California IME, AME, QME, PQME. What’s the Difference?
IMEs, AMEs and QMEs are all types of medical-legal exams performed by physicians to determine the cause, extent and medical treatment of injuries where liability is in question, so what’s the difference between them? It’s a common question in the medical-legal industry, and the answer varies depending on the state. In most states, the distinction is easy because QMEs and AMEs don’t exist. However, California has all three primary types of medical-legal evaluations, which we will discuss.
Qualified Medical Evaluators (QMEs) only pertain to California Workers’ Compensation cases. If an employee is injured while working and there is a dispute between the employee and the insurance carrier, that person would likely need to have a QME to help resolve the medical dispute. A QME would review the medical records and any other pertinent information and conduct an evaluation. The QME would then issue a medical opinion that can be used as evidence before the Workers’ Compensation Appeals Board.
QMEs are physicians that are trained and certified in med-legal evaluations by the Department of Workers’ Compensation (DWC). In order to become a Qualified Medical Evaluator in California, a physician must pass a test and take a 12-hour QME report-writing course. The test is not easy to pass. In fact, half of physicians do not pass it the first time.
Once a physician completes the above mentioned requirements, he/she gets appointed by the DWC for a 2-year period. At that point, the physician is now eligible to start performing evaluations.
If a party needs to utilize a QME physician for an exam, they would submit a panel request to the DWC, which would produce a panel of 3 QME physicians. In order to make the process fair to both sides of the case, the injured worker’s attorney and the insurance company’s claims administrator or attorney would each eliminate one of the names, leaving one name left, and that QME physician would be the person requested to conduct the evaluation.
An Agreed Medical Evaluation (AME) is very similar to a QME in that it deals with Workers’ Compensation cases. The only difference is in the process followed to select the physician. An Agreed Medical Evaluator is chosen if both sides of the case can agree on a physician without involving the DWC in the selection process. An AME physician is usually a QME, but does not have to be one.
In California, an Independent Medical Evaluation (IME) is an exam by a physician involving an injury that is not work-related. For example, if someone was injured in a car accident, that person could sue the other person’s auto insurance company for lost income due to the injury. IMEs are not connected to the DWC and have much fewer regulations than QMEs and AMEs. There is no official process for choosing an Independent Medical Evaluator, and no special certifications beyond a medical license are required. In most other states, the med-legal industry is much less regulated than in California, and Workers’ Comp cases are also handled as IMEs.
California Medical Evaluators (CME) has a network of 150 physicians across the state of California who regularly conduct all types of medical-legal evaluations including QMEs, AMEs and IMEs. We have physicians in all specialties and can assist you to find the doctor you need. To request a medical expert, click here.
Mr. Stoddard is a transformational sales and marketing leader who serves as Vice President, Sales & Marketing. With more than 15 years of experience in building and leading sales and marketing programs in the healthcare space, he is focused on enhancing the company’s brand, while expanding value added service lines. He earned his MBA from Northeastern University and holds a BS from the University of Massachusetts.