Workers Comp Zone


Most important issues in California workers’ comp cases are resolved by the QME process (QME is short for “qualified medical examiner”).

This usually occurs when the insurance adjuster sends the worker a letter saying that the worker must request a QME panel from the state. Often, the adjuster says that they are “objecting” to a determination by the treating doctor on issues of medical treatment, temporary disability or permanent disability. The worker is sent a form to request the medical specialty (i.e. kind of doctor) of the QME. If the worker does not pick the specialty, the adjuster can do so. That is important, but the real fun starts when the list of three doctors from the state arrives.

Many workers choose a QME for dumb resaons:

– “the doctor’s office was the closest to where I live” (what makes you think that doctor will be the most sympathetic to you?)
– “I picked the doctor who went to the most prestigious medical school” (do you believe that makes that doctor the most likely to be thorough?)
– “I picked the youngest (or the most experienced) doctor” (do you think that is an indicator of who will be most fair?)
– “I didn’t know anything about any of the doctors, so I just picked one at random”(did you consider talking to an attorney or to your treating doctor about the pros and cons of the various choices?)
– “the adjuster (or nurse case manager) suggested one of the three names, so I went with that one” (do you really think that employees of the insurer are looking out for your best interests?)
– “I chose a doctor at random because I figure an attorney can send me to another QME if I don’t like this one” (true under California law at one time, but not true now)

The bottom line: talk to an attorney BEFORE you pick a QME evaluating doctor from a panel of three. Due to the fast time lines for picking a specialty and picking the doctor once the panel is issued, you should act quickly. Otherwise, the adjuster can pick the specialty AND the particular doctor. That’s bad news for you.

Julius Young

Category: QME process