What is the difference between a QME and an AME?
If you find yourself in a dispute with your employer over your medical treatment or what benefits are due, an independent evaluation from a third party might help resolve the disagreement.
QME stands for Qualified Medical Evaluator, and AME stands for Agreed Medical Evaluator. A QME or AME can help you resolve a dispute with your employer or their workers’ comp insurance carrier over your benefits, diagnosis or medical treatment. An AME is only an option if you have an attorney representing you.
What is a QME?
A qualified medical evaluator (QME) is a physician who has been certified by the Division of Workers’ Compensation (DWC) as a specialist in a particular medical field. In addition to their medical training, QMEs are also specially trained in the examination of injured workers and the provision of independent opinions regarding medical issues that are the subject of a dispute between an employee and employer.
Your employer’s workers’ compensation insurance carrier can have a QME examine you whenever they have a question regarding some aspect of your injury, such as how extensive the injury is or how much your treatment is likely to cost. QMEs are common, for instance, whenever the treating physician determines the employee has a permanent disability.
If the claims adjuster requests a QME, the Division of Workers’ Compensation (DWC) will send you a list of three QMEs based on the type of injury and where you are located. This list of three is called a Panel QME or PQME. You have ten days within which to choose a QME from the list, make an appointment with them, and let your employer know you have done so. Otherwise, the insurance company will select a QME for you to see.
The QME will examine you and your medical records and render an opinion that either agrees or disagrees with the treating physician and resolves whatever medical issues are in dispute between you and your employer.
What is an AME?
Instead of choosing a QME from a list provided by the DWC, your attorney and the insurance carrier can get together and select an AME to evaluate you. This process gives you more leeway to choose a doctor you believe will provide an independent opinion and not be biased in favor of the employer. You and your employer and their insurance company will all agree to be bound by the decision of the AME. An AME is only available if you are represented by legal counsel. If not, you will need to pick a QME from the list provided to you.
