What is a QME?
How do you navigate the QME process with or without an attorney?
In California Workers Compensation injuries are “rated” for impairment. Another lengthy blog entry will try to condense that complicated topic later. Essentially, a “rating” assigns a monetary value to the injury and the permanent disability that injury has caused you. That is what the legislature has determined to be the value of your body part, with plenty of help from the Insurance and Employer lobbyists, but please allow me to get back on topic.
Before an award of disability can issue in your case a medical legal evaluator must provide a report on your level of impairment. Whether you are represented or not determines the process from there.
If you are unrepresented the insurance company will try very hard to get a report on your impairment from your treating physician. Odds are that since you are not represented by an attorney the insurance company was very eager to help you “find” a doctor, and even set you up with your first several doctors visits going so far as to not even inform you that you could go to a different doctor if you wanted to. This is not because they are being helpful, but because they want to have control over which doctor you are evaluated by. So, when your treating physician issues a report on your impairment, bear in mind that the report was issued by a doctor vetted and selected by the insurance company. Also keep in mind that the insurance company will be paying you for your level of disability. I know it is sinister, but this is how workers compensation works- and why I have tossed aside a long and very successful career representing THEM, to now fight for YOU.
Once your treating physician issues the impairment report (called a PR4) you will receive a letter from the insurance company offering you “an award” based on that doctor’s report. Along with this letter you will receive forms advising you of your right to a Panel Qualified Medical Evaluator. The insurance adjuster will probably call you (the first time you have spoken with them in months, right?). They will “caution” you that if you go to a PQME your award could be less, and that your treating physician (their doctor, not yours) knows your medical condition better than a PQME. They will ask if you want to sign a “waiver” and not proceed with the PQME process.
If you decide to not take the bait and proceed with the PQME process, you (as an unrepresented injured worker) have a lot of control over that panel. You get to pick the panel specialty (some adjusters will send you the panel already designating an Orthopedic Surgeon, but YOU get to pick the specialty- not them). Once you mail the panel in to the Medical Unit and receive the panel (3-5 weeks later), YOU get to pick the doctor from the list of three doctors. Finally, even if the claim adjuster has convinced you to get a panel in the specialty THEY want, and you select a doctor THEY recommended, so long as you do not attend an evaluation with that PQME you have an opportunity to get an entirely new panel with a different PQME specialty if you hire an attorney before you go to the evaluation. So if you are reading this, even if the evaluation is tomorrow DO NOT GO UNTIL YOU SPEAK TO AN EXPIRIENCED ATTORNEY IN YOUR AREA.
I strongly urge any injured worker to take a step back, and ask themselves if they are getting information from a party who stands to gain from their loss. WHEN YOU RECEIVE THE PQME LIST OR THE PR4 FROM YOUR TREATING DOCTOR IT IS THE BEST TIME TO ENGAGE AN ATTORNEY WHO REPRESENTS INJURED WORKERS FOR A FREE CONSULTATION.
The Workers Compensation System is complicated. It can be navigated by you, but if you have an extremely friendly adjuster be cautious. They are very friendly so long as you do what they want you to do. Insurance companies have buildings and football stadiums with their name on them, and that is because they do not give money away. Their business model is to pay no more than they have too. Insurance companies will ask you to take less than they have to pay. Why not? If only a small portion of the people agree, that still equates to millions of dollars in savings for the insurance company.
Who needs the money more, a large corporation, or you- an injured worker who will experience a lifetime of physical limitations from their injury? While the permanent disability award will never make an injured worker “whole” it is one way that the legislators in the state have provided at least some compensation for you. Don’t miss out on the already inadequate recovery you are entitled to.
Please call me, even if you are not located in my area, if you have any questions regarding your doctors report or the PQME process.
Patrick C. Gorman, ESQ- newclient@gormancomplaw.com – 530-262-2168
