Workers’ compensation is inherently collaborative, bringing together professionals from different fields with unique roles, responsibilities, and perspectives. Within this collaboration, attorneys and QMEs may rely on the same medical evidence, but they will typically approach it from very different directions. Understanding that distinction helps preserve the integrity of the process, promotes effective communication, and allows each professional to contribute their expertise toward a fair and well-supported outcome.
The Attorney’s Perspective
Attorneys and QMEs may work with the same medical evidence, but they have different responsibilities.
In a workers’ compensation case, an Applicant’s Attorney (AA) represents the injured worker and advocates for the worker’s rights and interests, while a Defense Attorney (DA) represents the employer, insurer, or claims administrator. Both attorneys evaluate the available evidence, identify the issues that matter to the case, and develop their positions based on the facts and applicable law. However, because they represent different parties, they naturally have different interests to protect.
This can be reflected in the questions they ask and even in how those questions are framed. For example, an AA may focus on evidence supporting industrial causation because the applicant bears the burden of proving that an injury or condition is industrially caused, and a QME’s opinion on this issue can affect the applicant’s entitlement to workers’ compensation benefits, including treatment. A DA, by contrast, may focus on evidence supporting apportionment to non-industrial causes by identifying other factors that contributed to the applicant’s disability. In doing so, the DA seeks to ensure that the employer is not held responsible for any portion of the disability that is not legally attributable to the industrial injury. The perspective behind the question may differ, but the QME’s responsibility remains the same: to independently evaluate the evidence and provide an opinion based on the medical facts.
While an attorney is expected to advocate for their client’s interests, that does not mean they will disregard unfavorable evidence or seek an outcome at any cost. It means they make the strongest appropriate legal case based on the evidence available. An attorney may therefore ask questions that challenge a medical opinion, seek clarification about the basis for a conclusion, or identify areas where additional analysis may be needed.
The QME’s Perspective
A QME is, by definition, an independent evaluator and, therefore, does not advocate for either side. The QME approaches the case from this position and is responsible for objectively evaluating the medical evidence, regardless of which side requested the evaluation or what position that party may take.
The QME’s role is to assess the medical issues presented and provide an independent medical-legal opinion based on the available evidence. While a QME may agree with the position of one party or the other, that conclusion must come from the medical evidence rather than from any obligation to support a particular outcome. The QME must be willing to consider the evidence from all sides, identify what the medical record supports, and explain the reasoning behind the opinions expressed.
That distinction does not eliminate the need for a QME to be familiar with legal issues and their implications. On the contrary, to provide a useful medical-legal opinion, a QME needs to understand the questions being asked and the legal context in which the opinion will be considered. This does not mean advocating for an attorney’s position. Rather, understanding the perspectives of attorneys, whether they be representing the applicant or the defense, as well as those of the other professionals involved in a claim, can help a QME communicate an independent opinion more clearly while maintaining their neutrality.
Bridging the Gap
Although applicant attorneys, defense attorneys, and QMEs all seemingly have different roles, the workers’ compensation system ultimately depends on their ability to work together. That collaboration is not always easy, and effective communication between the medical and legal sides is essential to reaching a fair and well-supported resolution. This is where medical-legal companies such as OrthoLegal can help. From coordinating evaluations and managing records to assisting with report preparation, scheduling, and communication, the goal is to make the medical-legal process more efficient for everyone involved. But support does not end with the administrative side of the process. OrthoLegal also provides QMEs with continuing education, report-writing training, and workshops, while facilitating ongoing interaction with attorneys. These opportunities allow QMEs to develop a better understanding of what makes a medical-legal report clear, complete, and responsive in a way that considers the needs of all involved parties.
Ultimately, the goal is not for attorneys and QMEs to approach a case in the same way. Their roles are different by design. The goal is for each side to understand the other’s role well enough to communicate effectively, ask the right questions, and make meaningful use of the expertise the other brings to the process.