San Francisco, CA asked in Workers' Compensation for California

Q: My claims adjuster scheduled me for a QME, after agreeing upon a doctor for an AME with my lawyer. Is this normal?

My lawyer and claims adjuster made an agreement on a doctor for me to get an AME at a later date. I just recently received paperwork for a QME that was requested by my claims adjuster. The paperwork was postmarked for a recent date, so I know that the request was not an old request. I've contacted my lawyer (still waiting to hear back), but I am wondering if the claims adjuster is allowed to do this, knowing that I have a lawyer?

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2 Lawyer Answers

A: Unless you actually attend the AME appointment, the claims adjuster can decide to use a QME. I strongly suggest you wait until you hear from your attorney. It may be there was an assistant working on your file and inadvertently requested a QME. Remember, the QME process has protocols and if they were not followed, the QME is invalid. Further, if problems develop with the AME, it is a good approach to have a QME in place to reduce delays.

A: You have a lawyer, you will be paying that lawyer thou$ands or ten$ of thou$ands, you should be speaking with her. that said, if this doctor is truly an AGREED medical evaluator , then no, all parties should be writing to this doctor as the AME. If the doctor thinks he is a Qualified Medical Evaluator only and he doesn't like you or believe you , he will write you did not sustain a work injury... but if he is an Agreed Medical Evaluator and he knows this is your one and only medical report for trial, he may try a lot harder to follow you and make a finding in the middle.

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