Medical legal evaluations are health assessments undertaken by an independent, approved physician to comply with a range of legal obligations. You might need a medical assessment to enable you to drive professionally, for health insurance purposes, or when you take on a new job.
One of the most frequent reasons why people need medical legal evaluations is when they’re involved in a case for compensation. Workers pursuing compensation claims against their employers must have a medical legal evaluation to provide evidence that their condition is directly related to a problem for which the employer is responsible. The evaluation also needs to give details of the extent to which the employee is affected by their condition.
Other claims that often need a medical legal evaluation are auto accident and other personal injury cases. Again, it’s all about having an independent evaluation of the extent of your injuries and how they affect you, as well as to what extent another person or organization is to blame.
What happens at a medical legal evaluation?
The first stage of a medical legal evaluation is filling out questionnaires that give your evaluating physician the background information they need on your case. If you can fill out these forms before your evaluation appointment, that can be a great help.
The exact evaluation process might differ according to the reason for your evaluation, but the session typically starts with a review of your medical history and a physical exam. Your evaluating physician at RehabOne Medical Group checks all your vital signs and other health indicators, including:
Heart rate
Breathing rate
Temperature
Blood pressure
Physical reflexes
Reaction times
Balance
Cognitive responses
They then examine the symptoms that are the cause of the evaluation. If it’s chronic pain following a back injury, they spend some time carrying out a comprehensive examination of your back and look at how well you can move.
You may also need to undergo diagnostic tests, such as X-rays, a CT scan, or an MRI scan, and possibly blood tests.
Can any physician offer medical legal evaluations?
Physicians need approval from the relevant governing body or authority before they can offer a medical legal evaluation service. RehabOne Medical Group has approved physicians with many years of experience who provide evaluations for medical and legal purposes.
They offer comprehensive consultations by qualified, independent medical evaluators, using state-of-the-art technologies, including electrodiagnostic studies. Both comprehensive, holistic medicine evaluations and functional capacity evaluations are also available at RehabOne Medical Group.
To find out more about medical legal evaluation services, call RehabOne Medical Group today.
QME
If you do not have an attorney, a Qualified Medical Evaluator (QME) is who will conduct the evaluation for the purpose of resolving a dispute between you and your employer’s insurance company. A QME in California is a physician who has undergone training and been certified to evaluate workers’ disabilities and create medical-legal reports, which are used to determine workers’ eligibility for benefits, according to the California Department of Industrial Relations. They must pass a test regarding the workers’ compensation evaluation process to become certified by the Division of Workers Compensation (DWC) Medical Unit. Once certified, the doctor’s name is placed in the QME database, which is used when a party involved in a workers’ compensation case requires the assistance of a QME.
AME
An Agreed Medical Evaluation (AME), is an evaluation that is made by a provider who is selected by an agreement between an injured worker’s attorney and the insurance company’s claims administrator and their attorney. A medical examination is conducted, and a medical-legal report is prepared to help resolve a dispute. The AME is also used to apportion the workers’ compensation claim. In other words, the evaluation will be used to determine what portion of your work-related injury was responsible for your disability, and what, if any, portions came from other causations or sources.
This evaluation is performed by an Agreed Medical Evaluator. An AME is a doctor who has had additional training in workers’ compensation requirements and work-related injuries. Again, this is a provider who is agreed upon to do the evaluation by an injured worker’s attorney and the insurance company’s claims administrator and their attorney.
IME
An Independent Medical Examination (IME) is a medical evaluation performed by a credentialed physician on a patient who was not previously involved in the treatment of that patient, to evaluate the patient’s course of prior treatment and current condition. The physician will establish an informed expert opinion on the validity and nature of a diagnosis and provide a comprehensive report. An IME may be conducted at the request of an employer, plaintiff attorney or an insurance carrier to obtain an independent opinion of the clinical status of the individual. Workers’ compensation insurance carriers, auto insurance carriers, and self-insured employers have a legal right to this request an IME.
SIBTF
The Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIBTF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least 70 percent. The fund enables employers to hire disabled workers without fear of being held liable for the effects of previous disabilities or impairments.
FCE’s
A functional capacity evaluation (FCE) evaluates an individual’s capacity to perform work
activities related to his or her participation in employment (Soer et al., 2008). The FCE
process compares the individual’s health status, and body functions and structures to the
demands of the job and the work environment. In essence, an FCE’s primary purpose is to
evaluate a person’s ability to participate in work, although other instrumental activities of
daily living that support work performance may also be evaluated.
CIVIL
Civil lawsuits are generally started when one party (the plaintiff) files a complaint against one or more other parties (defendants), to settle a dispute. Parties in a civil lawsuit can be individuals, companies, or government agencies. In most civil lawsuits, the plaintiff is seeking money for losses caused by the dispute. However, a civil lawsuit can also seek an order requiring one party to do or not do something.
RehabOne Medical Group 