The Insurance Company Selected a Qualified Medical Examiner for My Case and The Doctor Did A Lousy Job of Examining Me and Reporting. What Can I Do?


The first step in addressing a bad Qualified Medical Examiner (QME) report is to contact the Law Offices of Marc Francis, a work injury lawyer in Santa Rosa, and schedule a free consultation at our Santa Rosa office. We serve the greater North Bay area including Sonoma, Napa, Mendocino, and Marin Counties. We have complimentary consultations available on an expedited basis, and look forward to assisting you with prompt service addressing your workers compensation needs.

The QME examination and report is one of the most important steps in securing a fair settlement of your workers compensation case, which may provide for a lifetime medical award and temporary or permanent disability benefits for your work injury.

Frequently, we discover on investigation that the QME designated to perform your medical-legal exam was incorrectly selected, that the QME’s specialty is not correct for your particular work injury medical problems, that the examination and/or report were not timely done, that the QME report leaves out discussion of injured body parts, that future medical needs are not addressed, or that the insurance carrier failed to provide the QME with all appropriate information including your medical records, or sent the QME misleading or unfair comments about you or your work injury.

Often we find that the insurance adjuster completes the government form requesting the QME examination and chooses the medical specialty of the QME for you. This often results in a situation where the injured worker is deprived of her or his right to select a QME from any reasonable medical specialty. The adjuster will usually select an orthopedic surgeon for your examination and report and they tend to produce reports that are more conservative  — and thus more helpful to the insurance company—than some other medical specialties such as physical medicine, pain medicine, or chiropractic. The rules require to adjuster to send forms to an injured worker who is not represented by an attorney that allow that injured worker to select the QME specialty. If the forms arrive already filled out the adjuster will usually have selected a specialty more favorable to the insurance company. This is often neither fair nor legal.

If the QME examination date is beyond 60 days from the time of the request you may be entitled to a different QME doctor. Similarly, if the report is not produced by the QME within 30 days of the examination you may be entitled to a new QME for that reason as well.

Sometimes the QME will fail to address all injured body parts or systems. This may give rise to a request to the Workers’ Compensation Appeals Board for an order for a replacement QME doctor.

Other times the medical specialty of the QME is simply not appropriate for some or all of the parts of the body injured in the work accident. For example, a lifting injury may result in a back injury and a hernia as well. An orthopaedic doctor should not examine for hernias and instead should refer the injured worker to a doctor specializing in internal medicine or gastroenterology. Another example is a work injury to the neck or shoulders that results in headaches, and should be examined by a neurologist instead of an orthopaedic surgeon. We can assist you with these important questions.

How long did the QME spend examining you? Did the QME take a detailed history of your work injury and answer all of your questions? Did the QME listen to all of your complaints of pain and discomfort? Did the QME review all relevant medical records? All of these points need to be addressed.

In recent months, we have received calls from injured workers who report that they are being asked to travel long distances, such as from Sonoma County to Los Angeles, to see a QME doctor for examination and report for their work injuries. Sometimes this is because there are not enough certified QME doctors in our local area, but other times this problem can be remedied by obtaining an order from the Workers’ Compensation appeals Board for a new QME doctor panel on grounds that the one provided does not provide doctor choices within a reasonable geographic distance from the injured worker’s home. Another possible remedy is for your attorney to negotiate with the insurance company for an agreed medical examiner closer to your home who the parties have experience with as being a doctor that provides fair and impartial examination. This requires many years of experience in the practice of workers’ compensation law and familiarity with the available doctors. You will find that experience and knowledge of the doctors at the Law Offices of Marc Francis.

Your QME may order diagnostic tests, such as an MRI, nerve conduction studies, X-rays, or blood tests in order to correctly diagnose your injury and make findings about the workers’ compensation benefits to which you are entitled for your injury. Oftentimes the insurance company will oppose these diagnostic tests because they tend to support your complaints of pain or discomfort and therefore result in the insurance company being required to provide you with benefits. We spend considerable time in court on these cases obtaining orders for our clients’ needed diagnostic testing.

Your attorney may need to take a deposition of the QME doctor or do other discovery work in order to obtain the most accurate information to support your need for workers’ compensation benefits. At the Law Offices of Marc Francis we specialize in workers’ compensation law and we look forward to meeting you and discussing how we may be of service to you. Reach out to one of the best work injury lawyers in Santa Rosa and the greater North Bay area, including Sonoma, Napa, Mendocino, and Marin Counties. Call today for a free consultation at 707-664-9675.

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