What Happens After QME Report in California?
When an employee is injured on the job in California, they have the right to seek workers’ compensation benefits. These benefits are designed to help cover medical expenses, lost wages, and other costs associated with the injury. However, determining the extent of the injury and the appropriate level of compensation can be a complex process.
One crucial step in the workers’ compensation process is obtaining a Qualified Medical Evaluation (QME) report. A QME report is a comprehensive medical evaluation conducted by a qualified physician who is certified by the state of California. This report plays a significant role in determining the injured employee’s eligibility for benefits and the amount of compensation they may receive.
After the QME report has been completed, several important steps follow. This article will explore what happens after the QME report in California, including the necessary procedures and frequently asked questions.
1. Reviewing the QME Report:
Once the QME report is completed, it is sent to the claims administrator, the injured employee, and their attorney. The report provides a detailed assessment of the employee’s medical condition, including the diagnosis, prognosis, and any recommended treatments. It also addresses the employee’s work restrictions and limitations.
2. Challenging the QME Report:
If either party disagrees with the findings of the QME report, they have the right to challenge it. This can be done by filing a petition with the Workers’ Compensation Appeals Board (WCAB). The WCAB will review the evidence and make a determination on whether to accept or reject the QME report.
3. Negotiating a Settlement:
After reviewing the QME report, the claims administrator, the injured employee, and their attorney may attempt to negotiate a settlement. This involves reaching an agreement on the amount of compensation the injured employee will receive. If a settlement is reached, the case will be resolved, and the employee will receive the agreed-upon benefits.
4. Requesting Further Medical Evaluations:
In some cases, the QME report may not provide sufficient information to make a fair determination of the employee’s eligibility for benefits. In such situations, either party may request further medical evaluations. These evaluations can be conducted by additional QMEs or agreed medical evaluators (AMEs). The subsequent reports will be considered alongside the initial QME report in making a final decision.
5. Attending Hearings and Resolving Disputes:
If the parties cannot reach an agreement through negotiation or additional medical evaluations, the next step is to attend hearings before the WCAB. These hearings are conducted to resolve any disputes regarding the QME report or the injured employee’s eligibility for benefits. The WCAB will consider all evidence and make a final determination.
Q: Can I choose my own QME?
A: No, the QME is selected from a panel of physicians provided by the California Division of Workers’ Compensation. Both parties can strike names from the panel, and the remaining physician becomes the QME.
Q: What if I disagree with the QME report?
A: If you disagree with the QME report, you have the right to challenge it by filing a petition with the WCAB. The board will review the evidence and make a determination.
Q: How long does the QME evaluation take?
A: The QME evaluation typically takes around 30 days from the date the employee’s attorney submits a request for a QME panel.
Q: Can I receive treatment while waiting for the QME report?
A: Yes, injured employees have the right to receive medical treatment while waiting for the QME report. The claims administrator is responsible for authorizing and providing the necessary treatment.
Q: What if the QME report contradicts my treating physician’s report?
A: If the QME report contradicts your treating physician’s report, it may create a dispute. This can be resolved through negotiation, further medical evaluations, or hearings before the WCAB.
In conclusion, the QME report is a crucial element in the workers’ compensation process in California. It provides a comprehensive evaluation of an injured employee’s medical condition and helps determine their eligibility for benefits. After the QME report, several steps follow, such as reviewing the report, challenging it if necessary, negotiating a settlement, requesting further evaluations, and attending hearings to resolve any disputes. Understanding this process is essential for injured employees to navigate the workers’ compensation system effectively.