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How to Prepare for a QME: The Ultimate Guide

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Let’s say you got injured at work, but the insurance company denies the treatment your PTP (Primary Treating Physician) prescribed. This could mean upsetting news for you, as you don’t want to have any delays in your recovery. So what can you do when this problem knocks on your door? Get a QME (Qualified Medical Evaluator) to assess your case.  

Now that you have your appointment set with the QME, you must be ready for a successful encounter, which is key to obtaining accurate results regarding your treatment. Having that in mind, we share these five steps to help you prepare for your QME and get the most out of it.

Summary:

1. Learn What a QME Does

2. Be Nice and Polite

3. Remember That a Qme Is a Neutral Evaluator

4. Review Your Medical Records

5. Be Patient

1. Learn What a QME Does

Firstly, if you have a QME coming up, you must learn exactly what the QME’s job is. It is fundamental to know that QMEs (Qualified Medical Evaluators) are impartial authorities who congregate to give an opinion concerning your treatment.

Even though they are doctors, they do not provide medical care. Instead, their job is to build a thorough report containing their judgment on certain topics in a Workers' Comp case, which eventually helps solve the treatment disagreements you're facing.

2. Be Nice and Polite

It comes as no surprise that QMEs play a critical role in determining the outcome of your case. Since their reports are so complete, they are often viewed more favorably than the treating physician's (PTP). Therefore, you will want to be polite and pleasant to them.

Above all, behave smartly around QMEs or their workers because, if they don't have a good impression of you, they can put anything into your report that can negatively impact your case. And, of course, it is something almost impossible to disprove.

However, it doesn't mean you shouldn't hold the QME accountable if something undesirable happens. It is possible they only show up at the appointment for a few minutes, or that they don't examine you as they should have, or other similar situations. In cases like these, you must speak up and talk to your attorney.

It's just as crucial to keep records of everything that happens. If you want to dispute the QME's conclusions later, holding that information might help remove the faulty evaluation from the case.

3. Remember That a Qme Is a Neutral Evaluator

The QME is picked from a certified panel of doctors. By and large, they don't represent the insurance company or the injured worker. Their given role is to deliver their impartial medical opinions about the state of the injury, its subsequent treatment, or whatever is on the table.

Nevertheless, some doctors play sides. On the one hand, there are more liberal and injured worker-oriented doctors; these are the most likely to help you as you need to. On the other hand, some doctors favor the insurance company, and those are the ones we want to avoid the most.

If this is your first time in a QME, start by researching the doctors that will impart the exam. In preference, do some digging on all three doctors on the panel. Take your time to know them and ensure you'll have the best shot with them.

It's also critical to seek a Workers' Comp attorney who knows the subject, as they are more likely to select the appropriate doctor according to their experience. A doctor may have great ratings and an excellent CV, but they may not be what you really need. So, having a lawyer means a substantial advantage for you, for they'll know what to expect from the chosen doctors and use those insights to your advantage.

4. Review Your Medical Records

The squeaky wheel gets the grease. If you don't speak up about what is bothering you, no one will know you need help, let alone how to help you. Review your medical records, get to know your physical problems and pains, and make sure you understand your current health situation correctly.

We can't stress enough the importance of taking this step in your success. Imagine your knee is giving you problems, but if you go into an evaluation and only talk about your back pains, no one will address your knee. In the examination, you must express everything you feel, even if you think it's not related or relevant.

Often QMEs will send you a pre-evaluation questionnaire. This formulary allows you to pinpoint your pains, symptoms, and other crucial aspects of your overall situation. Double-check that you've documented everything. That is the best way to confirm you addressed everything meaningful at the QME evaluation.

If QMEs do not address every pain, it won't be the end of the case. Nevertheless, it's easier to do it at the evaluation rather than go back later requesting another report, sending additional medical records, and trying to clean up the already set declaration.

5. Be Patient

The QME report takes about 30 days to issue, sometimes longer, depending upon whether the parties agree. But when the QME report comes out, you'll have to decide how to proceed with it. Sometimes, a QME's report can be subject to dispute, which usually results in a long wait before trial.

If the defense disagrees with the presented declaration, they may request a new one from the QME. Even so, they may want to depose the QME, which can prolong the process. Regardless of the outcome of this procedure, patience is the key to not falling into despair. It is hard to wait, but it's better to prepare yourself for it.

Conclusion

The QME is just a stepping stone to getting the appropriate treatment you need. Don't forget that it is not the QME report that determines the outcome on its own; on the contrary, what matters is what happens afterward. Therefore, you must take these five steps to be prepared for a QME, as you'll want to get the best outcome possible for your case.

Going through this process alone can be cumbersome for you. An attorney covering your back will help you have some peace of mind and focus on getting better. Pacific Workers' is here for you; just make an appointment for free here or contact us at 800-606-6999.

Pacific Workers', The Lawyers for Injured Workers in Northern California's Premier Workers' Compensation Law Firm. Representing First Responders, Health Care Workers, Construction Workers, Delivery Workers, Warehouse Workers, and all the hard-working people that keep our community moving in their Fight for Justice against the Insurance Companies.

With over 250+ Five Star Reviews; an incredible staff of caring, well-trained, advanced technology for superior client communication: a track record of an over 98%-win rate, and giving back to our community through the Pacific Workers' Foundation, it is easy to see why Pacific Workers' is the go-to law firm for all injured workers in Northern California. Offices in Oakland, Concord, Stockton, Tracy, San Jose, and Sacramento.

If you or a loved one need help or just have a question, give us a call at 800-606-6999 or email us at Intakes@pacificworkers.com.

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