In California, when a worker gets injured or sick while working, they are entitled to workers’ compensation. To claim this right, the injured employee must undergo evaluation, including a medical examination for the purpose of determining where and how an injury may have occurred, as well as how severe it may be. There are, however, a few different kinds of medical evaluations that exist – and it is common for first time claim filers to be unsure about what differentiates one from another. Read on for a summary of the different kinds of medical evaluations available in the Golden State.
- Qualified Medical Evaluation (QME) – These types of evaluations exist only in California Workers’ Compensation. A QME is the kind of evaluation required when it comes to resolving any disputes between injured employees and insurance companies. During a Qualified Medical Evaluation, a doctor registered with the state as a Qualified Medical Evaluator will review any medical records as well as other bits of information about a case prior to coming up with a medical opinion. This is then submitted to the Workers’ Compensation Appeals Board (WCAB) and can be used as evidence to make a case of whether a claimant should be granted injury benefits or not. It is not easy to become a QME – doctors must pass a difficult examination as well as a course on how to write reports, and around half of the physicians who attempt to register fail on their first try.
- Agreed Medical Evaluation (AME) – This is almost the same as a QME, the only difference being the way in which a doctor is chosen is different. An AME is a physician that is agreed upon by both patient and insurance company without arbitration by the Division of Workers’ Compensation (DWC), whereas QMEs are selected through a process involving the DWC, the insurance company, and the patient’s attorney. Finally, AMEs can be done by any doctor if both parties agree to it.
- Independent Medical Evaluation (IME) – These are evaluations made by physicians for injuries that are not work related. California’s Workers’ Compensation system is far more regulated than most other states and is therefore not relevant when seeking out workplace injury benefits in California. In other states, however, Workers’ Compensation cases can also be handled by Independent Medical Evaluators, even though nothing more than a license to practice medicine is required.
Writing QME reports in California can be challenging with all the regulations that are currently in existence. Good thing you found TukkoMed – your partner in ensuring all reports achieve state compliance. What are you waiting for? Ease your pain by sending us a message today!