Q. What is a QME and why do I need one?

A.  A QME (Qualified Medical Examiner) is a physician certified by the State of California to perform disability/impairment rating evaluations. After you have had an injury at work, the QME will evaluate you for any residual disability you may have. The results of this evaluation will determine if you are entitled to additional benefits.

 

Q:  Who can I call for questions about the QME process?

A:  You can go to the Department of Workers' Compensation website or contact the Information and Assistance Unit at 1-800-736-7401.

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Q. Why does it take so long to get an appointment?

A:  The guidelines for scheduling appointments are set by the Department of Workers' Compensation. These parameters require the appointment be set greater than 30 days from the initial request, but before 90 days have elapsed. This can be extended to 120 days if all parties agree.

 

Q:  Why can't I send medical records to all of your office locations?

A:  All records and correspondence must be sent to our main office only to ensure receipt and routing to the appropriate doctor by the appointment day.  Some of our locations are in other doctor's offices and used for evaluation purposes only.  Those offices have their own day to day functions and do not accept mail for us as they are not associated with our practice.  

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Q:  How important is filling out the history questionnaire?

A:  Extremely important.  Our physicians require you to fill out the history questionnaire in advance to expedite the evaluation process.  This information is heavily relied upon and is used in finalizing your report.  This is a chance for you as the injured worker to provide information in your own words, not otherwise available to the physician which can then be reviewed and discussed during the evaluation.   

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Q:  I am the injured worker, will I get a copy of the QME report report when it is completed? 

A:  Yes. We are required to provide all parties a copy of the completed QME report. 

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Q:  If I am not represented by an attorney, how do I request additional information from the QME?  

A:  You must make your request in writing and make sure you copy your claims adjuster.  Then E-fax  your correspondence to (916) 777-2072 or mail to our main office. 

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Q:  How long does it take before the QME report is completed?

A:  The Labor Code states that physicians have 30 days to produce their evaluation reports.  Supplemental reports are allowed 60 days for processing.   

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Q:  I received an order to obtain new x-rays before my appointment, but my doctor already took some nine months ago.  

A:  Our podiatrists require a new set of x-rays at the time of your evaluation to determine your current condition and that a proper impairment rating is provided.  Actual x-ray images are required and you are requested to hand carry these films and/or CD of images with you to the appointment. 

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Q:  What is an Agreed Medical Evaluation?

A:   An Agreed Medical Examination is performed by a physician selected by agreement between the defense and applicant's attorneys to perform a medical-legal evaluation in a workers' compensation case.  

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Q:  What is an Independent Medical Evaluation?

A:   In workers' compensation, an Independent Medical Examination is used to resolve disputes about the medical treatment of injured employees.  Medical treatment disputes for all dates of injury will be resolved by physicians through IMEs, rather than through a court system.  IMEs can also be performed outside the worker's compensation system to resolve disputes in personal injury, retirement and other medical-legal situations. 

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Q:  What is SIBTF or Subsequent Injuries Benefits Trust Fund?

A:   If an injured worker has a pre-existing disability (either industrial or nonindustrial) and then sustains a new compensable injury, they qualify for SIBTF benefits under Labor Code 4751. The pre-existing disability needs to be labor-disabling or ratable. The combined effects of the pre-existing disability and the subsequent injury must be greater than or equal to 70% and the combination of both disabilities must be greater than just the effect of the subsequent injury alone.

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