In a workers’ compensation case,
it is very likely that an injured worker will be evaluated by a Panel Qualified
Medical Examiner (QME). What is less
clear is how the Panel QME becomes selected or appointed in a workers’
compensation case. The confusion may
lie, in part, in that the California Labor Code has two separate routes to the
selection or appointment of a Panel QME.
One route is for injured workers not represented by an attorney and the
other route is for injured workers represented by an attorney.
When an injured worker is not
represented by an attorney, the workers’ compensation claims adjuster may start
the process of requesting a Panel QME by sending a letter to the injured worker
objecting to a substantive issue in the case.
The same letter is then submitted to the Division of Workers’
Compensation’s Medical Unit for issuance of a Panel QME List comprised of three
doctors. If the injured worker does not
participate in this process, the workers’ compensation claims adjuster will select
the Panel QME doctor he/she believes may be more advantageous to the employer.
When an injured worker is
represented by an attorney and if the workers’ compensation claims adjuster
objects to a substantive issue in the case, written notice must be sent to the
attorney for the injured worker. Once
the Panel QME List comprised of three doctors is issued, the attorney for the
injured worker will research the list of three doctors and remove/strike the
medical doctor that may be less advantageous to the injured worker. Second, when an injured worker is represented
by an attorney, the parties may agree to forgo the Panel QME process and agree
to use an Agreed Medical Evaluator (AME).
What happens when an injured
worker goes from unrepresented to represented by an attorney and a Panel QME
List issued while the injured worker was unrepresented, is the injured worker
entitled to a new Panel QME List now that he/she is represented by an
attorney? There is persuasive authority
to argue that an injured worker is entitled to request a new Panel QME List
when the injured worker has not attended an examination by a Panel QME
scheduled while the injured worker was not represented by an attorney. (Nelly Romero v. Costco Wholesale, 72 Cal
Comp. Cases 824).
If you have questions, please
contact attorney Eli Moreno-Sanchez at (916) 318-4633.