QME EXAM NEWEST 2024 ACTUAL EXAM COMPLETE 370
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS)
QME - ANSWER-Qualified Medical Examiner
permanent and stationary - ANSWER-When a condition reaches a
state of maximal medical improvement.
Escobedo case - ANSWER--Set standard of reasonable medical
probability (standard a physician is expected to
follow, that based on superior evidence,
something is probably/more likely than not)
-These words turn the report
into substantial evidence
Rolda issues/Limits on compensability of psych issues - ANSWER-
1. Did psych injury involve "actual events of
employment"? (IW has
burden of proof)
2. Is there >50% industrial
causation (IW burden)
3. Was there personnel action and was it lawful, non-
discriminatory, and in good faith? (Defense burden)
,4. Were personnel actions the substantial (>35-40%) cause
of the psych injury. (defense burden)
Granado case - ANSWER--Set standard that medical tx (MT) is not
apportionable
Benson case - ANSWER--Clarified parsing out
impairment to different injury dates
-If they can't be parceled out, you can say they
are "inextricably intertwined."
Guzman case/Almaraz-Guzman standard - ANSWER--Alternative
rating of disability (when case is complex/extraordinary and AMA
good doesn't accurately reflect the persons impairment)
-WPI rating can be made if it's accurate and based on AMA guides
(fairness is not allowed anymore)
Blackledge v BofA - ANSWER-
WCAB defined roles for:
-
physician
-DEU
rater
-parties
,-Work comp
judge
Blackledge case: physician requirements - ANSWER-1. Compare
medical findings
2. List WPI for each med condition
3. Select impairment in the range based on impact on ADLs
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
Alternative rating under Almaraz/Guzman - ANSWER-1. Begin w
strict rating found in the chapter address the
injured
body part
2. Explain what specific facts
require an alternative rating
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
, Original intent of WC - ANSWER--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
-MT for job related
injuries/illness
-TD benefits for
lost wages
-PD benefits for finished ability to
compete in open labor market
Boyton act - ANSWER--1913: required most employers to have WC
coverage
-Later expanded to include provision that when rating disability,
persons diminished ability to compete in open job market should be
considered
Historic compromise - ANSWER--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 exchange
for protection from lawsuits -3 components
1. No fault
2. Exclusive remedy
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