10/17/24, 3:42 PM QME EXAM NEWEST 2024 ACTUAL EXAM COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED A…
QME EXAM NEWEST 2024 ACTUAL EXAM
COMPLETE 220 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
Terms in this set (227)
QME Qualified Medical Examiner
When a condition reaches a state of maximal medical
permanent and stationary
improvement.
-Set standard of reasonable medical probability
(standard a physician is expected to follow, that based
Escobedo case on superior evidence, something is probably/more
likely than not)
-These words turn the report into substantial evidence
1. Did psych injury involve "actual events of
employment"? (IW has burden of proof)
Rolda issues/Limits on 2. Is there >50% industrial causation (IW burden)
compensability of psych 3. Was there personnel action and was it lawful, non-
issues discriminatory, and in good faith? (Defense burden)
4. Were personnel actions the substantial (>35-40%)
cause of the psych injury. (defense burden)
-Set standard that medical tx (MT) is not
Granado case
apportionable
-Clarified parsing out impairment to different injury
dates
Benson case
-If they can't be parceled out, you can say they are
"inextricably intertwined."
,10/17/24, 3:42 PM QME EXAM NEWEST 2024 ACTUAL EXAM COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED A…
-Alternative rating of disability (when case is
complex/extraordinary and AMA good doesn't
Guzman case/Almaraz-
accurately reflect the persons impairment)
Guzman standard
-WPI rating can be made if it's accurate and based on
AMA guides (fairness is not allowed anymore)
WCAB defined roles for:
-physician
Blackledge v BofA -DEU rater
-parties
-Work comp judge
1. Compare medical findings
2. List WPI for each med condition
3. Select impairment in the range based on impact on
Blackledge case: ADLs
physician requirements 4. ADL analogies
-Role of evaluator is to assess WPI % by a report that
sets forth facts and reasoning to support conclusions
and are in line with AMA & case law
1. Begin w strict rating found in the chapter address
the injured body part
2. Explain what specific facts require an alternative
Alternative rating under rating
Almaraz/Guzman 3. Provide analysis as to why alternative rating is more
accurate
4. Set forth how Dr arrived at alt rating
5. State position with reasonable medical probability
-Provide minimum level of benefits promptly
-To prevent IW from becoming a burden on others
and help IW return to work thru rehab
-Help dependents if IW dies
Original intent of WC
-MT for job related injuries/illness
-TD benefits for lost wages
-PD benefits for finished ability to compete in open
labor market
, 10/17/24, 3:42 PM QME EXAM NEWEST 2024 ACTUAL EXAM COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED A…
-1913: required most employers to have WC coverage
-Later expanded to include provision that when rating
Boyton act
disability, persons diminished ability to compete in
open job market should be considered
-Trade-off of rights and benefits
-Employee gives up right to sue for lots of $ and gets
protection from legal system against discrimination
-Employer provides benefits regardless of fault in
Historic compromise exchange for protection from lawsuits
-3 components
1. No fault
2. Exclusive remedy
3. Assured and fixed benefits
-Employer pays benefits no matter who caused injury,
as long as it occurred during employment
*Exceptions
-self inflicted injury
-injury from serious/willful misconduct by employee:
No Fault & exceptions
benefits reduced by half unless employee died or has
PD of 70% or more
-injury from failure of employer to comply with health
and safety reg
-employee was under 16yo
Workers' compensation benefits are the only benefits
injured workers may receive to compensate for a
Exclusive Remedy work-related injury. (Even if employer negligent)
-unless employer uninsured
-or third party is involved, that party can be sued
-WC has defined benefits employer must pay
Assured & Fixed Benefits -WC is a statutory benefit w no arbitrary limits on freq,
duration, or extent of services
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