During the process of getting and receiving benefits from workers’ compensation, you may have to see a qualified medical evaluator. A QME is a doctor that has met certain criteria and completed ongoing education through the system.
If you need to see a QME, it helps to understand what this person will do and how he or she functions within the workers’ compensation system.
Clearing up disagreements
The main job of a QME is to help when issues come up between you and the claims administrator. Typically, the QME will come in when there is a problem with your medical evaluation and the claims administrator does not believe your physician is accurate.
Evaluating your condition
If you need to see a QME, the doctor will assess your condition and write up a report. The QME can weigh in on various issues, including determining what caused your injury, how extensive it is and what treatment you need. He or she also can state the disability rating you should have.
You or the claims administrator may request the help of a QME. If you do not agree with the report of the QME, you can appeal it.
A qualified medical evaluator can help your case but also is there to help the insurer. This person is neutral and only considers the facts of the situation to provide an unbiased medical opinion and help to prevent fraud or other issues within the workers’ compensation system, which is beneficial to everyone. Regardless of who makes the request for the QME, his or her report will become a part of your claim.