Worker's Compensation Insurance

7 The percentage of permanent disability is determined by using the formula found in the Schedule for Rating Permanent Disabilities after an assessment of the injured worker’s permanent impairment and limitations. There are three schedules and each one is applicable to specific dates of injury. These Schedules for Rating Permanent Disabilities can be accessed through the DIR’s website at http://www.dir.ca.gov/ dwc/dwcrep.htm. Please see the “Resources” section of this brochure for complete DIR contact information. The assessment of the injured worker’s permanent impairment and limitations is made by a physician who is either the treating physician, a Qualified Medical Evaluator (QME), or an Agreed Medical Evaluator (AME) if the employee is represented by an attorney. QMEs are appointed and regulated by the DWC’s Medical Unit. (Please see the “Resources” section of this brochure for DWC Medical Unit contact information.) If there is a disagreement regarding the treating physician’s opinion, and the worker is not represented by an attorney, the worker can choose a QME from a three-member panel provided by the DWC’s Medical Unit to perform a separate evaluation. When a worker is represented by an attorney, the attorney and workers’ compensation insurer must attempt to agree on an (AME) to perform the evaluation if there is a disagreement regarding the treating physician’s opinion. If the parties are unable to agree on an AME and the date of injury is 2005 or later, a three-member QME panel will be appointed by the DWC’s Medical Unit. The parties try to agree on a physician from this three-member panel. If there is no agreement, each party is allowed to strike off one physician’s name from the panel in order to narrow the selection down to one final physician who will perform the evaluation. If there is no agreement on an AME and the date of injury is before 2005, each party may select its own QME. If the evaluations are different, the amount of permanent disability will be determined through negotiation or litigation, if necessary.