2 requirements for a condition to be considered an injury - Answer- (1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease - Answer- Disease that in whole or part is caused by work
1911, seventeen days after the devistating fire at the triangle shirtwaist comp...
QME exam 2024/2025 with 100% correct
answer
Holds authority to appoint physicians as QME evaluators - Answer- Administrative Director (AD) (LC
139.2)
Term of appointment as QME evaluator - Answer- 2 years (LC 139.2)
3 requirements when seeking appointment as QME - Answer- (1) Pass the QME competency exam;
(2) Complete a 12-hour course in disability eval report writing;
(3) Devote at least 1/3rd of total practice time to providing direct medical treatment (or have served as a
AME on 8+ occasions in past 12 mos prior to application)
2 reasons for termination/suspension of a QME w/o a hearing - Answer- (1) Licensing board
suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
6 reasons for discipline (suspension/termination) of QMEs after a hearing - Answer- (1) Violation of
material statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
(3) Failure to comply with the timeframe standards;
(4) Failure to meet licensing/certification requirements;
(5) Preparation of medical-legal evaluations that fail to meet the minimum standards for those reports as
established by the administrative director or the appeals board;
(6) Making material misrepresentations or false statements in an application for appointment or
reappointment as a qualified medical evaluator.
3 types of substantive medical disputes resolved by QMEs - Answer- (1) Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and further disabilities after permanent
disability (detereoration of original injury), compensability of new body part added to claim)
,Definition of *injury* in compensability claims - Answer- (1) An injury or disease arising out of
employment;
(2) A *derivative* injury caused by treatment of an injury arising out of employment;
(3) Any reaction to or side effect from preventative health care the employer provides to health care
workers
*Specific injury* - Answer- Occurs as the result of a single incident or exposure
*Cumulative injury* - Answer- Results from repetitive trauma (mental or physical) over a period of time
2 requirements for a condition to be considered an injury - Answer- (1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease - Answer- Disease that in whole or part is caused by work
1911, seventeen days after the devistating fire at the triangle shirtwaist company factory in new york
took 146 lives - answer- when was the 1st work comp act passed?
1. no fault
2. exclusive remedy
3. assured fixed benefit - answer- what are the 3 components of the work comp system
e employer is required to pay benefits no matter who caused the injury, as long as the injury arose out
of or occurred in the course of employment. - answer- no fault
less the employer is uninsured, the worker cannot pursue other forms of recovery from the employer,
even if the employer was grossly negligent. - answer- exclusive remedy
the workers' compensation system establishes defined benefits, which must be paid for by the
employer. workers' compensation awards are typically far less than comparable negligence awards in a
civil suit. for example, although the maximum workers' compensation death benefit may be far less than
the possible award in a civil wrongful death suit, a civil action may take years to resolve while a death
claim can be re-solved in as little as a few months. additional recoveries are available to employees for
an employer's serious and willful misconduct and unlawful discrimination (labor code § 132a and §
, 4553). although group health coverage may include arbitrary limits on the extent of treatment covered,
workers' compensation is a statutory benefit with no arbitrary limits on the frequency, duration, or
extent of services. - answer- assured and fixed benefit
deliberately self-inflicted injuries are excluded from coverage - answer- what type of injyuries are
excluded
for injuries that result from the serious and willful misconduct of the employer, the employee's
compensation is increased by half - answer- what happens if the injury is due to serious misconduct of
the employer?
for injuries that result from the serious and willful misconduct of the injured employee, benefits are
reduced by half, unless the injury resulted in death or a per-manent disability of 70% or more; the 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 the time of in-jury - answer- what happens if the injury is due to
serious misconduct of the employee?
measures were enacted that allowed employers (1) to establish medical pro-vider networks—from
which injured workers are required to select treating doctors, (2) to conduct utilization review to ensure
that medical care was consistent with evidence-based guidelines, and (3) to limit the amount of physical
therapy and chiropractic treatment. these measures also affect-ed permanent disability ratings and
benefit payments to injured workers. an evidence-based medi-cal treatment utilization schedule (mtus),
or set of guidelines, was also adopted. - answer- what measures were enacted in 2003 and 2004
7 types of excluded injuries - Answer- (1) Caused by employee's use of alcohol or illegal controlled
substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured employee is the *initial physical aggressor*;
(5) Resulting from the employee's commission of a felony, for which the employee has been convicted
(including "wobbly felonies," which are crimes that may be prosecuted as misdemeanors or felonies)
(6) Resulting from off-duty recreational activities, in which participation in the activities does not
constitute part of the employee's work-related duties and the activity is not an expressed or implicit
condition of employment;
(7) Psychiatric injuries claimed after notice of termination/layoff unless certain conditions exist
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Academicaffairs. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.79. You're not tied to anything after your purchase.
