How To Prepare for Your Qualified Medical Examination (QME) in California - Law Office of Alice Strömbom (2024)

If you have experienced a work injury and have filed a workers’ compensation claim, you will likely be scheduled to be seen by a qualified medical examiner (QME). A QME (or AME which is a QME that your attorney and the insurance company have agreed upon) is a doctor that has certification from the Division of Workers’ Compensation Medical Unit (DWC). They will examine you and all your medical records to determine the extent of your work-related injury. They will decide if you have any permanent disability and what future medical care you may need. It is important that the doctor has all your medical records. If they don’t and you have a favorable report, the defense could argue that the examination was not thorough.

Here are ways to help you prepare for this examination:

  • List the degree/intensity of all your injuries. (Make a physical list to bring to the examination. An examination can be stressful and if you are under stress you can easily forget important facts that the doctor should know)
  • Make a list of secondary side-effects such as depression, headaches, stomachaches (caused by medication or not), anxiety, tingling, numbness, changes to your vision, loss of sleep, etc., that have occurred since the date of injury.
  • After completing your lists, write how each body part has been affected since your work injury such as: Does it hurt only when you move it a certain way or does it hurt all the time? Has your range of movement been limited in any way?
  • Rate all body parts/areas affected on the pain scale of 1 to 10 (10 being the most painful, 1 being the least). If the pain increases with certain movements, you will have an additional rating number for that specific body part during that movement. (Example: At rest, my wrist is a 3 on the pain scale, but when typing it increases to a 5)
  • Write a detailed timeline of what’s happened between the date of your work injury up to the QME appointment. (If you have experienced weight gain due to eating more because you are depressed or because of lack of normal exercise due to your injury, include this in your timeline).

All of this will show that you are serious about recovering from your injury and that you want to get back to work as soon as you are able.

It is wise to have help from a Sacramento Workers’ Compensation Attorney for the process of choosing your medical examiner from the provided QME panel (list). Though these certified doctors are supposed to be unbiased, an experienced comp lawyer will help select the ones than tend to generate reports that lean toward the injured worker and avoid the doctors who tend to produce reports that favor the insurance company.

You may want to bring a family member, spouse or friend for support. 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. Because of this, it’s critical to have assistance from a workers’ compensation lawyer before your examination.

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. This will give the examiner a more thorough understanding of your current condition.

Please also read about The Day of Your QME.

How To Prepare for Your Qualified Medical Examination (QME) in California - Law Office of Alice Strömbom (2024)

FAQs

What to expect at a QME exam? ›

In addition to asking questions about your medical history and workplace injury, the doctor will perform a physical exam and fill out a report with his or her findings.

What happens after QME appointment in California? ›

What Happens After a QME in California? After the QME completes their evaluation, they prepare a comprehensive report detailing their findings and conclusions. This report is submitted to the workers' compensation administrative judge, who considers it along with other evidence presented in the case.

How long does a QME evaluation take? ›

The QME report takes about 30 days to issue, sometimes longer, depending upon whether the parties agree. But when the QME report comes out, you'll have to decide how to proceed with it. Sometimes, a QME's report can be subject to dispute, which usually results in a long wait before trial.

How hard is the QME exam? ›

With a 50% failure rate, the QME Competency Examination is not something to take lightly and it's important to use a study guide that is tailored to the specific test.

Does a QME determine your disability rating? ›

Either the DEU, QME, or AME will review your case, including all medical records, and determine your disability rating based the factors discussed above. You have a right to receive a copy of the disability rating report and challenge its findings if you disagree with them.

What happens when a QME gives a disability? ›

A QME's determination that an injured worker has suffered some degree of permanent functional limitations as a result of the work injury, triggers the entitlement to receive permanent disability benefits. The QME will write a report and determine whether or not MMI status has been reached.

How much does QME pay? ›

As of Aug 22, 2024, the average annual pay for a Qme in the United States is $275,955 a year.

What is the next step after a QME report? ›

If you have an attorney, the QME will send a copy of the report to your lawyer and the claims administrator. From here, a disability rater from the DWC Disability Evaluation Unit will issue you a disability rating within 20 days, after which you and your attorney can begin discussing settlement of your case.

Is a QME a final? ›

The QME is not responsible for rejecting or approving a medical claim. Their job is simply to attest to the validity of the claim. After receiving a QME evaluation, the insurance company will make a final determination regarding the claim.

How is a QME selected? ›

A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. QME lists are generated randomly. An AME can only be used if you are represented by an attorney. Once you see an AME you are not entitled to see a QME.

How do you qualify for a QME in California? ›

Step 1: Pass the QME Competency Exam offered by the Division of Workers' Compensation (DWC). This exam is given twice per year (April and October). Step 2: Complete a 12-hour QME report writing course from an approved DWC education provider. Step 3: Finalize the application for QME appointment.

What is the point of a QME? ›

Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker's eligibility for workers' compensation benefits.

What to say and not to say at a disability doctor? ›

Avoid saying you are “o*kay” or “fine,” even out of habit. These statements can undermine the severity of your condition. Instead, be honest about your symptoms, discomfort, and limitations.

What not to say to Workmans Comp doctor? ›

Knowing what not to say to a workers' comp doctor can help ensure injured workers protect their right to compensation. When speaking with a workers' compensation doctor, injured workers should avoid exaggerating or lying about their injuries and hiding details about prior injuries or how the current injury occurred.

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