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QME Exam 2024 questions with complete solutions
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QME Exam 2024 questions with complete solutions
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QME Exam 2024 questions with completesolutions
when was the 1st work comp act passed? - ANSWER: ➡ 1911, SEVENTEEN DAYS AFTER
THE DEVISTATING FIRE AT THE TRIANGLE SHIRTWAIST COMPANY FACTORY IN NEW
YORK TOOK 146 LIVES
WHAT ARE THE 3 COMPONENTS OF THE WORK COMP SYSTEM - ANSWER: ➡ 1. NO
FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT
NO FAULT - ANSWER: ➡ 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.
EXCLUSIVE REMEDY - ANSWER: ➡ less the employer is uninsured, the worker cannot
pursue other forms of recovery from the employer, even if the employer was grossly
negligent.
ASSURED AND FIXED BENEFIT - ANSWER: ➡ 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.
, WHAT TYPE OF INJYURIES ARE EXCLUDED - ANSWER: ➡ deliberately self-inflicted
injuries are excluded from coverage
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE EMPLOYER? -
ANSWER: ➡ For injuries that result from the serious and willful misconduct of the
employer, the employee's compensation is increased by half
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE EMPLOYEE? -
ANSWER: ➡ 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
WHAT MEASURES WERE ENACTED IN 2003 AND 2004 - ANSWER: ➡ 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.
WHAT MEASURES WERE ENACTED IN 2013 - ANSWER: ➡ In 2013, measures were
enacted that made wide-ranging changes, which included (1) increasing permanent
disability paid to injured workers and simplifying the permanent disability rating meth-od,
(2) resolving medical treatment disagreements through independent medical review and
bill payment disputes through independent bill review, (3) improving medical provider
networks, and (4) updating the Official Medical Fee Schedule and establishing fee schedules
for copy services, in-terpreters, vocational experts, and in-home health care.
MEDICAL UNIT - ANSWER: ➡ Which unit investigates complaints filed against QMEs con-
cerning violations of the Labor Code and regulations as well as other statutes for
misconduct com-mitted in the QME process
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