QMEs and AMEs evaluate any medical issues that arise in contested workers’ compensation claims. These conditions can be acute injuries, meaning they happened because of a specific incident, or acquired on-the-job illnesses, like mesothelioma. Not every workers’ compensation case will involve a QME or an AME; only those that have unresolved disputes may call for these professionals.
If you’re ever concerned about the progression of your workers’ compensation case, you have legal options. You can partner with an attorney who handles these situations and let them manage your claim.
QMEs and AMEs Evaluate These Medical Issues
First things first: let’s discuss the difference between a QME and an AME. A computer program randomly assigns a QME (qualified medical evaluator) to contested workers’ compensation cases. You might not agree with the QME’s evaluation.
So, you might hire a workers compensation attorney Los Angeles who can help you partner with an AME (agreed medical evaluator). Here, you get a say in what doctor you want to work with. For instance, you and the insurance provider may agree on a physician who you have a long-standing relationship with and who understands your health from a different perspective.
That being said, QMEs and AMEs may evaluate these conditions:
- Traumatic brain injuries
- Spinal cord trauma
- Broken bones
- Nerve damage
- Soft-tissue injuries, such as whiplash
- Mental health ailments, such as post-traumatic stress disorder
- Torn ligaments
This is not an exhaustive list. The truth is, there’s no limit to what condition a QME or an AME may evaluate. If a worker claims to have a certain condition, but there are questions surrounding it, a medical professional may evaluate it.
Types of Physicians That Qualify as QMEs and AMEs
The QME you see depends on the type of condition you’re claiming. The California Division of Workers’ Compensation outlines which doctors qualify as QMEs and AMEs.
If you suffer an injury, it is likely that the first physician you see is a medical doctor. If your condition falls outside of their expertise, then they may consult with another healthcare professional, per the California Department of Industrial Relations.
A medical doctor can determine if:
- Your injury happened at work.
- Your injury is temporary or will result in permanent damage.
- You had other previous injuries that could have led to your present condition.
- You can return to work and when.
A medical doctor could be assigned as your QME if your injuries are broad and do not require a specialist’s opinion.
If you suffer damage to your teeth, jaw, or mouth, then a dentist could be assigned as your QME. The dental QME would determine if your injuries are work-related.
For example, if you broke a tooth while eating an apple on your lunch break, you could not claim workers’ compensation benefits. However, if you were hit in the face and broke your front teeth, you could file a claim for benefits.
In addition to physical ailments, workers’ compensation claims can also encompass mental health issues. Some disorders that can qualify for workers’ compensation are:
- Post-traumatic stress disorder (PTSD)
- Generalized anxiety disorder
The California Department of Industrial Relations reports that claiming mental health injuries as part of workers’ compensation comes with many obligations. There’s generally a high burden of proof required, meaning that a QME may be called in to evaluate your condition.
Many work-related injuries result from lifting heavy objects. This can lead to back injuries, including herniated discs and a misaligned spine. The California Department of Industrial Relations notes that, in those cases, claimants may have a chiropractor assigned to evaluate their case.
Some of the most common medical issues that chiropractors evaluate include:
- Neck pain
- Lower back strains
- Carpal tunnel syndrome
- Back pain
Osteopaths have specialized training that allows them to see how a condition affects the body as a whole. These physicians can evaluate:
- Back pain
- Posture problems
- Joint pain
- Repetitive motion injuries
It can be hard to prove that some of these conditions resulted because of your work and not because of your everyday life. If your osteopath asks about previous injuries, be honest with them.
If you suffer an eye injury at work, or if you believe that your eyesight has decreased to a point where you can no longer work, an optometrist may evaluate your condition.
Harm to your eyesight will not result in workers’ compensation unless you can prove that the loss of eyesight was a result of work-related activities.
If you suffer injuries to your feet, legs, or ankles, then a podiatrist may be assigned as your QME. Podiatrists can offer treatment options for all types of foot-related injuries.
Once again, it will be the role of your podiatrist to determine that your injuries resulted from work and not from your everyday activities.
What Conditions Don’t Qualify for Workers’ Compensation?
While QMEs and AMEs evaluate just about any medical condition, they may not consider conditions caused:
- By an act of God
- While at work but not performing a work-related task
- While on a break
- While on a work trip but performing an activity that was not work-related
There are no specific injuries that would lead to an automatic denial of your workers’ compensation claim. The healthcare professional’s role is to determine if your injuries happened at work, how they affect your earning power, and to what extent.
Contact KJT Law Group Today
If you suffered a work-related injury and have concerns about filing a workers’ compensation case, you can connect with a Los Angeles personal injury attorney today. KJT Law Group can explain the types of issues evaluated by QMEs and AMEs, among other things. To learn about your options in a no-obligation case review, Dial (818) 507-8525. We can take your call and answer your questions now.