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QME Exam/50 Accurate Questions and Answers
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QME Exam/50 Accurate Questions and Answers
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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
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