Exam (elaborations)
QME Exam/50 Accurate Questions and Answers
- Course
- Institution
QME Exam/50 Accurate Questions and Answers
[Show more]
Content preview
QME Exam/50 Accurate Questionsand Answers
1911, SEVENTEEN DAYS AFTER THE DEVISTATING FIRE AT THE TRIANGLE
SHIRTWAIST COMPANY FACTORY IN NEW YORK TOOK 146 LIVES - -when was
the 1st work comp act passed?
-1. NO FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT - -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. - -
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. - -
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. - -ASSURED AND FIXED BENEFIT
-deliberately self-inflicted injuries are excluded from coverage - -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 - -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 - -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. - -WHAT MEASURES WERE ENACTED IN 2003
AND 2004
-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. - -WHAT MEASURES WERE ENACTED IN
2013
-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 - -MEDICAL UNIT
-• How to Take a Complete Occupational History
• How to Define:
o An Injury
o First Aid
• Aggravation
• Recurrence
• Arising Out of Employment (AOE)
• Occurring in the Course of Employment (COE)
• Causation
• Presumptions
• Psychiatric Injuries - -WHAT ARE THE KEY COMPONENTS OF
COMPENCABILITY
-• Any injury or disease arising out of employment (Labor Code § 3208)
• Any "derivative" injury caused by the treatment of an injury arising out of
employment
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 Nursephil2023. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
81989 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now