The Role of Qualified Medical Evaluators in worker’s compensation claims.
Represented injured workers have a choice of utilizing two different types of “qualified” medical examiners when there is a dispute in their case regarding what body parts are injured or whether they have permanent disability or if they have reached a permanent stationary status.
When dealing with experienced insurance adjusters and attorneys we can sometimes agree to a specific doctor to decide the medical issue. That doctor is called an agreed medical evaluator. (AME) If the parties cannot agree to an AME then you must request from the division of Worker’s Compensation a list of three doctors to choose from. (PQME) If you are represented then your attorney has a right to strike one name from the list and the insurance company has a right to strike another, leaving the chosen evaluator by attrition. We hope there are at least two well trained doctors on the list. This is seldom the case. Therefore, it is often a choice of which doctor is not as bad.
The doctors who are provided are often former experts that did work for the insurance companies that are now defending your claim. The specialty you choose in your case can dramatically affect whether or not you will receive a fair evaluation. By regulation the State of California has created technicalities which control what type of doctor specialty you can request.
As an experienced attorney, I am familiar with which doctors bring insurance company biases to the examinations or that are lacking in training. I can help you avoid walking into the lions den. If you are so unlucky I can help keep them honest with depositions and cross examination. Unfortunately, the pool of unbiased and knowledgeable doctors is very limited. Once you have been examined by a qualified medical evaluator you cannot change to another one. Therefore, it is very important to hire an experienced attorney early on in your case.