Medical Legal Services

Medical-legal services provide health assessments that are used for making decisions during legal disputes over insurance claims for injuries. Orthopedic surgeon and spine specialist Darren L. Bergey, MD, at Executive Medical and Surgical Associates is a qualified medical examiner (QME) who has extensive experience performing medical-legal evaluations and completing the required reports. He also treats patients involved in litigation (when not serving as their independent QME). Dr. Bergey welcomes referrals for medical-legal services. Just click the online booking feature or call the office in Colton or Costa Mesa, California.

What are medical legal services?

Medical-legal services are health evaluations performed by an independent physician (who’s not treating you). You need medical legal services when you face a legal dispute over a workers’ compensation claim or an insurance claim for medical care following a car accident or after suffering a personal injury.

In most cases, the insurance company requests an independent exam because they disagree with decisions made by your treating physician. However, a judge could also ask you to have an evaluation.

What is the purpose of medical-legal services?

An independent health exam provides information that’s not biased by either party, allowing it to be used when making legal decisions about compensation for the injured person. 

The QMEs who provide medical legal services are certified, trained to complete the required written reports, and serve as expert witnesses in court.

Dr. Bergey performs three medical legal exams:

Qualified medical evaluator (QME)

QMEs perform physical evaluations for workers’ compensation cases. If there’s a dispute between you and your employer’s insurance company, the California Division of Workers’ Compensation (DWC) recommends three possible QMEs, and you use one from the list.

Agreed medical evaluation (AME)

An AME is similar to a QME except you don’t go through the DWC. Instead, both sides agree to the QME they will use.

Independent medical evaluation (IME)

An IME is a physical exam to verify injuries that didn’t happen on the job, such as auto accident injuries and personal injuries. A personal injury occurs when you suffer a wound or physical harm due to another person’s negligence.

What should I expect during a medical legal evaluation?

Dr. Bergey reviews your medical records and any other documents, such as injury reports filed with your employer. Then he performs a physical examination and prepares the appropriate written report. In the report, he provides information that answers questions such as:

• Was your condition properly diagnosed?
• Was it a work-related accident?
• Are you getting the proper treatment?
• Do you need additional treatment?
• Will you be able to return to work? If so, when?
• Will your activities be restricted upon returning to work?
• Do you have a permanent or long-lasting disability?
• Will you need rehabilitation?

Dr. Bergey has years of experience as a QME and welcomes referrals if you know someone needing an AME or IME. To schedule an appointment, call Executive Medical and Surgical Associates or request an appointment online.