I reported injury to my employer for stress and anxiety that resulted as a result of my job. My case has not been accepted but they are referring me for an appt with a QME and requested my medical records for the last 10 years. Why?
A QME is a Qualified Medical Examiner. In your case, a PQME or Panel QME. This is an independent physician who will examine you and your records and make a decision as to whether he thinks you have a psych injury and if so, how much, if any, is caused by work.
As you can see, the PQME becomes the God of your case. You cannot take the selectiion of your God lightly. Before requesting a PQME list, consult with a good W.C. attorney. Before picking a doctor off of the panel, consult with a good W.C. attorney. Both before and after going to the PQME, consult with a good W.C. attorney.
There are some very good W.C. attorneys in Bakersfield. Find a good one here at www.avvo.com or at www.caaa.org. CAAA is the association for attorneys here in CA who represent injured workers. Or you can call me for a referral.
They want the Panel Qualified Medical Examiner to have all your medical records to analyze any other potential causes of your anxiety. Chemical Dependency, AIDS, Financial Complaints, Sexual Difficulty, and Therapy History are not exhaustive, but are a good place to start unraveling your perceived work issues.
We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY upon any legal advice.
WHY you ask? Because the adjuster needs Medical Evidence to take the claim to trial to get a WCAB Judge to find you do not have any compensable work injury.
WHY get your medical records for the past 10 years?? The adjuster hopes something in that stack will show a few reasons other than work for your emotional difficulty .... OR THAT a pattern emerges from those records showing a very strong emotional reaction to routine life events (such as taking a month off work because your cat died).
When you write "...they are referring me for an appt with a QME" I am troubled. The adjuster should just be sending you the Request For Panel QME Form, and YOU are supposed to make the appointment yourself when the list of 3 psychiatrists arrives from the Medical Unit (in Oakland).
IF THE ADJUSTER really did schedule the appointment, something bad has happened.
THAT could me nobody wrote to the Medical Unit in Oakland, and the adjuster is just hand-picking a 'buddy' from the Medical Provider Network she knows will write you have no psych injury, and that doc will write as though he is your Primary Treating PHysician and you have no basis for any work-related psychiatric injury claim.
OR IT COULD ME you got the list of 3 docs from the Medical Unit and ignored it too long, so the Adjuster chose from the list for you....and chose the worst option possible from that list.
As Mr. Borah suggested, this QME from the panel becomes 'God' in this case, and if you didn't research and pick the name very, VERY carefully, your claim will be dead in the water when an unfriendly doctor writes you have no industrial injury at all.
It's the Insurance Adjuster's job to pick the QME doc when you fail to do so within just a few days of getting that list...but if you have the list and you haven't gone to the QME Appointment yet, either do a LOT of homework immediately on each doc on that list, or get to a Certified Specialist attorney to pick the right doc from that list.
O NOT 'JUST GO' AND SEE WHAT HAPPENS and hope somebody might fix the damage later.
A QME is a Qualified Medical Examiner. He will evaluate you, probably give you a few tests if he is a PhD. It will be his opinion that determines if you sustained an industrial injury, i.e. your stress was caused by the work place. If your employer has demoted you, given you a negative evaluation then this could be determined to be a 'good faith personnel action' and you might not be able to prove you sustained an industrial injury. You may need to seek the help of an attorney after you have the evaluation.