Bulletin No. 23-04
May 5, 2004

SB 899 changes process for choosing QMEs

The passage of SB 899 changed the process for choosing Qualified Medical Examiners (QMEs). Employees seeking workers' compensations benefits who are not represented by an attorney must now select a QME from a panel of three medical evaluators provided by the DWC Medical Unit to resolve claims disputes on both accepted and denied cases. After January 1, 2005, represented employees who do not utilize an Agreed Medical Examiner must also use QME panels.

New "Request for Qualified Medical Examiner" forms are under development at this time -- one for unrepresented employees and one for represented employees. Until the effective date of the new forms, both employees and claims administrators may use the existing form.

In addition to the new requirement to utilize QME panels, there are now time limits to make the request, selecting a medical evaluator from the panel, and making an appointment. The following time limits apply to unrepresented employees as of April 19, 2004:

These new requirements are now in effect, but DWC will develop regulations to help clarify the process