QME EXAM PREP P2 WITH ACTUAL
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What are the limitations to apportionment?
1) Apportionment applies only to permanent disability and is based on causation
2) only permanent disability is apportioned, never treatment, work restrictions, etc.
What is the signing date for QME reports?
the date the report is completed, not the evaluation date. include the county of the report
What are the five major categories of QME disciplinary action?
1) consistent late reports
2) lack of availability
3) ex parte communications
4) self-referral
5) reports do not meet DWC minimum standards
What must be included with the HPI?
A discussion of the mechanism of injury
What are the 5 main types of workers comp benefits?
1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913?
Requires CA employees to have worker's comp insurance
what is the definition of a medical-legal report?
to prove or disprove an aspect of a contested claim
, What is the impairment rating?
Rates the degree to which the impairment decreases a person's ability to perform ADLs, excluding work
What are AOE and COE?
AOE: arising out of employment
COE: through the course of employment
What is ex parte communication?
Occurs when a party to a case communicates with one side only. a QME CANNOT do this (but can speak
with the treating MD if questions arise)
What is the difference between exacerbation and aggravation?
Exacerbation: temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability.
Permanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury?
No
Define apportionment
Estimate of the % of permanent disability was caused by work-related injury
What are temporary disability payments?
2/3 of average weekly pay, limited to 104 weeks (2 years)
when are supplemental job displacement benefits offered?
if the employer doesn't offer a RTW (return to work), a voucher can be offered to the IW, but must be
used within 2 years of offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable?
Non-psych: if 1% or more of the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp?
1) Firefighters & peace officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues if >5 years work
What are the medical treatment utilization schedule (MTUS) guidelines?
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