Qualified Medical Evaluations (QMES)
Need a Qualified Medical Evaluation (QME) in Van Nuys?
Hussain & Gutierrez Law guides injured workers through the QME process to protect their workers’ compensation rights. Whether you’re dealing with a disputed injury or your benefits are being delayed, we help ensure fair medical evaluations, proper disability ratings, and maximum benefits. Call 888-997-3701 for a free consultation.
What Are Qualified Medical Evaluations (QMEs)?
Qualified Medical Evaluations (QMEs) are independent medical exams conducted by state-certified physicians to resolve disputes in workers’ compensation claims. These evaluations are required when there’s disagreement between the injured worker and the insurance company over:
- Whether an injury is work-related
- The extent of the injury or illness
- Necessary medical treatment
- Permanent disability rating
Under California Labor Code §4060 and Title 8, §9785, a QME provides a legal opinion that can determine your eligibility for benefits.
Role of QMEs in Workers’ Compensation Claims in California
QME Role | Description | Legal Reference |
Assess Injury | Evaluates injury severity and causation | Labor Code §4060 |
Determine Treatment | Recommends future medical care needs | Labor Code §4600 |
Impact Benefits | Provides disability rating using AMA Guides | Title 8 §9785 |
A QME report can significantly influence your workers’ comp benefits. It’s critical to ensure that the report is accurate, comprehensive, and fair—especially if the initial claim was denied.
How Hussain & Gutierrez Law Helps with QMEs
With over 33 years of combined legal experience, the attorneys at Hussain & Gutierrez Law offer expert guidance throughout the QME process.
- Judge Gutierrez, a former workers’ compensation judge, uses his deep understanding of California workers’ comp laws to ensure your QME protects your rights.
- Fakhrudeen Hussain brings a history of successful case resolutions, helping clients receive the medical care and compensation they deserve.
- We assist in selecting the right QME, preparing documentation, and challenging biased or incomplete reports.
- Our team supports Spanish, Sinhala, and Tamil-speaking clients, including undocumented workers, who are fully protected under Labor Code §1171.5.
Common Issues Requiring QMEs in Van Nuys
In Van Nuys, common workers’ comp disputes that trigger a QME include:
- Injury Causation Disputes: Example — a warehouse worker develops back pain, but the insurer claims it’s not work-related.
- Treatment Necessity: Ongoing care for repetitive stress injuries is denied by the insurer, requiring medical review.
- Disability Ratings: The initial doctor gives a low rating for a serious injury. A QME may offer a second opinion to justify higher benefits.
These situations require aggressive legal representation to ensure your rights are upheld.
California law provides strong protections for injured workers:
- Labor Code §4060 – Authorizes the QME process for disputed injuries.
- Labor Code §4600 – Ensures access to medical care even during disputes.
- Title 8, §9785 – Regulates QME selection and reporting procedures.
- Labor Code §1171.5 – Guarantees benefits for all workers, including the undocumented.
Understanding these laws helps us secure the best outcome for your claim.
Once the Qualified Medical Evaluation is completed, the doctor prepares a detailed report outlining their medical findings and legal conclusions. This report is critical—it may determine whether you receive ongoing medical care, disability payments, or vocational retraining.
Here’s what typically happens:
- Review by Parties: Both your attorney and the insurance company receive a copy of the QME report.
- Evaluation of Findings: Your lawyer will analyze the report to determine if it supports or harms your claim.
- Challenging Inaccuracies: If the report is biased, unclear, or incomplete, your attorney can request a supplemental report or seek a new evaluation.
- Use in Hearings: The QME report is often used as evidence in Workers’ Compensation Appeals Board (WCAB) hearings.
- Benefit Determination: The judge may rely heavily on the QME’s findings when deciding on medical benefits or disability awards.
At Hussain & Gutierrez Law, we ensure the QME process is not just procedural—but strategic. We challenge unfavorable findings and use every legal tool available to fight for your rights.
Injured workers often unknowingly damage their claims during the QME process. To avoid common mistakes, follow these tips:
- Don't go alone. Always consult your lawyer before attending a QME.
- Don't exaggerate or minimize symptoms. Be honest, consistent, and clear.
- Don’t miss your appointment. Rescheduling without notice can result in denial of benefits.
- Don’t assume the doctor is neutral. While QMEs are state-certified, many have longstanding ties to insurance companies.
- Don’t fail to report new symptoms. Updates help shape accurate diagnoses and benefit decisions.
With Hussain & Gutierrez Law on your side, you’ll be fully prepared for your QME—from the paperwork to the final report. Your future is too important to leave to chance.
Why Choose Hussain & Gutierrez Law for Your QME?
Hussain & Gutierrez Law brings unmatched insight to workers’ compensation cases. Judge Gutierrez’s background as a former workers’ comp judge ensures strategic representation, while our multilingual team delivers compassionate service tailored to every injured worker.
Have a question? Ask our
QME lawyer
QME is an independent exam by a certified doctor that resolves disputes in a workers’ comp claim. It’s required under Labor Code §4060.
Yes. All injured workers, including undocumented immigrants, are entitled to QMEs under Labor Code §1171.5.
The doctor is selected from a state-issued panel list. We help you choose a fair and qualified evaluator. (Title 8, §9785)
If there’s a dispute over injury causation, treatment, or disability rating—especially in warehouse or delivery jobs—a QME helps resolve it.
Yes. A lawyer ensures the QME process is fair and the report accurately reflects your condition.
It typically takes 1–3 months, including exam scheduling and report completion.
