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FAQ, Medical Evaluations For My Case

What Happens During A Panel QME Or AME Evaluation?

Before the medical examination occurs, your medical records and any other documents relevant to your injuries (such as your injury report or statements you’ve given in your case) will be sent to the evaluating doctor. The doctor will decide whether to review the documents before or after the examination. The insurance company will write a letter to the doctor explaining your injury, summarizing your course of treatment to date, and posing specific questions about your medical condition. These questions are used to frame the issues for the doctor. For example, the doctor may be asked his or her opinion about whether your current symptoms are related to your work accident or whether a surgery recommended by your treating doctor is necessary. Our office will do the same and review the insurance company letter for accuracy. (If you are unrepresented, you should author your own letter to the doctor so they are aware of your position and questions) You should provide our office with any information you believe will be helpful for the correspondence to the evaluating doctor. Any information (letters and/or medical records) provided to evaluator must be sent to the doctor and claims examiner or defense attorney at least 20 days before the evaluation. It is not appropriate to bring new documents to the evaluation and the doctor will likely refuse to review them.

During a medical legal evaluation, there is generally no expectation of a normal physician-patient relationship. This means that anything you tell the doctor is not privileged or protected in any way. Your statements to the doctor could even be used against you in your workers’ compensation case. The same goes for observations the doctor makes. For example, if the doctor sees you walking normally from your car to the office, but then sees you grimacing with pain and favoring one leg in the office, he or she will make a note of that. You can bet that this inconsistency will show up in the doctor’s report, and the judge or hearing officer will take this into account when assessing your credibility. Be truthful and do not exaggerate. Make to tell the doctor about any prior accidents or injuries, especially those involving the same parts of the body.

During the examination, the doctor will likely start out by asking you about how your injury happened, what your relevant medical history is, and the course of your treatment so far. To prepare, you may want to go over your notes and review the timeline of what happened between your accident and the date of the evaluation.

You should ask questions about your condition and any potential treatment options that might help. You should provide any information you feel is helpful to the doctor in learning about the history and injury. If the doctor will be giving you a permanent impairment rating, you should ask how the doctor calculates the rating. You should also be sure to tell your doctor about any areas of your body that are still in pain and about any activities that you still have difficulty performing. Once your physical examination is done, the doctor will write a report and send it to all parties. We will send you a copy copy of this report upon receipt. Read it carefully so that you can point out any factual mistakes in your treatment or medical history.