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QME Latest Exam1. Workers' Compensation laws in California originated with the _______________
which was passed in ________________. - ANSWER-Boynton Act; 1913
10. Non-psychological injuries are considered compensable if ________ of the
injury was industrially caused; Subject to a few exceptions, psychological
injuries are considered compensable if ______ of the injury was industrially
caused . - ANSWER-1% or more; greater than 50%
11. In order to claim psychiatric injury, an employee must have been - ANSWER-Employed for at least
6 months, except where psychiatric injury
was caused by a "sudden and extraordinary event."
12. "Permanent Disability" is calculated by: - ANSWER-A special "Rater" taking the physician's
"impairment rating," and
then adjusting based on nature of injury, age, and occupation
13. "Permanent and Stationary" or "P+S" status is achieved when - ANSWER-The condition has
"reached a plateau," meaning that the
applicant's condition is well stabilized and unlikely to change
substantially in the next year with or without medical treatment.
(P & S status may also be referred to as "MMI- Maximal Medical
Improvement" ).
14. "Apportionment" refers to the notion that - ANSWER-An employer is only liable for the
percentage of permanent
disability that was directly caused by an injury arising out of and
occurring in the course of employment. (Apportionment does not
reduce benefits owed as treatment or work restrictions).
15. Under Benson , where there is more than one Date of Injury (DOI), one must
apportion Permanent Disability (PD) amongst the various dates of injury and
must be done for each body part. If this cannot be done with reasonable
medical certainty, then the physician may opine that the DOI and the
impairment are all - ANSWER-"Inextricably intertwined."
16. In CA workers' compensation, the burden of proof (by a "preponderance of
the evidence") for injury is on the _____________ and the burden of proof for
apportionment is on the ______________ - ANSWER-c. Injured Worker; Employer
17. Under Blackledge, a report will be considered ___________ if the reasoning
, QME Latest Exam
behind a physician's opinion is not adequately explained. - ANSWER-Lacking as "substantial medical
evidence"
18. Under the QME Regulations, a QME must maintain records as follows: - ANSWER-Reports must
be kept for 5 years; bills must be kept for 3 years.
19. Under Labor Code 139.2, an initial QME report is due within 30 days of the
examination except where - ANSWER-The QME has filed for a 30-day extension while waiting for test
results or consulting physician reports OR has filed for a 15-day
extension for "Good cause" (e.g. natural disaster or medical
emergency).
2. The "Grand Bargain" of the workers compensation system involves
employers agreeing to pay assured and fixed benefits for industrial injuries
and workers agreeing to: - ANSWER-Not sue their employer in civil court for an industrial injury.
20. Under Labor Code 4628, a report must - ANSWER-Disclose the date and location at which the
evaluation took place.
21. Which of the following is included in Regulation 10606 as 1 of 15 items that
every QME report should include? - ANSWER-Treatment indicated, including past, continuing, and
future
medical care
22. QME reports may be read and utilized by: - ANSWER-Insurance companies/adjuster; workers'
compensation attorneys;
non-workers' compensation attorneys involved in 3rd party cases;
Judges; other QMEs/AMEs; treating physicians.
23. For dates of injury later than _________, either side may request a panel QME or
may, but need not, attempt to get __________________. - ANSWER-1/1/05; an AME
24. Which of the following is qualified to serve as a QME but may not opine on
permanent disability? - ANSWER-Acupuncturist
25. May a QME provide medical treatment within the workers' compensation
system? - ANSWER-Yes. A QME may perform treatment services within the workers'
comp system and may treat the same individual for whom the
physician has done a QME evaluation if the injured worker requests
such treatment.
26. Under California Civil Code 56.10, a physician may disclose medical
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