Understanding the Role of QME in Workers’ Compensation Claims

GDPR, CCPA, and Beyond

In the world of workers’ compensation claims, a Qualified Medical Evaluator (QME) has to make decisions about what degree an injured worker is incapable and whether it served by work. Knowing the functions and importance of a QME is necessary for people handling workers’ compensation claims.

  • Definition of QME:

A QME workers comp is a medical professional licensed by the state to review and evaluate workers’ compensation cases. These people are impartial and independent; they form an objective third party to provide unbiased medical comment on the character and extent of a worker’s injuries.

  • Role in Determining Medical Condition:

The main duty of a QME is to assess the degree and seriousness of an injured worker ‘s injury. A complete evaluation requires a thorough examination of the medical history, current symptoms, diagnostic test results and so on. The QME examines the effects of an accident at work on health and prepares a complete report of what he finds.

  • Impartial and Independent Evaluation:

The independence and impartiality of QMEs are key features. Unlike treating physicians who may have an ongoing relationship with the injured worker, a QME has no association with any of the parties involved. This independence means an impartial assessment of the medical condition.

  • Appointment by the Division of Workers’ Compensation:

The Division of Workers’ Compensation (DWC) in the relevant state appoints QMEs. A list of certified QMEs with specialist knowledge in various medical fields is kept by the DWC. If the scope or necessity of continued treatment is a matter in dispute, DWC can order QME to evaluate an individual’s injuries.

  • Addressing Medical Disputes:

QMEs are a key to settling medical disputes in workers’ compensation cases. If there is a difference of opinion between the physician treating the injured worker and one chosen by an insurance carrier to evaluate medical issues, that case can be referred for independent review before a QME (qualified medical evaluator). The QME’s judgment assists in reaching a settlement and deciding what course of medical treatment and compensation is appropriate.

To sum up, QMEs play an important role in workers’ compensation claims in judging the actual state of affairs as to injured employees. As neutral and objective judges, the QMEs play a role in resolving medical controversies, as well as deciding questions of what type of treatment to use or how much compensation is owed. Understanding the QME process well gives injured workers better ability to negotiate within the Workers’ Compensation system.

To consult with a reputed lawyer, please visit kenton koszdin law office.