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Difference Between QMEs and AMEs in Workers’ Compensation

Qualified medical examiners (QMEs) and agreed medical examiners (AMEs) have some key differences. Yet, the biggest one is choice. Computerized programs choose QMEs and assign them to injured claimants’ cases. The claimant generally does not get a say in whether they want to work with a specific QME.

However, matters change if an injured person gets legal representation. If they can work with the liable insurer and agree to work with an AME, then they do get a choice. If you have concerns about the outcome of your injury case, you may consider partnering with a workers’ compensation lawyer in your area.

What Is a QME?

QMEs and AMEs in Workers Compensation

According to the California Department of Industrial Relations (DIR), a QME is a licensed California physician that can legally practice in the state. They are also certified by the Division of Workers’ Compensation Medical Unit to perform medical and legal evaluations. Physicians that qualify as QMEs include:

  • Medical doctors
  • Dentists
  • Psychologists
  • Chiropractors
  • Osteopaths
  • Optometrists
  • Podiatrists
  • Acupuncturists

As noted, QMEs enter cases when there is a dispute between the involved parties about whether the injured person should receive benefits, how much they should receive, and for how long.

What Is an AME?

AMEs are similar to QMEs; they are trained physicians who evaluate injured workers in the aftermath of their accidents. Yet, the process for selecting them is different. Rather than having a computer program randomly select them, you, your attorney, and the defense must all agree on the doctor who performs your examination.

You may already have a relationship with the AME of your choice. This would benefit you because they would have “the whole picture” when it comes to your health profile. The relationship you’ve cultivated with your provider may also motivate them to advocate for you further.

Why Would I Need a QME or an AME?

Many injured people can file workers’ compensation claims and get the treatment they need without any problems. Sadly, this isn’t the case for everyone. Some employers retaliate against their workers in the aftermath of serious accidents. Insurers sometimes even deny claimants the compensation they’re owed for no justifiable reason.

QMEs and AMEs come into play when these issues arise. They’re unbiased parties who can assess your condition and assert your right to benefits. As stated by the DIR, an experienced QME or AME could address issues related to:

  • Whether your work caused your injury
  • If, and for how long, you must stay home from work to recover
  • Whether your injury is permanent or will heal
  • A new disability
  • A permanent disability rating

QMEs and AMEs generally don’t come into play when someone suffers a fatal workplace injury. Still, if there are disputes over your loved one’s claim, you may benefit from partnering with an attorney. They can consult with healthcare professionals to assert the cause of your loved one’s passing and advocate for what you need.

What if I Disagree with the QME or AME’s Findings?

If you disagree with the findings of your evaluator, then you have 30 days from the receipt of your report to address the problem. During these 30 days, you should consult with your lawyer about what options you have for securing benefits.

These options may comprise:

  • Getting another evaluation from the same healthcare provider
  • Requesting an evaluation from another healthcare professional
  • Supplying the healthcare provider with additional evidence
  • Negotiating for a settlement that satisfies both parties

Your lawyer may also examine whether you have the basis of a personal injury claim. This could provide an avenue for seeking compensation outside of the workers’ compensation system. Here, you would assert that because another party’s actions caused your accident and injuries, you deserve damages.

You Could Benefit From a Workers’ Compensation Lawyer 

One of the great benefits of having an attorney is that they give you the opportunity to seek an evaluation from an AME. You cannot request an evaluation from an AME if you are not represented by an attorney. This means that if you elect to forego legal representation, you must work with the QME already selected.

While simply having a workers compensation lawyer Los Angeles on your side does not guarantee you an AME, it does allow them to negotiate directly with the claims administrator to reach an agreement that could benefit you.

Lawyers With Experience Seek Fair Outcomes for People Like You

qme and ame in workers compensation

Filing a workers’ compensation claim can get complicated, especially if you’ve never filed a claim like this before. This is yet another reason to consider working with a lawyer. A Los Angeles personal injury lawyer with experience handling workers’ compensation claims can do more than help you work with an AME; they can also:

  • Notify the insurer of your accident and injuries
  • Gather evidence to supplement your claim
  • Assess the extent of your condition
  • Communicate with the involved parties
  • Negotiate for a fair settlement
  • Protect your rights

You didn’t expect to suffer life-threatening injuries when you arrived to work. Now that you have, you deserve to have an advocate who cares about your well-being.

Contact KJT Law Group Today for a Free Case Review 

If you disagree with the findings of your physician following an injury that occurred at work, you have the right to partner with an attorney. They can help you seek a proper evaluation from a qualified physician who can serve as another expert opinion in your case.

If your evaluation does not produce the results you were hoping for, then the team at KJT Law Group can discuss your options with you. We will explain how you can still receive benefits and what options you have for getting your life back. To learn about your next steps or the difference between QMEs and AMEs in workers’ compensation cases call us at (818) 507-8525. There is no obligation to partner with us when you call.

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