QME and AME Process
A Qualified Medical Evaluator (QME) is a licensed physician who performs medical evaluations to resolve disputes in workers’ compensation cases. To serve as a QME, doctors must meet strict educational and licensing standards, pass a certification exam, and engage in ongoing education. If both parties agree on one doctor, they use an agreed medical evaluator (AME) for medical disputes. Whether it’s a QME or AME, these physicians provide essential medical evaluation to determine workers’ compensation benefits and settle disagreements.
QME AND AME PROCESS
A qualified medical evaluator (QME) is a licensed physician who performs medical evaluations to resolve disputes in workers’ compensation cases. To serve as a QME, doctors must meet strict educational and licensing standards, pass a certification exam, and engage in ongoing education. If both parties agree on one doctor, they use an agreed medical evaluator (AME) for medical disputes. Whether it’s a QME or AME, these physicians provide essential medical evaluation to determine workers’ compensation benefits and settle disagreements.
A Qualified Medical Evaluator (QME) is chosen from a state-certified list of doctors issued by the DWC Medical Unit, with lists generated randomly. An Agreed Medical Evaluator (AME) is used when you have an attorney, and once you see an AME, you cannot see a QME. An AME physician can perform a medical evaluation regardless of the year of injury and may or may not be a QME. Both AMEs and QMEs play a key role in resolving workers’ compensation medical disputes.
PDE'S ROLE
- PDE registers with the Division of Workers compensation QME locations chosen by physician.
- All fees associated with registration with DWC are covered by PDE.
- Physician is selected by attorneys or injured workers from a QME panel.
- PDE receives requests from attorneys or injured workers in unrepresented cases, to set up QME appointment.
- PDE handles everything pertaining to those appointments.
- PDE is processing and finalizing QME reports including but not limited to:
- Scheduling appointments commonly 45-60 days in advance according to doctor’s availability.
- Serving appointment notices to all the parties.
- Processing and summarizing medical and nonmedical records.
- Providing trained and highly experienced medical assistant at QME locations.
- Providing concierge services for all the communications between the physician and PDE.
- Performing appropriate testing ordered by the physician.
- Providing physicians with professional transcription services.
- Proofreading and prepping dictated and typed by physicians initial drafts and final reports.
- Serving final copies of the report and billing via certified mail to appropriate parties involved in the case.
- Processing supplemental reports requests and assisting physicians with supplemental reports completion.
- Providing new physicians with mock depositions with Dr. Sherman to familiarize physicians with commonly asked questions by attorneys and the process of deposition itself.
PHYSICIAN'S ROLE
- On the day of the appointment physician arrives to the location where he/she would be assisted by trained and highly experienced medical assistant.
- Medical assistant would be greeting and assisting arriving injured worker.
- Physician performs QME or AME examination at the location.
- Medical assistant handles all communications with injured workers at the location.
- After evaluation physician dictates the report using provided by PDE recorder or phone dictation services. Physician may opt to type the report.
- Within 24 hours report gets transcribed and received by PDE.
- Initial draft is sent to the preparation services or directly to the physician depending on personal preferences of the physician.
- Physician reviews the draft, makes edits and sends the report back to PDE for final processing.
- Report is being proofread.
- The final and approved by the physician report would be mailed out to all the parties involved in the case.
- Its physician’s responsibility to complete the final report within 30 days according to DWC regulations in regards to QME evaluations.
