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California QME Exam 2024 - Based on ICAC Course Material – Q’s and A’s
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California QME Exam 2024 - Based on ICAC Course Material – Q’s and A’s
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California QME Exam 2024 - Basedon ICAC Course Material – Q’s and
A’s
California passed first workers compensation act in what year? What event
caused this? - -1. 1911
2. Fire at Triangle Shirtwaist Company Factory
-Was the first workers compensation act voluntary or mandatory? - -
Voluntary
-What year was the Boyton Act passed? What did it require most employers
to do? What did this act establish? - -1. 1913
2. required most employers to have workers compensation coverage
3. established the State Compensation Insurance Fund (SCIF)
-What act replaced the Boyton Act in 1917? What was the new added
provision? - -1. Workers' Compensation Insurance and Safety Act
2. "permanent disability must give consideration to diminished ability to
compete in the open labor market"
-In what year did the California State Senate allow for subjective factors
such as pain and mental disturbances? - -1951
-Federal, Maritime, and Railroad workers are covered under what? - -
Federal Work Comp
-What 3 things was the workers' compensation system created to pay for? -
-1. Medical treatment
2. Temporary payment for lost wages
3. Permanent disability to compensate for decreased ability to compete in
the open labor market
-What is the Historic Compromise? - -1. Employee gives up the right to
pursue legal action in exchange for benefits.
2. Employer provides benefits, regardless of fault, in exchange for legal
protection.
-What are the 3 components of the Historic Compromise? - -1. No Fault
2. Exclusive Remedy
3. Assured and Fixed Benefit
, -The employer is required to pay for benefits, regardless of fault, as long as
the injury is AOE/COE - -"No Fault" component of Historic Compromise
-Worker cannot pursue other forms of recovery from the employee, even if
the employer was grossly negligent. (exception: 3rd parties may be sued). -
-"Exclusive Remedy" component of Historic Compromise
-Workers compensation system established defined benefits which must be
paid by the employer. - -"Assured and Fixed Benefit" component of Historic
Compromise
-What are two exceptions to the "No Fault" rule? - -1. Self inflicted injuries
are excluded from coverage (Labor Code 3600)
2. Injury resulted from failure of the employer to comply with the law or
safety and health regulations or the employee was under 16 years old at
time of injury (Labor Code 4551)
-When can benefits be reduced by half? When can they be increased by
half? - -1. reduced when injury is result of employee serious and willful
misconduct (unless result is death or permanent disability of 70% or more)
2. increased when injury is result of employer serious and willful misconduct
-In 1989 and 1993, measures were enacted to address the QME process
including.... - -1. Med Legal fee schedule
2. Physician referral
3. QME advertising
4. Compensability of psychiatric and post termination
5. Fraud deterrence
6. Benefit payments for injured workers
-In 2003 and 2004, measures were enacted that allowed employers to... - -
1. establish medical provider networks (MPN)
2. Conduct utilization review to ensure that medical care is consistent with
evidence based guidelines
3. limit the amount of physical therapy and chiropractic
4. increase PD ratings and benefit payments to employees
5. require UR and MTUS guidelines
-In 2013, measures were enacted... - -1. increasing PD and simplifying PD
rating method
2. Resolving medical treatment disagreements through IMR and IBR
3. Improving MPNs
4. Updating Official Medical Fee Schedule (OMFS)
5. establishing fee schedules for copy services, interpreters, vocational
experts, and in-home health care
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