Where The Injured
Go To Protect Their Rights

What is the role of a QME in a workers’ compensation claim?

| Aug 17, 2021 | Workers' Compensation |

Workers’ compensation protects anyone with a work-acquired medical condition, but getting benefits when you get hurt on the job isn’t always easy. Sometimes, you have to take special steps or appeal a decision that would negatively impact your health.

For example, if you and your physician don’t agree about what care you need or if your employer questions whether you actually need treatment at all, you may need the help of a neutral professional. Disputes related to the condition itself, the treatment required or the origin of the condition can all impact someone’s right to workers’ compensation benefits.

Thankfully, California has a system that connects workers’ compensation claimants with qualified medical examiners (QMEs) when there are questions about the extent of their injuries or the care that they need.

When do injured workers need to work with a QME?

For many people who get hurt on the job, medical treatment for their injury is straightforward. A broken bone requires diagnostic imaging, proper setting and immobilization. Later, once the bone has knit, the worker with the healed arm may require physical or occupational therapy to get back to work.

Other times, like when someone suffers a brain or spinal cord injury, there may be disagreement about both their prognosis and the treatment that they need. A qualified medical examiner is a specially-certified California physician who helps evaluate injuries for workers’ compensation claims.

The state randomly appoints QMEs to workers’ compensation cases. The injured worker has to submit to an in-depth exam, and the QME creates a report explaining what treatment is necessary and the impact of the condition on their work functions. The documents from the exam can help someone get the care they need. Learning about how workers’ compensation benefits operate can help you get the benefits you need after an injury.worke