Have you heard your medical provider or attorney mention you may need an AME, QME or IME evaluation? Are you wondering what that could involve? Our team at RehabOne Medical Group can assist you with understanding the evaluation you have been referred for and will partner with you on the process. These evaluations are offered in our Los Gatos, San Jose, Gilroy, and Salinas, California offices. Find out more by calling RehabOne Medical Group today.
An AME, is an evaluation that is made by a provider who is selected by an agreement between an injured worker's attorney and the insurance company's claims administrator and their attorney. A medical examination is conducted, and a medical-legal report is prepared to help resolve a dispute. The Agreed Medical Evaluation is also used to apportion the workers' compensation claim. In other words, the evaluation will be used to determine what portion of your work-related injury was responsible for your disability, and what, if any, portions came from other causations or sources.
An Agreed Medical Evaluation is performed by an Agreed Medical Evaluator (AME). An AME is a doctor who has had additional training in workers' compensation requirements and work-related injuries. Again, this is a provider who is agreed upon to do the evaluation by an injured worker's attorney and the insurance company's claims administrator and their attorney.
If you do not have an attorney, a Qualified Medical Evaluator (QME) is who will conduct the evaluation for the purpose of resolving a dispute between you and your employer's insurance company. A QME in California is a physician who has undergone training and been certified to evaluate workers’ disabilities and create medical-legal reports, which are used to determine workers’ eligibility for benefits, according to the California Department of Industrial Relations. They must pass a test regarding the workers’ compensation evaluation process to become certified by the Division of Workers Compensation (DWC) Medical Unit. Once certified, the doctor’s name is placed in the Qualified Medical Evaluator database, which is used when a party involved in a workers’ compensation case requires the assistance of a QME.
An independent medical examination (IME) is a medical evaluation performed by a credentialed physician on a patient who was not previously involved in the treatment of that patient, to evaluate the patient's course of prior treatment and current condition. The physician will establish an informed expert opinion on the validity and nature of a diagnosis and provide a comprehensive report. An independent medical examination may be conducted at the request of an employer or an insurance carrier to obtain an independent opinion of the clinical status of the individual. Workers' compensation insurance carriers, auto insurance carriers, and self-insured employers have a legal right to this request an IME.