Generally, when a person claims to need compensation for an injury, they are required to submit to some sort of legal evaluation that involves a medical examination. The most common type of legal case that requires a medical legal evaluation is a case concerning workers’ compensation benefits.There are many different types of medical legal evaluations that an employee may be required to submit to, including Independent Medical Evaluations, Psychological Medical Evaluations, or Fit for Duty Evaluations. These medical legal evaluations are used to determine the status of an employee’s medical condition and the results are used in court to decide how much workers’ compensation the employee is entitled to.
The legal evaluation process begins when a request for the employee to submit to a medical legal evaluation is submitted to the claims administrator in charge of the case. Usually the employer or the insurance company submits this request. Once the request has been submitted, a California QME (Qualified Medical Evaluator) may be selected at random from the state system. If the employee has legal representation, the attorney and the claims administrator must agree on which physician will conduct the legal evaluation. Because the results of these types of legal evaluations directly impact the settlement of the case, the physician who conducts the evaluation must not have any type of previous relationship with the employee. This is to ensure a completely neutral legal evaluation in which neither the employee or the employer is favored.
The next step of the legal evaluation is the medical examination. The physician starts by recording the employee’s family and medical history as well as the current symptoms being experienced by the employee. A brief physical exam is then conducted that focuses on the employee’s claim of injury. If the physician requires more information to make a final decision, he or she will order other types of tests, such as x-rays or lab tests. Once the exam has concluded and all other test results are analyzed, the physician will write up a report that summarizes all of the findings of the medical legal evaluation. The physician has 30 day to submit a copy of the final report to the employee, the claims administrator, the employer, and the Division of Workers’ Compensation Disability Evaluation Unit.
Different types of legal evaluations are used under different circumstances. When the employee does not have the legal representation of an attorney, they must have a Qualified Medical Evaluation that is performed by a California QME. In the event that the employee does have legal representation, the attorney and the claims administrator must agree on the physician to perform the medical legal evaluation; this is called an Agreed Medical Evaluator. A Psychological Medical Evaluation takes place when the employee’s claim involves a mental, psychological, or behavioral condition. A Fit for Duty Evaluation is a legal evaluation that examines both psychological and physical capabilities to ensure that an employee is able to perform all necessary job-related responsibilities.