What Is an Agreed Medical Evaluator (AME) in a Workers’ Compensation Case?
In a California workers’ compensation case, medical disputes can arise regarding the severity of an injury, the need for treatment, or the level of disability. When this happens, the injured worker and the insurance company may agree to use an Agreed Medical Evaluator (AME) to provide an independent medical opinion. The AME plays a critical role in resolving disputes and determining benefits.
When Is an AME Used?
An AME is used when both the injured worker (or their attorney) and the insurance company agree to select a neutral doctor to evaluate the case. This often happens when:
- There is a disagreement about the extent of the injury or necessary medical treatment
- The insurance company questions whether the injury is work-related
- There is a dispute over permanent disability rating
- The worker has legal representation and both sides prefer to avoid using a Qualified Medical Evaluator (QME) from a state-appointed list
How Is an AME Different From a QME?
A Qualified Medical Evaluator (QME) is a doctor chosen from a state-certified panel when there is a medical dispute, but an AME is selected by mutual agreement between the injured worker’s attorney and the insurance company. If the injured worker does not have an attorney, they must use a QME, as an AME is only available to represented workers.
What Happens During an AME Evaluation?
The AME will:
- Review medical records related to the work injury
- Examine the injured worker to assess their condition
- Consider job duties and work limitations
- Issue a medical report with findings on the injury, treatment, and disability rating
The AME’s report is highly influential in determining benefits. If both parties agreed to the AME, the findings are typically binding unless successfully challenged.
Can an AME Decision Be Disputed?
While an AME’s opinion carries significant weight, it can still be challenged if there is evidence of bias, errors, or missing information. If the injured worker disagrees with the AME’s report, they may need to take their case before a workers’ compensation judge for further review.
Do You Need Legal Help With an AME?
Since an AME is only used when a worker has legal representation, it is important to have an experienced workers’ compensation attorney to help select the right medical evaluator and ensure that the AME’s findings are fair. If you have questions about your claim or medical evaluation, the Law Offices of Norman J. Homen can help. Contact us today for a free consultation.
