Why do I want to request a QME? What can a QME do in my case?

This video reviews the most common reasons that injured workers choose to request a panel of QME's. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
Jeremy Lusk is a certified specialist in workers’ compensation with about two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at [e-mail]

[@Analysemarie]

My injury to my knee (shredded Cartlidge) was back August 2022. My original primary Dr. I was seen through Workmans comp seemed to be on my side but then their office closed down and I got transferred to a new primary that makes me feel like I’m just a number. They referred me to a specialist in a separate office to see about surgery or steroids. He stated that he wouldn’t recommend either for me and told me that I need to be on disability … come to find out on my next doctors appointment. My now primary doctor told me that in his report he said that he did not think I was injured at work. So they’re now referring me to another specialist. My PD said that she sent a request in for me to see QME. I told the original specialist that I saw that I can’t even lift a 10 pound weight without being in extreme pain. I was injured at my job due to a patient prior to my injury, literally the night before it happened I was able to lift 200/300 pound patience with out an ounce of pain.

[@myworkerscompguide]

Your case sounds like it has some complicating factors, and I cannot offer any advice. You may want to reach out to the I&A Officer at your local WCAB office, or to a local attorney for a consultation. Then you can get specific advice for your case.

[@Bradley_Bern]

You are 100% right. I was informed by my attorney today, yhe workers comp adjuster has ordered me to see one of their IME physicians. Is an IME the same as QME? This is for a reinjured rotator cuff, same body part, different employer, same work comp insurer

[@myworkerscompguide]

If you're in Oregon, it's different than California. In California it's fairly rare to see an IME. AME's are agreed to by the applicant attorney and defense. QME's are appointed at random by the State of California in panels of three. IME's are appointed by a judge. Since you have an attorney, you'd have to ask him or her. Best of luck.

[@juniorromeo7590]

Hello. My workers' compensation payments stopped after PTP cleared me to go back to work. (But I still have pain.) 1. Now why hasn't the employer reached out to come back to work? 2. I also sent my employer a couple of emails about the doctor clearing me and when I could start but there was no reply. 3. Three months later, with no benefits or money coming in, I went to QME. With QME results, will I get back workers' compensation benefits payments reinstated? 4. What are my options to get some type of weekly payment into my hands while still injured? since they stopped my comp. payments. (edd or any) 5. Why do some work comp lawyers not reply to emails when sending these types of questions? In your experience, can you help with these questions? Thank you

[@myworkerscompguide]

Your questions are really best answered by an attorney going over your case with you. My channel is just designed to give injured workers information as to how the system works and inform workers so they can better represent themselves. I don't know why your employer has not responded. As to benefits that may be paid, or may be paid retroactively, it all depends on what the QME says and what the PTP has said and what the employer says. There are many variables. As to why some attorneys do not answer, if you mean just attorneys in general on the Internet I suspect it is because they are busy with their clients and you have very detailed questions. If you mean you have an attorney and want to know why he or she is not responding to your emails, you would have to ask your attorney.

[@badgalsheilabb2548]

HI I was wondering do both the adjuster in the attorney selects a QME together

[@myworkerscompguide]

Good question. The general rule is that an injury will only have one QME (unless there are multiple different specialties required), and whichever side picks the QME first gets to decide the specialty. So it's the old rule of - First come first served.

[@tayjay1164]

Thank you for your informative videos. Are you allowed to cancel a QME if it is too late? I got injured last year and am expected to make a full recovery. QME is scheduled 5 months after injury, I feel like that is too late. Can I request my Attorney cancel the appt?

[@myworkerscompguide]

I'm not sure how a QME could be too late. If the injured worker has made a full recovery, then the QME would still need to address likely future medical care and any work restrictions. In your case you would have to ask your attorney about strategy as to QME timing. Best of luck to you.

[@tayjay1164]

Thank you so much. @@myworkerscompguide

[@betterthanezra2583]

Hi I was hurt in WA State and had surgery in WA State as well, But now I live in NC If was was going to get a lawyer would I need a WA State lawyer or NC?

[@myworkerscompguide]

A good question, and I don't know the answer. But my gut says you should reach out to Washington state lawyer and try to get a consultation. That would probably be the best starting point. If the facts were similar and someone lived in California, was injured in California, and then moved out of state, it would still be a California case. Best of luck to you.

[@betterthanezra2583]

thanks for answer!! I def will I had a serious back injury and I can't go back to my work and prob will have perma work restrictions @@myworkerscompguide

[@myworkerscompguide]

@@betterthanezra2583 Best of luck to you.

[@mikebryant2413]

I was injured at work due to a fall. Damage done to my right knee. Badly damaged the bones this happened on February 26th 2024. ive been doing physical therapy and MRIs. Just recently spoke with my ptp. He flat out told me if my knee is not any better my next visit he will have nothing further he can do for me medically. So during this visit he gave me a steroid shot in the knee. He then told me that i would be permanent stationary duty. What does any of this mean.

[@myworkerscompguide]

When a doctor says the injured worker is permanent and stationary (or P&S, or MMI), that means the injured worker's condition has hit a plateau and is not likely to get much better or worse in the next year with or without treatment. A case can generally be settled at that point. The injured worker can object to that report and request a QME for an independent evaluation. The injured worker can also seek a new primary treating doctor if unhappy with the current. Also, the injured worker can request a second opinion if he or she disagrees with a treating physician's recommendations.

[@syntheticturtle]

Does an injured worker still have a right to go to a QME if there is no medical dispute? For instance... there's a denied post term CT claim (psych only), and there is no medical evidence of injury, I.e.,Applicant never goes to psych treatment during the delay period. AA then requests a QME panel under LC 4060 to address compensability using the denial letter. The insurance company objects to the evaluation taking place. I'm thinking of CCR §35.5 (c)(1) "The evaluator shall address all contested medical issues arising from all injuries reported..." Since there is no medical reporting indicating that a psych injury exists, it seems there would be no medical issue for the QME to address? Very interested in hearing your thoughts on this. Thank you.

[@myworkerscompguide]

I cannot speak to your case. As you have an attorney you would have to ask him or her as to strategy. I will say that in general there do not need to be treatment reports for there to be a dispute that a QME can address. A QME could still address whether there was a psychiatric injury and causation of it. That said, it is also possible to go to trial without a QME report depending on the basis of the denial. If the carrier denied the claim based on a post term defense and that the applicant was not an employee at the time, or perhaps that there was not six months of employment, then a trial could take place without a QME. Every case is unique with different fact patterns. I can only recommend asking your attorney in your case. Best of luck to you.

[@syntheticturtle]

@@myworkerscompguide Thank you very much, kind sir

[@myworkerscompguide]

@@syntheticturtle Happy to help inform. Best of luck to you.

[@ginacampbell8766]

I haven't seen a QME in 2+ years or so and my case has dragged out for 4 years after having left hip replacement January 2023. Now my right hip was recently diagnosed with major issues so this seems to never ending. I don't believe my right is a part of my claim.

[@myworkerscompguide]

Workers' comp claims do tend to drag on forever. I tell my clients that no matter how long they think the case will take, it will take longer. If your right hip is not yet part of the claim, and you believe it was injured due to your original injury, then you need to file an amended claim form adding the right hip and see if the adjuster accepts or denies it. You can also ask your treating doctor for treatment for your right hip, and then see if the adjuster denies it completely. If the adjuster does, you'll likely need to go back to the QME for a re-exam to address the right hip.

[@ginacampbell8766]

@@myworkerscompguide thank you very much. We are blessed/lucky to have you provide us w your subject matter expert advice and support. I love how your feedback is always thorough and articulate.

[@myworkerscompguide]

@@ginacampbell8766 Thank you for your kind words. Best of luck to you.

[@quinnoaechase7432]

Even though my case was accepted there is one body part was denied and not accepted for the PD rating and 4 the settlement, and which way is the best to dispute this body part denial?? Thank you Sir for your help 🙏

[@myworkerscompguide]

It likely depends on the reason for the denial. It may be that a QME re-examination is needed. Or perhaps a QME supplemental report. Or if the denial was more factual, then a trial may be needed. Fighting a denial, even of only a body part, can be very involved. You may want to reach out to your local I&A Officer at the WCAB near you, or consult with a local attorney to go over your options.