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Facts about Qualified Medical Examination


Qualified Medical Examiner (QME)

Physicians who are certified to contribute unbiased and actual opinion about work-related injury claims are called Qualified Medical Examiners. In short, a QME happens to be an expert in workers’ compensation and needs to be an unbiased judge – a QME is expected to review claims related to work injury without partiality of any sort.

The QME system has been formulated with a view of offering timely and impartial evaluation of compensation claims of workers which are disputed by parties concerned – i.e., the worker who is injured and the related insurance carrier.

Role of a QME in Work Injury-related Issues

When there is a dispute or if somebody is unhappy with any work injury claim, a QME is called in to look into the matter. Sometimes, patients may be unsatisfied that their impairment rating or when their case gets denied – they may refuse to accept it. Alternatively, the pertinent insurance provider may be under the impression that the victim’s physician has not provided complete information about the claim. Whichever may be the case, it is the responsibility of the QME to analyze the case closely.

Impact of QME on Injured Worker

If as a worker you have been hurt during work, and your insurance provider feels your physician has not furnished complete details on your claim, then you will probably be subject to a qualified medical examination. In case the QME findings show that your physician’s report pertaining to your claim is largely incomplete, it will bring change to your rating of impairment and also to the treatment amount payable by your insurance provider. Otherwise, when you are not satisfied with your work-related injury claim, you are eligible to call in the QME for reviewing your case.

Distinction between QME and AME

An Agreed Medical Examiner (AME) is a physician who is mutually agreeable to the worker involved in the work injury as well as the insurance provider. They both accept to be bound by the verdict of the AME. On the other hand, a QME is selected from the list of certified physicians with a view to get an impartial opinion about the disputed claim.

Working of a panel of QME

A QME panel consists of three qualified examiners who happen to be located close to the injured worker’s place of work. Panel QME exam aims at engaging unbiased examiners who will effectively consider the case, enquire about facts, and arrive at a solution that would supposedly resolve the issue in hand by moving toward an appropriate settlement and treatment. Assisted with chart records that are essential for the exam, they need to schedule the exam within a period of six weeks from the appointment call.

Initially history and physical examination are performed by the QME, followed by review of complete medical records that are furnished by the insurance provider. The QME has to prepare a standard report addressing the fundamental considerations of the compensation claimed by the worker. Facts such as cause of injury, current and permanent status, treatment needs, and calculation of impairment value must be addressed properly.

The QME has to serve copies of the QME report to the insurance provider, the worker who is injured, and concerned governmental authorities if needed, within a period of 30 days from the examination visit. If in case any further diagnostic test or documentation is found to be required, the QME has to hold reporting an opinion till such a time as the complete information are received.

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