Working as a QME requires a working knowledge of the language that the attorneys use.
Adjuster (ADJ): Also known as Claims Administrator. Representative from the insurance company who helps the flow through the claims process.
Applicant: Injured worker with a claim being seen by the QME.
Applicant Attorney (AA): Attorney representing the injured worker (applicant).
Cover Letter: A document, possibly accompanying medical records, from the attorney to the QME physician detailing specifics regarding the report requested. This must have a date and a signature. These are not strictly considered to be medical records and do not require a declaration for review when received alone.
Declaration: Also called Attestation. This is shorthand for the declaration sent by a party to indicate the number of pages of medical records that need to be reviewed by the QME physician and then billed. This declaration must be dated and signed, and accurate to the page count within +/-10 pages. If any of these is missing, it is considered invalid.
Deposition: Also called a Cross-Examination. Recorded testimony under oath. In QME work, the physician will have their deposition taken by one or both parties and this may be done in person or via video conference. A court reporter is present to take the deposition under oath.
Encounter: Any billable event (Initial Evaluation, Re-Evaluation, Supplemental Report, or Deposition).
Ex parte: This is communication between the physician and less than all parties. This is illegal. A physician must only communicate between the parties in the form of a formal report, and all parties must be served with that report simultaneously. Likewise, a physician cannot accept records directly from the applicant or any one party, as not all parties are privy to that communication. Everything must be done through the law firms or DWC.
Initial Evaluation: An applicant’s first evaluation with that QME.
In pro per: An injured worker not represented by an attorney.
Panel Qualified Medical Evaluator (PQME): A QME selected from a panel of three physicians based on location of their office of examination and its proximity to the residential address of the injured worker.
Re-Evaluation: A follow-up evaluation with the QME.
Reflex Supplemental Report: In all ways identical to a Supplemental Report except that this occurs when records are received after an evaluation (late receipt of records). The due date is then 60 days after receipt of the records and is not based on the date in the cover letter or declaration.
Review of Record (ROR): A word document that is a transcription of the medical records and nonmedical records sent. This is necessary in order to format it properly for insertion into the report.
Strike Panel: Three physicians selected by a computer algorithm to be a QME for an injured workers claim. Each party (applicant and defense) is required to strike one name, resulting in one QME being selected. The strike panel is paperwork that we must save for our records and contains useful information relevant to the case.
Sub-Rosa Footage: Video footage of the applicant taken in secret. This is evidence to verify an applicant’s claims of disability. In a practical sense, it is sorted and filed in the same way as any other digital files, and requires comment from the physician in their report.
Over time, QMEs will have these terms memorized like the back of their hand. For those that may need the occasional refresher, QMEs can reference their OrthoLegal physician training guide for the full glossary of terms utilized in Workers’ Compensation.