QME Appointments

Many of our clients want to know what to expect when they are attending an appointment with a Qualified Medical Evaluator. The purpose of these evaluations is to provide a medical opinion from a legal point of view on the issues in the case.

What To Do Before the Appointment

First, most doctor offices will send a questionnaire for you to fill out. It is important that you adequately fill out the form to the best of your ability. Make sure you discuss all body parts affected by your injury. For instance, if you have a lower back injury and you have symptoms in your right leg, then describe the symptoms (pain, numbness, etc.). Be specific as to which leg is affected (right in this example).

Second, make sure the doctor is aware in the comment or additional notes sections provided in the questionnaire (if there isn't a section specific to this) any medical care prescribed by your treating doctor that has been denied by Utilization Review. If your doctor wanted an MRI, CT SCAN, EMG or other diagnostic test that wasn't authorized, then ask the doctor if he/she could comment on his/her opinion on the need for that treatment.

Third, it's important to call the doctor's office two weeks before the appointment and confirm the appointment date, time, and location to make sure you are prepared.

We recommend that if you don't have an attorney, to contact an attorney that specializes in workers' compensation if you have a QME appointment coming up. If you are in the Eureka area or any other area surrounding Eureka, contact Wells Law at 707-532-4344.

What to Do at the Appointment

First, do not take anything to the appointment unless 1) you are represented by a lawyer and they indicate that the defendants and your lawyer have agreed to allow you take particular information or 2) you are not represented and the insurance company has indicated that you should take particular information with you. It is against workers' compensation rules to take any items or information without the defendants being made of aware of that information and they have agreed that is "ok."

Second, you want to be polite and helpful to the doctor, but you need to be firm with that doctor when it comes to your condition. Make sure the doctor addresses all body parts and conditions. You need to make sure the doctor understands your pain level (1-10) with daily activities. What is the pain level with those same activities when taking medication? How much is it reduced? What is the pain without the medication? When and if you have worked during your workers' compensation claim, how did that affect your pain levels? What exact work activities caused the pain levels to increase?

Third, don't discount problems that you think are unrelated. If since the injury you have felt depressed, have anxiety, have had your sexual life affected, or you are losing sleep because of the pain of the injury, then make sure the doctor hears that from you both at the appointment and in the questionnaire.

An example of what might appear an unrelated condition: you have and your family have never had any kidney problems, but you have developed some serious issues with your kidneys. Doctors have indicated that long-term medication use (ibuprofen or other anti-inflammatories) is a likely cause. You may not realize it, but if you were taking medication (especially self-medicating for years) to work through pain in your back, knees, shoulders, etc., you could have another claim for kidneys as a "compensable consequence."

Failing to share all body parts that you are having problems with would not give the doctor the entire picture on what is going on in your body. They are the experts. Give them all the information and let them decide what is related to your work injury and what isn't. They may at the very least indicate in their report that more investigation needs to be done by a different specialist that is a QME.

Conclusion

A QME evaluation is critical stage in your case. If you selected a doctor from a list provided to you by the State of California, we recommend you contact an attorney before you attend that appointment. As we discussed in a different article titled Panel QME List | Workers' Compensation, you may be unknowingly going to a doctor that an attorney would never select. You might have other options if you have attorney.

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