California Qualified Medical Examiner (QME)
A California QME, or Qualified Medical Examiner, is a physician certified by the California Division of Workers’ Compensation – Medical Unit to perform exams on injured employees so that disability can be evaluated. When there is a question about what kind of benefits an injured employee should receive, a California QME is the type of physician who evaluates the employee. There are many different types of California QME physicians including, but not limited to, medical doctors, psychologists, doctors of osteopathy, acupuncturists, chiropractors, podiatrists, optometrists, and dentists.
The first requirement a California QME must fulfill is being board-certified in a medical specialty. The physician must then pass an administrative exam that is non-specialty specific (there are no questions about medicine). There is also a 12-hour report writing program the physician must complete before becoming eligible to be a California QME. Upon fulfillment of all California Division of Workers’ Compensation (DWC) requirements, the physician is listed as available for performing QME examinations in the area of their medical board specialty. In order for a California QME to remain active, the QME must complete a minimum of 12 hours of DWC-approved medical education every two years.
A California QME is used to perform qualified medical examinations for workers’ compensation cases because the injured employee or the claims administrator may disagree with the doctor’s initial diagnosis. There also may be other medical issues they disagree with. To settle these disagreements, a California QME performs the exam and addresses each issue. Some issues the QME might need to address are whether the injury resulted from work-related activity, whether the worker needs treatment, and if so what kind of treatment.
Another reason a QME is used is because the physician performing the exam needs to have an objective position and should not have a previous relationship with any party involved in the workers’ compensation claim. The physician to perform the exam is chosen from a randomly generated list of California QMEs. The list is generated through a computer program based on the worker’s zip code. Going through California’s state QME system ensures that the physician chosen will be unbiased and will not have a relationship with any party involved in the case.
Qualified medical examinations begin with the QME recording the employee’s medical history. Then the QME performs a physical exam and reviews the medical records given by the insurance provider. Once the exam is finished, the California QME writes an official report that covers all the essential issues of the workers’ compensation claim. Included among these issues may be causation of the injury, an impairment value calculation, what the appropriate treatment is, and workers’ compensation allotment.
It is mandatory for the California QME to serve a copy of the official report to the injured worker as well as the insurance provider. If all parties are content with the California QME’s opinion, then the QME’s job is finished at this point. If additional diagnostic testing or other things are needed, the QME might suspend judgment until they have received all the information.