What to Expect at a QME or AME Examination

When you are injured at work and you file a Workers’ Compensation claim you will most likely be seen by a Qualified Medical Examiner (QME) or an Agreed Medical Examiner (AME). All QMEs and most AMEs are certified to evaluate the injured worker’s levels of permanent disability. Both QMEs and AMEs are neutral medical-legal evaluators who also decide your need for future medical care, work restrictions and whether the injury was caused by work.

Each QME/AME is certified in specific area of medical expertise for example if you have a hernia, you would see an internal medicine evaluator, or if you have hearing loss, you would see an otolaryngologist evaluator. But did you know the specialty of the QME or AME you choose can severely impact the outcome of your case? That is why it is important to retain legal counsel early on in the Workers’ Compensation claim. The attorneys at Mastagni Holstedt have decades of knowledge about the medical-legal evaluators across California.

The QME/AME examination is a very important step to the Workers’ Compensation case and can determine your level of permanent disability which can determine your settlement award payout. A lot of Applicants wonder what to expect at this QME/AME Examination.

Before the Exam

It is important to notify your employer weeks before the examination so you are excused from work for the exam. You may think that the adjuster is informing your employer of the examination but that is not always the case.

Before the examination the QME/AME will review all of your medical records pertaining to your alleged work injury. The QME/AME may even have someone in their office call you weeks before the examination to get your personal medical history. It would be beneficial for you to review all of your medical records pertaining to your work injury that way you can recall specific treatments you have received, procedures done, or medications prescribed.

Day of the Exam

It is very important that you arrive at least 30-45 minutes before your scheduled exam time because most QME’s/AME’s require you to complete paperwork. Please keep in mind that while in the waiting room at the examiner’s office the doctor’s medical staff will also be watching you and give their first impressions about you to the evaluator.

One of the most important forms is a questionnaire about your Activities of Daily Living. Sometimes these forms can seem boring and most injured workers are inclined to skip through these questions, however this form is not like the standard one you fill out for your normal doctor’s appointment. This form gives you the opportunity to highlight all the ways in which the work injury has caused a negative impact on your day-to-day activities. It is important to use the Activities of Daily Living to write down how your injury impacts your ability to care for yourself and do tasks such as laundry, cooking, etc.

The QME/AME will review the Activities of Daily Living questionnaire and your responses will be included in the evaluator’s final report. These forms generally have you rate your pain on a scale of 1-10, 1 being the lowest and 10 being the highest. You do not want to rush through these documents. The QME/AME will also ask you about the answers you provide; therefore, it is imperative that you answer the questions honestly, both on the form and with the doctor. Even if you do chores or activities that cause you pain, you want to explain the circumstances to the doctor as the questionnaire alone may not provide the entire picture.

During the actual examination the QME/AME will ask you how the injury occurred at work and your levels of pain. All questions should be answered honestly and without exaggeration of your symptoms, as doctors are able to sense insincerity. The amount of time spent with the QME/AME varies on a case-by-case basis but do not be alarmed if the evaluation itself seems to run shorter than expected. Please note that this is your time to advocate for yourself and the QME/AME will only know what bothers you if you explain it to them. Sometimes the QME/AME does not ask all the right questions or know all of the details of your injuries so you must inform them.

Please keep in mind that the QMEs are neutral evaluators, and they may ask questions you may find offensive or that imply that your injury is not that serious. However, do not take offense to these questions.  The AME/QME’s job as a neutral evaluator is to determine your levels of permanent disability without any bias.

You may also include if your injury has affected you mentally, your sleep, your motivation, your exercise, etc. When you have your AME/QME appointment please mention all body parts that bother you even if you think they are not relevant. Please let the doctor know if you are taking any medication for the injuries or have any current work restrictions.  Also, name any doctors that you have seen for the injuries and their recommended treatment. The doctor will also ask you how your job duties affect your injuries and what pain you have while doing your job duties.

There is also a possibility that insurance company has hired a private investigator to follow you around and take surveillance footage of you. This footage can be given to the QME/AME so it is best to be truthful about the extent of your injuries.

After the Exam

The QME/AME has 30 days after the date of the exam to issue their report. The report once done is then sent to you, the Insurance Adjuster, and to any legal counsel. Understanding the medical-legal report can feel like you are reading a document in another language. That is why it is important to have legal representation to help you understand the report and how it affects your case. Contact our office for a free consultation. At Mastagni Holstedt, A.P.C. our attorneys are dedicated to helping clients navigate California’s complex Workers’ Compensation system.