Agreed Medical Evaluation

An Agreed Medical Evaluation, also known as AME, is a medical examination performed by a medical provider under an agreement by the insurance company's claims administrator and the worker's work compensation lawyer. The AME is used to determine the extent and cause of the worker's injuries after a workplace accident.

The goal of the AME is to receive an examination from a trustworthy, unbiased, and competent physician, who can provide enough information about the worker's injuries, to resolve any disputes surrounding the worker's compensation claim.

After the AME is completed the medical doctor will prepare a medical report which is used by the insurance company to determine whether the work injury was responsible for the worker's disability or if there were other causes.

When do you need an AME?

Not all workers will need an AME. Common reasons an AME may be required include a disagreement over the doctor's treatment plan, disagreement about whether the injury was caused by work or if there is a need for treatment, and what type of treatment is necessary and appropriate. The worker may also need an AME if there is a disagreement in the assigned permanent disability rating and whether the worker will need to miss work. Workers who have not hired a workers' compensation lawyer may not have the option to request an AME but may have to allow the DWC Medical Unit to provide them with a choice of one out of three doctors who can provide a medical evaluation.

The selected doctor becomes the qualified medical evaluator (QME). If a Qualified Medical Evaluator (QME) is used they will conduct the medical evaluation for the purpose of resolving a dispute between the worker and their employer's insurance company.

Unfortunately, there have been some complaints that these examinations are not always impartial or unbiased. Some individuals have complained that insurance companies use doctors who will make evaluations which are helpful to them. Talk to a work comp lawyer if you have questions about a QME.