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Understanding the types of workers’ comp medical evaluators in California

| Nov 30, 2020 | Workers' Compensation |

If you’ve suffered a work-related injury or illness here in California, two terms you may hear as you go through the process of obtaining workers’ compensation benefits are qualified medical evaluator (QME) and agreed medical evaluator (AME). 

What kinds of issues do medical evaluators address?

Both QMEs and AMEs are physicians who can evaluate your condition if there is any dispute or question about your workers’ compensation benefits based on your treating physician’s findings. They determine things like:

  • Is your condition a work-related one?
  • Is your condition temporary or permanent?
  • Did you have a disability prior to the injury?
  • Are you able to return to work?

What’s the difference between a QME and an AME?

Anyone, whether they’re represented by an attorney or not, can choose a QME from a randomly generated list of doctors three doctors certified by the state. That list is provided by the Division of Workers’ Compensation (DWC) Medical Unit. To be a QME, physicians must meet specific licensing and educational requirements and be certified by the DWC. They know California’s workers’ comp evaluation process. 

If you’ve retained an attorney, you have the option of choosing an AME instead. This is a doctor agreed upon by your attorney and the claims administrator. Only people who have legal representation can choose to have an AME. An AME may also be a QME, but they don’t have to be. If the two sides can’t agree on an AME to review your case, you’ll need to choose a QME.

As with any process where the state is involved, obtaining a medical evaluator for your workers’ comp claim can be a confusing and frustrating process. The people you’re dealing with have a lot of experience with this and chances are that you don’t. On top of that, you’re likely still suffering some pain and possibly disability caused by your injury or illness. An experienced workers’ compensation attorney can help you protect your rights and work to seek the compensation you deserve.