There could be a number of reasons why an injured worker or insurance company/adjusting agent may want to get another Qualified Medical Examiner (QME). If an injured worker has multiple body parts and the QME that examined him/her could not address all of them, then the parties may be entitled to an additional panel QME in another specialty. The process for an additional panel is available when the doctor clearly states he is unable to address a particular aspect of the injured workers’ claim and recommends the parties to secure another medical-legal examiner to address those issues outside his area of expertise.
What if the QME claims to have the necessary knowledge to address the injured worker’s condition but you do not believe he does, such as an orthopedic examiner addressing a psychiatric claim? You can always write to the Medical Unit and request that they direct the evaluator to consult with a physician in the appropriate specialty. The claims administrator/insurance company is only required to pay for one medical-legal examination. However, upon a showing of good cause, by written agreement between the parties in a represented case, or by an Order from the Workers’ Compensation Judge, an additional panel can be issued.
What if you desire a replacement QME? In order to do so, a party would have to prove good cause. Some of the reasons that you might be able to get a replacement panel are as follows:
The above are just some of the reasons used to get a replacement panel or an additional panel.
If you have questions about treatment for your workers' compensation injury and want to talk to an attorney in Fresno, please call 559-408-7436 or fill out the form to the right.
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