A Summary of the QME Process in California Workers’ Compensation Cases

The Qualified Medical Examiner or QME Process is a very important part of an injured
worker’s claim. This article will briefly summarize some important things about QME’s and
provide tips to injured workers to apply to ensure a thorough and accurate QME examination.
But before we continue, Remember, this article is not legal advice. If you have any questions,
consult with legal professionals with experience representing employees. Gateway Pacific Law
Group has over 15 years of experience representing employees. If you have any questions, feel
free to call GPACLAW at 562.338.1194 or visit GPACLAW’s website at www.gpaclaw.com.

The QME Process

QME’s are physicians specifically certified by the Division of Workers’ Compensation’s
Medical Unit. They provide an unbiased medical perspective on the worker’s injury. ‘Unbiased’ is
the keyword here. Unlike a treating physician who might have an ongoing relationship with the
patient, a QME reviews an injured worker’s injuries with fresh eyes and then prepares a
comprehensive report, which can greatly influence the outcome of a worker’s compensation
case, affecting the benefits an injured worker may receive.Their main role is to examine the
injured worker and prepare a comprehensive unbiased medical-legal report that will be used in
the claim process. So, understanding what a QME does and how they prepare for an
examination can be crucial for injured workers.

The process a QME follows to prepare for an injured worker’s examination starts with
reviewing the medical information related to the body part(s) that the worker injured. This
includes, but isn’t limited to physical examinations, diagnostic tests, and other relevant medical
records. It will also include a careful review of the injured worker’s deposition transcript, if a
deposition was taken. Next, the QME will conduct an examination of the injured worker. Finally,
the QME will analyze all of the information and prepare a comprehensive report.

Through this detailed process, the QME is able to make an informed judgment about the
worker’s condition, the treatment they need, and how the injury may affect their ability to work in
the future. Usually, the QME will review all relevant records related to the injured workers’
injuries, before and after the examination. But, the QME’s assessment is not a one-way street,
the injured worker’s input plays a significant role in shaping the final medical-legal report.

Preparing for the QME Examination

The injured worker’s role begins even before the actual examination. Communication
between the injured worker and their attorney is very important. The injured worker must tell
their attorney about all the medical care they received for the injured body part(s) when they first
meet their attorney. This is necessary so that the attorney can decide whether the medical
treatment is related to the work-injury. If it is, the attorney has to order those records so the
QME can review them.

Once an injured worker receives a deposition notice or they are notified about their QME
examination, they should immediately tell their attorney the last day they obtained medical
treatment for their work injury, so the attorney can obtain the injured worker’s most current
medical records, including doctor’s reports, test results, photographs, and any other
documentation that can shed light on the injury and its impacts.

The injured worker should also think about how the injury has affected their ability to
work, to do daily life activities, and leisure activities, like hobbies. They should think about how
to describe their pain. Is it intermittent or constant? Is the pain worse if the body part is moved a
particular way? The more details the better.

The Examination

On the day of the QME examination, the injured worker should arrive at the examination
site on time. The examination will usually take place at the QME’s office. The examination will
likely take at least a couple of hours and the injured worker will usually have to fill out
documents about themself and their injury.

After filling out the paperwork, the QME will conduct an examination of the worker’s
injuries. The injured worker must actively participate in the QME examination itself. Active
participation during the examination is also crucial. They must be open and honest with the
QME about their symptoms and how their injury has affected their ability to work and the
limitations on the injured worker’s personal and leisure lives.

In the context of work, the injured worker should discuss how their injury has affected
their productivity, their ability to perform their job tasks, or even their relationships with their
colleagues. The injured worker should tell the QME if they have had to take time off work, or if
they have needed to seek additional help to get their tasks done. Each detail contributes to the
overall picture of the injury’s impact on the injured worker.

The injured worker should be ready to tell the QME how the injury has affected their
ability to do mundane daily tasks. This can include anything from cooking and cleaning to
shopping and self-care. The injured worker should tell the QME about all the activities where the
work-related injury made these and similar tasks more difficult or even impossible.
Finally, the injured worker should be prepared to discuss how the work-related injury has
affected the worker’s ability to enjoy leisure activities. It is important for the injured worker to tell
the QME about the leisure activities they’ve had to give up, like a beloved hobby, or inability to
enjoy time with their family and friends as they used to. Maybe the injury has led to feelings of
isolation or depression, this information must be communicated to the QME. These are all
important factors that can influence the injured worker’s claim.

The QME is there to understand the injured worker’s condition, not to judge them. So, an
injured worker should not hold back on sharing details related to their injuries, no matter how
insignificant they may seem.

Active participation also means asking questions. If there are aspects of the
examination, or the process, the injured worker doesn’t understand, they should not hesitate to
ask the QME for clarification. Cooperation and active participation can significantly impact the
outcome of an injured worker’s compensation claim. So, every injured worker who attends a
QME examination must be prepared, be active, and be honest.

What Happens After the Examination?

Now that the examination is over, it’s time for the QME to get to work on preparing a
comprehensive report about the injured worker’s condition. This report, as we’ve mentioned
before, is incredibly important to the injured worker’s compensation claim. We will briefly
summarize some of the many topics discussed in this report.

First, the QME will identify all of the information they gathered and analyzed in order to
prepare the report. They will then summarize the worker’s medical history, and the specifics of
the worker’s injury. They will then analyze this data, focusing on the nature and extent of the
worker’s injury, the treatment they’ve received, and any resulting disabilities.

Once the QME has established that they have a clear understanding of the worker’s
medical condition(s), they will then determine if the injury was indeed work-related – a critical
factor in the worker’s claim. The QME will also consider the worker’s current and future medical
conditions, including any future medical treatment.

The QME will outline any other benefits the worker may be entitled to receive due to their
injury. This comprehensive report is essentially a blueprint of the worker’s health status and is
critical in determining the compensation they could receive.

Finally, QME generally has 30 days after the examination date to prepare their
comprehensive report. While it may seem like a long wait, remember that this process is a
marathon, not a race. The thoroughness and accuracy of this report can significantly influence
the outcome of an injured worker’s claim.

Workers Compensation lawyer Roger Haag
About The Author

Roger Haag is an attorney who specializes in consumer, labor, and employment law, primarily representing employees. Mr. Haag has extensive experience in various legal proceedings, including arbitration hearings, administrative hearings, bench and jury trials, and has even presented arguments before the California Courts of Appeal. Additionally, Mr. Haag served in the United States Navy and also has professional experience with the Department of the Navy’s Civilian Acquisition Workforce and Chief of Naval Operations Executive Panel in Washington D.C.


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