What Is a Qualified Medical Evaluator (QME)?

A Qualified Medical Evaluator (QME) is certified by the state to perform medical-legal evaluations in workers’ compensation cases. QMEs provide critical assessments and objective insights in the following areas:

  • Injury Evaluation
    QMEs conduct thorough examinations of injured workers to determine the nature and extent of their injuries, including whether the condition is work-related and to assess any lasting disability.

  • Medical-Legal Reporting
    Based on these evaluations, QMEs prepare detailed reports that inform decisions regarding a worker’s eligibility for compensation and other benefits.

  • Independent Medical Opinions
    In cases involving disputes or disagreements—such as whether an injury is industrially caused or if the individual has reached Maximum Medical Improvement (MMI)—QMEs offer impartial, medically-based opinions to support fair resolution.

Why do I need to see a QME?

  • A QME provides an impartial medical evaluation when there is a dispute regarding your condition, diagnosis, recommended treatment, or level of disability.

  • Their assessment helps resolve disagreements and supports fair decision-making in workers’ compensation claims.

How is a QME different from my treating physician?

  • Your treating doctor offers ongoing care and treatment.

  • A QME does not treat you; they perform a one-time evaluation and submit a formal report used to determine benefits and eligibility.

How is a QME selected?

  • The state issues a randomly generated panel of three certified QMEs based on your location.

  • You, your attorney (if applicable), or the insurance carrier may select a provider from this list.

Can I choose which QME I see?

  • Yes, but only from the three physicians listed on the official QME panel.

  • If a timely selection is not made, the opposing party may choose on your behalf.

Can I reschedule my QME appointment?

  • Rescheduling is possible, typically handled by your claims adjuster or legal representative.

  • However, state-mandated deadlines must be adhered to without exception.

What happens if I miss the appointment?

  • Missing your QME appointment can delay your claim and may impact eligibility for benefits.

  • It is crucial to notify the evaluator in advance if you are unable to attend.

How long is a QME appointment?

  • The evaluation typically lasts between 2 to 3 hours, depending on the complexity of the case.

Can I bring a friend, family member, or legal representative?

  • You may bring someone with you to the appointment; however, they will usually be asked to wait in the lobby and may not enter the exam room.

Will the QME prescribe medication or offer treatment?

  • No. The QME’s role is limited to assessment and reporting. They do not provide medical treatment or prescribe medications.

After the Exam

How long does it take to receive the QME report?

  • The completed report is typically delivered within 30 days of the evaluation.

  • It is sent to your attorney (if you are represented), the insurance carrier, and in some cases, directly to you.

Can I obtain a copy of the QME report?

  • Yes. If you do not have legal representation, the QME may send you a copy directly.

  • If you are represented, your attorney will receive the report and can share it with you.

What should I bring to my QME appointment?

  • A valid government-issued photo ID.

  • Any medical questionnaires or documentation provided in advance.