What Is a QME?
Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker's eligibility for workers' compensation benefits.
QMEs include Medical Doctors, Doctors of Osteopathy, Doctor of Chiropractic, Dentists, Optometrists, Podiatrists, Psychologists and Acupuncturists.
What is the Role of a QME?
When a medical treatment claim is sent to an insurance company for preauthorization, the insurance company has to decide whether or not to approve the associated treatment or procedure. If they have any doubts about the validity or scope of a claim, they will hire a QME to provide a QME evaluation of the medical situation.
The primary role of a QME is to meet with the patient to determine the extent of the patient’s medical condition. During the QME evaluation process, the QME will review the patient’s medical and hospital records. They do this to rule out the possibility of a preexisting condition that might account for the injury.
Becoming a QME
A Physician who desires to conduct examinations as a QME must meet certain requirements specified by the Medical Unit of the Division of Workers' Compensation. A QME is required to take a comprehensive written examination, and also, they must complete a 12-hour course in report writing. The examination is given twice a year, in October and in April.
For more information on becoming a QME, contact the SCS QME Division at:
Email Us or Call 916-475-6310
