An attorney and an employer's claims administrator may agree on a doctor without using the state system for getting a QME. The doctor they agree on is called an AME. If they cannot agree, they must ask for a QME panel list. A “Request for Qualified Medical Evaluator” form must be submitted to the DWC Medical Unit either by the employee or employer. Whoever submits the request form picks the specialty of the doctor for the exam.
If you agree with the treatment requested by your doctor and the treatment is denied under utilization review, the dispute will be resolved by a QME. If you disagree with your MPN doctor about your diagnosis or treatment, you do not go to a QME – you have other options. If you disagree with your MPN doctor on any other issue, you will go to a QME. If the employee agrees with the treatment requested by MPN doctor and the treatment is denied under utilization review, the dispute will be resolved by a QME. If there is disagreement with the MPN doctor on any other issue, the dispute between employee and employer should be taken to a QME.
The QME is a physician who meets additional educational and licensing requirements, and is able to evaluate the recommended treatment and adjudicate the compensation issues. If the claimant’s attorney and the employer’s claims administrator agree on a qualified doctor to resolve medical disputes, this doctor is called an Agreed Medical evaluator (AME). In the case of mental health issues, a forensic psychiatrist QME has both the medical and legal credentials needed to deal with treatment and compensation issues.
Dr John M Stalberg spoke at the State Bar of California 84th Annual Meeting (Sept. 17, 2011, Long Beach, CA)
Download Meeting PDF: Psychiatric Injuries