What is a Medical-Legal Evaluation?

If an employee sustains a work-related injury, there is a lengthy process of reports, evaluations, and paperwork involved in a claims process. This starts immediately with the worker reporting the incident and the employer reporting to its insurance company. Part of the process involves a medical-legal evaluation. If either the employer or the employee does not agree with the opinion of the employee’s treating physician, they may request a medical-legal evaluation in order to obtain a new medical opinion.

A medical-legal evaluation is a special kind of doctor’s appointment scheduled for the employee. This appointment will involve the employer’s attorney (or the insurer’s attorney), the employee’s attorney, the employee, and a neutral doctor. The neutral doctor is called a Qualified Medical Examiner, and this doctor will have completed special training through the state to obtain this license. The doctor’s job in these situations is to evaluate the employee’s injury. The doctor will determine a variety of medical issues, including whether the injury was a work-related injury, if the injury was sustained in the manner described by the employee, and the degree of disability. The doctor will also assess what type of improvement has occurred, whether the impairment resulting from the injury is permanent, and whether future medical treatment will be necessary. Finally, the doctor may provide an opinion on whether the employee will ever be able to return to the same line of work. Of note is that this doctor does not provide treatment to the employee. The doctor or team of doctors providing treatment or therapy to the employee will be a different set of doctors entirely. The purpose of the doctor associated with the medical-legal evaluation is to be neutral, and not the same medical professionals involved in the rest of the employee’s treatment.

Recent trends in California case law demonstrate there are interesting issues surrounding telemedicine and medical-legal evaluations. In a 2016 case, the WCAB rejected the effectiveness of a medical-legal evaluation where the evaluator performed his examination via interactive audio/video telecommunication and used a designated chiropractic specialist to conduct the physical examination while he was only present electronically. The WCAB concluded that it was not certain whether such a method complied with California regulations that require the doctor have at least 20 minutes of “face time” during the evaluation.

Medical-legal evaluations can be a key component in challenging an employee’s medical status. and I have extensive experience with these evaluations. Call me today at (714) 516-8188 and let me help you with your pending workers’ compensation case and with deciding such an evaluation is right for your case.

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