least, they may be able to give you some direction on how to fill out the form.