What is a Qualifed Medical Evaluator, and why are they important?

The State of California defines Qualified Medical Evaluators (QMEs) as “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.”

What does this mean for workers? If a workers compensation case is denied by the insurance company, workers are still entitled to a Qualified Medical Evaluation. QMEs are run by the state as neutral medical experts who work neither for the worker, employer, or the insurer. They review cases based solely on the medical merits of the case, including the workers credibility. The QME will study the medical history of the worker and evaluate the injury.

QMEs provide an important service in workers compensation cases. Physicians are required to pass a QME Competency Exam and complete a 12-hour QME report writing course from a provider approved by the Division of Workers Compensation. QMEs are not limited to a specific specialty. Medical doctors, dentists, optometrists, psychologists, and many other specialty practitioners can apply to become QMEs.

To ensure neutrality, three QME panel doctors are randomly selected by the Medical Unit based on the workers zip code. Defendant and Applicant each strike a doctor from the QME panel and the remaining doctor is the default QME evaluator. QMEs may disqualify themselves from cases if they have a conflict of interest, such as a personal relationship with an injured worker or employer. That neutrality is vital to ensuring a fair evaluation in every case. The QME is there to help both the worker and the insurer by providing neutral medical expertise.

If you have any questions about QMEs or another area of workers compensation law, feel free to contact us for more information.