Dan Whitehead, Ph.D., Q.M.E.
Cell: (619) 518-2051
Phone: (800) 807-9618
Fax: (800) 807-9198
Psychological Evaluation San Diego
 

Qualified Medical Evaluation (QME)

Qualified Medical Evaluators (QMEs) are physicians who are certified by the California Division of Workers’ Compensation Medical Unit, to examine injured workers. They evaluate disability claims and write medical-legal reports that give guidance to how the claim is processed and settled.

QME

The QME reports are used to help determine an injured worker’s eligibility for workers’ compensation benefits. In psychological injuries, which are referred to as Injury to the Psyche cases in the workers’ compensation world, the determination of the injury can be complicated. This is because of the many special rules and regulations that apply to psychological stress and injury claims.

Injury to the Psyche claims can develop out of general or specific stresses encountered in the workplace. Examples include sexual harassment, hostile work environment, stress and trauma from workplace robberies, and other complex workplace situations and dynamics between workers, supervisors, and co-workers. The determinations can be very complex, and the QME must do an excellent job of analyzing and reporting what has happened, and how this has affected the worker. The QME also has to consider the special State of California rules and regulations that apply in such cases.

Injury to the Psyche claims can also arise from physical injuries that lead to chronic pain, such as a back injury, neck injury, shoulder injury, severe hernia, broken bones, machinery accidents that create physical injuries, and any other problems that lead to chronic pain. Chronic pain can sometimes lead to the development of depression, anxiety, mood instability, sleep problems, and other related problems.

Head injury and brain injury are also assessed by QME’s. These can result from blows to the head during robberies, exposure to toxic substances, vehicle accidents, machinery malfunctions, and a variety of other incidents in which brain function has been affected. This QME even once evaluated an injured worker who was thrown from a horse at work, landed on his head, and fell into a 3 month coma. In such cases, the effects of injuries on memory, attention, concentration, reasoning ability, and other general cognitive effects have to be evaluated thoroughly and fully reported.

QME

It is the job of the QME to fully and fairly assess all these complex and challenging issues, and provide written and supportable opinions that help the case to move on to being finalized. But how does the QME process start?

When a workers compensation claim is filed, The DWC Medical Unit is tasked with generating a ‘QME Panel’, which is a sheet of paper with the name of three randomly generated QMEs close to the injured workers home zip code. The injured worker can pick a name off the list, call the doctor, and schedule an appointment. If the injured worker does not choose a QME in a timely fashion, the insurance adjuster gets to make the choice. There are several different types of QME panels. A Strike Panel QME occurs when the injured worker has an attorney. The insurance company also usually has an attorney representing them. One of the attorneys requests a Panel from DWC. Then one attorney gets to cross out the name of one doctor, and the other attorney does the same. The doctor who is left is then assigned the QME case. There is also a type of QME selection which is called an "Agreed Panel QME". This means that in a represented case, the two sides agree to one of the names on the QME Panel, without the ‘striking’ process.

A more detailed overview of the QME process is available at the following link: http://www.dir.ca.gov/dwc/medicalunit/faqiw.html