Workers’ compensation was designed to be an easy system for everybody involved. Since fault isn’t an issue, workers are supposed to be able to get the medical treatment and benefits they need without resorting to long, complicated legal proceedings.
It doesn’t always work that way, however. It’s not unusual for workers to face questions about the true nature of their injuries and the full extent of their limitations.
When there’s doubt about your condition, you may need an independent medical exam
Independent medical exams are often used to break a stalemate between the injured worker and their employer or the workers’ comp insurer. In California, that exam can either be done by an Agreed Medical Evaluator (AME) or a Qualified Medical Evaluator (QME).
It’s wise to know the difference.
A QME is picked from a random list of state-certified physicians. You have little control over how qualified these experts may actually be — and there’s good reason to be concerned that they may tend to be biased in favor of the insurance companies.
By comparison, an AME can only be used when you have attorney representation and you and the administrator in charge of your claim can come to an agreement about which physician you should see for an evaluation.
While you may not have any concerns that an AME is biased in favor of the insurer, you are likely locking yourself into whatever opinion they render on your case. Since you had a big influence on the selection of the AME, their evaluation is likely to carry a great deal of weight.
Don’t try to handle disputed workers’ compensation claims on your own
Understanding the nuances of the workers’ comp system here in California can be difficult and frustrating. Let an experienced advocate protect your interests from the start.