From QMEs to claim administrators and Maximus, the language of California Workers’ Comp can be obscure to the uninitiated. But don’t worry — this short glossary will make things a lot easier.
AME, Agreed Medical Evaluator
When there are questions about the benefits an injured worker should receive (known as a medical-legal dispute), the worker can be evaluated by either a QME (Qualified Medical Evaluator; see below) or an AME (Agreed Medical Evaluator).
Only workers who have an attorney can see an AME because AMEs are chosen by agreement between the worker, the worker’s attorney, and the claims administrator (see below).
Claims Administrator
Also known as claims examiner or claims adjuster, the claims administrator is the person or entity (usually an insurance company) that handles a workers’ compensation claim.
IME, Independent Medical Examiner
See QME, Qualified Medical Examiner
QME, Qualified Medical Evaluator
A QME or Qualified Medical Evaluator is a physician who evaluates a worker when there are questions about the benefits the worker should receive.
Physicians have to meet certain education and licensing requirements in order to become a QME. To learn more about the differences between QMEs and AMEs, check out our previous blog “Medical Legal Billing: What Is the Difference Between a QME and an AME?”
Maximus
Maximus Inc. is a government services company that helps government agencies manage some of their programs.
In the case of California workers’ comp, Maximus is the independent review organization designated to perform Independent Medical Reviews (IMR), a non-judicial way to resolve disputes about the medical treatment of injured employees.
Medical-Legal Report
A report written by a physician that describes the medical condition of an injured worker. Medical-legal reports help clarify disputed medical issues.
Medical Unit
A unit within the California Division of Workers’ Compensation in charge of overseeing medical provider networks (MPNs), independent medical review (IMR) physicians, qualified medical evaluators (QMEs), and panel QMEs, among others.
Primary Treating Physician
Also called treating physician or treating doctor, this is the doctor who has overall responsibility for treatment of an injured worker. The primary treating physician writes medical reports that may affect the worker’s benefits.
Workers’ Compensation Appeals Board (WCAB)
This unit of the California Division of Workers’ Compensation consists of 23 local offices plus satellites throughout the state where disagreements over workers’ compensation benefits are initially heard by workers’ compensation judges.
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