Quality, On-time Reporting.
WHAT SETS US APART
As a QME applicant, advocate, or employer, you will find timely, quality reporting. We aim to streamline the process for the applicant. OrthoLegal is focused on care by Orthopaedic Surgeons in order to provide efficient reporting for musculoskeletal injuries.
Each team-member is cross-trained and familiar with all processes to minimize miscommunications.
Orthopaedic Surgeons are able to evaluate the most common injuries to workers compensation patients, which are musculoskeletal. At OrthoLegal, we focus on
musculoskeletal injuries to ensure the highest quality reporting.
AME (Agreed Medical Evaluator)
An AME is a medical specialist chosen by mutual agreement between the applicant’s attorney and the defense attorney to evaluate an injured worker. They provide medical opinions on key issues like injury extent, permanent disability, apportionment, and need for future care.
AME Attorneys/Applicant Benefits:
- Used when both sides are represented and can agree on a single evaluator.
- The AME’s opinion is given substantial weight by judges, so choosing the right AME is strategic.
- Limits litigation and helps streamline the case.
QME (Qualified Medical Evaluator)
A QME is a physician certified by the Division of Workers’ Compensation (DWC) to evaluate workers when there’s a dispute about their benefits. They issue medical-legal reports when parties can’t agree on an AME.
QME Attorneys/Applicant Benefits:
- If the applicant is unrepresented, a QME is selected from a panel list.
- The QME’s report determines benefits negotiated in the settlement.
SIBTF (Subsequent Injuries Benefits Trust Fund)
A special fund that provides additional compensation to injured workers who had a pre-existing disability and then sustain a subsequent industrial injury that increases their overall disability significantly. The SIBTF encourages employers to hire workers with disabilities by limiting liability for combined disabilities.
SIBTF Attorney/Applicant Benefits:
- Opens the door to additional compensation for severely disabled workers
- Supports inclusive hiring by reducing employer liability
- Requires accurate multi-specialty documentation and assessment
PI (Personal Injury)
Legal claims involving physical or emotional injury due to another party’s negligence (e.g., auto accidents, slip and fall).
Value to Attorneys & Parties:
- Attorneys help secure compensation for medical bills, lost wages, pain and suffering, and future damages.
- Unlike workers’ comp, PI allows for general damages (e.g., pain and suffering).
- Attorneys often coordinate with medical providers on liens and may work in tandem with workers’ comp cases in “crossover” scenarios.
What is a QME?
A Qualified Medical Evaluator is a physician who has been certified by the State of California to perform independent examinations of injured workers. These are required when there is a dispute between the worker’s injury claim and the employer.
QMEs review medical cases, help determine the course of treatment, assign disability ratings and more to ensure the injured worker receives appropriate treatment and employers are protected from inaccurate claims.