PQME's Are a Big Deal in a Workers' Compensation Case
Why is the Panel Qualified Medical Evaluation (PQME) so important to your Workers’ Compensation case?
When you get hurt on the job, sooner or later (usually sooner), the Claims Administrator on your case (i.e., the insurance company’s representative) says something to the effect of, “We disagree with what is going on with your treating doctor” or, “We deny your claim and you have to go see a PQME (panel qualified medical evaluator).”
I frequently meet people in my office who are at one of these steps with the PQME:
1. They just received “the package” of paperwork from the Claims Administrator which includes their disagreement with their treating doctor–or the denial of their claim. (In the package is also a form for requesting a PQME.)
2. They have received the package, filled out the form, and sent it in.
3. They did all of the above and now have the list of 3 doctors and must choose one within 10 days or the insurance company will impose one on them.
4. They have chosen 1 of the three doctors on the Panel List but have not seen the physician yet.
5. They have seen the PQME but have not received the report yet.
We can help you at anyone of these steps. But, the earlier in the process at which we see you, the more we can do to assist you with your claim.
At Step 1
It is important to identify the best choice of medical specialty for the PQME. For example, if your treating doctor is recommending pain management and the insurance carrier disagrees–thereby triggering the need for a PQME–then you might be better served by requesting a Panel of Pain Management doctors, instead of Orthopedic specialists.
At Step 2
If more than 30 days have passed, the Medical Unit (MU) probably has not received your request for a Panel of QME doctors. So, a courtesy call to the MU would be in order.
At Step 3
Choosing which one of these doctors would best serve your needs. (NOTE: This is one of the more crucial stages of this process.) This is where you can lose considerable advantage by making the wrong choice. You need to know the doctors working in the system. Some have preferences and dislikes that affect their opinions.
At Step 4
If you have already chosen one of the doctors–and may have made a poor choice–but have not seen him/her yet, there is still a way we can help you.
At Step 5
If you have seen the doctor and you feel (or we think it probable) that the doctor is not going to write a supportive report–and it has been 35 days since the date of your visit with him/her–we can help mitigate the consequences of that report.