The Qualified Medical Evaluator (QME) panel selection process ensures impartial medical evaluations for injured workers by a primarily geographic model that allows for some degree of flexibility in selecting a physician to act as the neutral medical expert in the case.
The QME Panel Selection Process
Request for QME Evaluation: When a dispute arises between the injured worker and the employer’s insurance company regarding medical treatment or benefits, either party can request a QME evaluation.
Panel Assignment: The requesting party for the panel chooses the specialty of the doctors on the panel. Upon receiving a request, the DWC generates a panel of three QMEs based on the geographic location of their listed office and its proximity of the injured worker’s home address.
Notification of Panel: The DWC sends a panel notification to both parties, providing the names, addresses, and biographical information of the selected QMEs. The parties then have 10 days to agree on one QME from the panel.
An unrepresented applicant has the ability to select one of the three candidate PQMEs. If they do not submit their selection within 10 days, the claims administrator will instead have the opportunity to select the QME from the panel [Title 8, California Code of Regulations, section 30, Labor Code sections 139.2(h), 4061(d), 4062(b)].
Strike Process: Each party “strikes” one QME from the panel of three, leaving one remaining to act as the QME.
Medical Evaluation: The selected QME will then examine the injured worker, review medical records, and provide an objective evaluation of the injury’s extent, treatment recommendations, and any work-related limitations.
The QME Workers’ Compensation QME panel selection system in California is a crucial mechanism that ensures injured workers receive fair and impartial medical evaluations. By maintaining a balance between the interests of both employees and employers, this system plays a pivotal role in resolving disputes, facilitating proper medical treatment, and promoting workplace safety.
A physician can maximize his or her chance of being selected as the QME in two key ways:
- Appear on more panels: this is a random process and is dependent on listing a maximum number of office locations and by strategic placement of these offices.
- Avoid being stricken from panels: this depends on the reputation of the QME. Writing high quality, neutral reports consistent with California law and submitted in a timely fashion will allow the physician to be selected as the PQME in more instances. Experienced QMEs are familiar with relevant case law and are able to confidently answer legal questions using their medical expertise. This comes through experience and an eagerness to learn from each case and continue to improve.
Very experienced QMEs can sometimes avoid the panel process altogether and be selected as an Agreed Medical Evaluator (AME) when both parties agree to forfeit the panel selection process and agree upon a QME. Being a QME is not strictly required to be an AME but is certainly the most common route. AME reimbursements are based on a multiplier of the QME fee schedule.