Workers' Compensation

Workers' Compensation

Request a QME

NMG’s Qualified Medical Evaluator (QME) is a physician who evaluates a claimant when there are questions about what workers’ compensation benefits are appropriate. Our expert physicians meet educational and licensing requirements to qualify as a QME. They must also pass a test and participate in ongoing education on the workers' compensation evaluation process. A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. QME lists are generated randomly.

You May Receive a QME Panel Request from the Claims Administrator

A panel QME is a randomly generated list of three QME physicians issued to the claimant when there is a question about whether or not your injury is work related, or if there is a medical dispute that hasn't been resolved by the treating physician's report. The submitter of the form to request the panel QME chooses the specialty of the doctors on the panel.

A claimant must return the form within 10 days, or the claims administrator will do it for you, and will get to choose the specialty of the QME you'll see in accordance with Title 8, California Code of Regulations, section 30, Labor Code sections 139.2(h), 4061(d), 4062(b)). The claims administrator is only required to pay for one QME evaluation. The selected QME can get a consultation from another physician if there is a need for input from more than one medical specialty.

Request an AME if Represented by Counsel

If a claimant has an attorney, the attorney and the claims administrator may agree on a doctor to resolve medical disputes without going through the state system used to pick a QME. The doctor, attorney, and the claims administrator agree on an agreed medical evaluator (AME). NMG’s Agreed Medical Examiners can only be used if the claimant is represented by an attorney. An AME may be used regardless of the year of injury. An AME physician may be a QME, but does not have to be one. An AME or a panel QME will be used to resolve medical disputes in your workers' compensation case. Once an AME is performed the claimant forfeits the opportunity to undergo a QME.

Services

Services programs are tailored expressly for California workers’ compensation market, focusing on both causation and escalation. Services include:

  • Agreed Medical Examinations
  • Independent Medical Examinations
  • Medical-Legal Reviews
  • Medical Necessity Reviews
  • Peer Reviews
  • Peer File Reviews
  • Pharmacy Negotiations
  • Pharmacy Medical Necessity Reviews
  • Qualified Medical Examinations
  • Return-to-Work Negotiations