How does the Qualified Medical Examiner process work?
In California, the Qualified Medical Examiner (QME) process is a way for workers who have suffered a work-related injury or illness to receive medical treatment and, if necessary, to resolve disputes about the appropriate level of benefits they should receive.
Here’s how the QME process works:
The injured worker seeks medical treatment for their work-related injury or illness.
The worker's employer or the employer's workers' compensation insurance carrier arranges for the injured worker to be examined by a QME. The QME is a licensed physician who has been certified by the California Division of Workers' Compensation to evaluate and report on work-related injuries and illnesses.
The QME conducts an evaluation of the injured worker's condition and provides a written report to the worker, the employer, and the workers' compensation insurance carrier. The report includes a diagnosis, a treatment plan, and any recommendations for further testing or treatment.
If the employer or the insurance carrier disagrees with the QME's report, they can request a second opinion from another QME. The second QME will review the first QME's report and provide their own evaluation and recommendations.
If the employer and the injured worker cannot agree on the appropriate level of benefits, either party can request a hearing before a workers' compensation administrative law judge. The judge will review the QME reports and other evidence and make a decision about the appropriate level of benefits.
It's important to note that the QME process is only one part of the workers' compensation system in California. Injured workers can also receive medical treatment and benefits through their employer's workers' compensation insurance carrier, or they may have the option to seek treatment from their own medical provider if their employer has a "designated provider" program in place.