The Medical Evaluation Process
Updated: Mar 8, 2021
Fortunately or unfortunately, many worker’s compensation cases come down to the opinions of the medical legal evaluator(s) assigned to the case. The medical evaluator, a qualified medical evaluator (QME) or an agreed medical evaluator (AME), will give his or her opinion as to the extent of a person’s injuries, and the parties are left to argue whether that report is substantial enough to hold weight in court.
Let me back up. First, why a QME/AME.
Often times, after an injury, an individual will go to a primary treating physician (PTP) for treatment. The PTP will treat and address the injuries, subject to an external review process. The PTP often provide his or her opinion and the injured worker will (hopefully) continue to improve.
At some point in the case, the parties will ask for a medical legal evaluation to obtain a different opinion of the injured workers’ progress. This is where the QME and AME come in. A QME is requested on unrepresented cases, or when the parties cannot agree on a specialty of doctor for the evaluation. If they can agree, they will use an AME. The evaluation is then set and the parties await the evaluation.
Before the evaluation, both parties can write to the doctor and request that he or she focus on certain aspects of the case. A QME or AME can be needed for a determination on whether the injury was work related, whether disability is owed, future medical care concerns, or simply a physical assessment of the injured worker.
It is important to note that a judge will put the same weight into a QME report as he or she would to a PTP. Therefore, if you get a good or bad report, use the other doctor’s report to dispute it. With that said, an AME report is controlling, when used, as the parties initially agreed to the AME in the beginning.
Once you get the report, you can push forward with settlement or trial, or you can request a supplemental report. Often times, the doctor will have his or her deposition taken by an attorney on the case to make sure the opinions he or she makes aren’t going to change.
One reason a deposition can be needed is to present additional information to the doctors for review. This will allow the doctor to revise his or her opinions as necessary. To avoid this, never lie to your doctors. If, for example, it turns out you tell the doctor you have never had a car accident, and the medical records indicate a car accident with multiple injuries, your credibility is tarnished and you may never recover. Always be truthful unless you truly cannot remember.
Do note that a medical evaluator can also request additional testing, such as MRI or X-Ray results. He or she will then amend, revise, or confirm his or her findings in prior reports.
Once a final report or the deposition transcript itself is obtained, your case can proceed forward. At this point, your doctor has likely indicated how your injuries were caused, your disability levels, and your future medical care concerns. This means, in terms of your case, that a settlement is likely nearing.
Overall, the process can take months. Not only that, but you could have multiple doctors and evaluators all pointing fingers and saying different things. The litigation aspect of your case will then need a trial or some great negotiators to figure out what is going on. This is where Liebert Law comes in. We can help navigate your claim through the medical legal evaluation process and get you on both the path to recovery, and the path to settlement. Never hesitate to contact us. Consultations are free and you only pay using a small portion of your settlement proceeds.