What Are the Differences Between an Agreed Medical Legal Examiner (AME) and a Panel Qualified Medical Legal Examiner (PQME) in California Workers’ Compensation?
Both AME’s and PQME’s are Medical Legal Evaluators. What that means, in part, is that they are not Treating Physicians. They are physicians that review medical records concerning a work injury. They also conduct a physical evaluation of the injured worker and write a report, typically between 15 and 30 pages, offering their opinions as to Maximal Medical Improvement (MMI), level of Permanent Disability, any permanent work restrictions, and future medical care.
A Panel Qualified Medical Legal Examiner (QME) is a doctor selected from a three-member panel list. There are different labor code sections on how to obtain this list, depending on whether or not an injured worker is represented by an attorney. If an injured worker is not represented, they can request a panel list of three doctors (typically in the specialty of the treating physician) and then can select one doctor off this list. Attorneys representing injured workers can also request panel list of three doctors. An Agreed Medical Legal Evaluator (AME), on the other hand, is a doctor that is agreed upon by the insurance company and the injured workers’ attorney. The panel process is bypassed. Note that unrepresented injured workers are not allowed to enter into an AME agreement with the insurance company because injured workers aren’t familiar with the Medical-Legal Evaluators in the industry. Despite efforts to be neutral, the truth is some Medical-Legal Evaluators are very biased for either the insurance side or the injured worker side. Competent Applicant Attorneys know who the reputable physicians are. Injured workers do not.
Another difference between a PQME and an AME, in addition to how each is selected, is that their reports and opinions carry very different legal weights. A PQME’s opinions carry similar weight to that of a Primary Treating Physician. If you get an opinion from a panel QME and it is different from the opinion of a Primary Treating Physician, and that case was taken to trial, a judge could decide that the Primary Treating Physician’s opinions are more accurate and thus carry greater weight than those of the PQME. Compare this with an AME. An AME’s opinion carries great legal weight. Unless it can be shown that the opinion is not substantial evidence, the AME’s opinion is going to be controlling and it will have more legal weight than that of the Primary Treating Physician. That said, it is very important that if your attorney is going to agree to an AME, that they choose a quality doctor who will give a good report. A seasoned workers’ compensation attorney will know how to do this.
One of the things that comp attorneys see quite often in their practice, is an injured worker that comes into their office, unrepresented and now seeking a lawyer because they got a PQME on their own and received a bad report. This is an unfortunate situation. A good workers’ compensation attorney may still be able to help correct the situation but it may mean doctor depositions, additional reports, and even taking the case to trial. Needless to say, it is so much better to have a good evaluator to begin with.
Sacramento Workers’ Compensation Lawyer
Hope this answers some questions you may have about the differences between an Agreed Medical Legal Examiner (AME) and a Panel Qualified Medical Examiner (PQME). For any additional questions please call The Law Office of Alice A. Strömbom at 916-444-7557 for your free consultation. We’re here for you.
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