A workers’ compensation medical report significantly influences the benefits an injured employee receives. If you believe your report contains inaccuracies or omits critical details, you have several options to dispute its findings.
Obtain and review the medical report
You have the right to access your medical report. If you have not received a copy, request one from the claims administrator. Carefully examine the report for discrepancies, such as incorrect medical history, misrepresented symptoms, or inaccurate work restrictions.
Consult the treating physician
If you identify errors, address them with your treating physician. In some cases, a discussion may lead to a corrected or clarified report. However, if the physician does not acknowledge the issues or refuses to make amendments, you may need to pursue further action.
Request a qualified medical evaluator (QME)
If disagreements persist, you can request an evaluation by a Qualified Medical Evaluator (QME). A QME is an independent physician who reassesses your condition and issues a new report. You must request a panel of QMEs within 10 days of receiving the initial medical report. If you do not act within this timeframe, the claims administrator has the authority to select a QME for you.
Prepare for the QME evaluation
Once you select a QME, schedule an appointment and gather all relevant medical records. Be prepared to discuss the inaccuracies in the original report and provide any supporting documentation. The QME’s findings will influence the determination of your benefits.
Explore independent medical review (IMR)
If you disagree with the QME’s conclusions, you can request an Independent Medical Review (IMR). This process allows another physician to reassess your case. The request for an IMR must be submitted within 30 days of receiving the QME’s report.
Challenging a medical report can impact your workers’ compensation benefits. Reviewing your report promptly and utilizing the appropriate dispute resolution methods ensures that your case is fairly assessed.