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:
- When the claims administrator requires an employee to see a QME, the employee has 10 days to submit the "Request for Qualified Medical Examiner" form to the DWC Medical Unit. If the employee does not submit the request within 10 days after receipt from the claims administrator, the claims administrator has the right to: (1) submit the request directly without further involving the employee; and (2) select the medical specialty of the QME panel.
- When the DWC Medical Unit issues a panel, a copy will be sent to both the employee and the claims administrator. The employee has 10 days from the date the panel issues to: (1) select a QME; (2) make an appointment; and (3) notify the claims administrator of the selection and the date of his or her appointment. If the employee fails to timely notify the claims administrator, the claims administrator has the right to select the QME and to make the appointment.
These new requirements are now in effect, but DWC will develop regulations to help clarify the process