QME exam -with 100% verified solutions 2024-2025.docx, Exams of Advanced Education

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QME exam -with 100% verified solutions

2024-

Tutor verified

1. Workers' Compensation laws in California originated with the _______________ which was passed in ________________. - correct answer Boynton Act; 1913
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: - correct answer Not sue their employer in civil court for an industrial injury.
3. The five basic categories of workers' compensation benefits are called: - correct answer Medical Treatment, Temporary Disability Benefits, Permanent Disability Benefits, Death Benefits, Supplemental Job Displacement Benefits.
4. Temporary Disability Benefits are paid at the rate of _____________ and are usually limited by a ______________ time cap. - correct answer 2/3 of average "weekly" wages; 2 year
5. Supplemental Job Displacement Benefits are available where: - correct answer The date of injury is AFTER "1/1/13" and the employer does not offer Return-to-Work.
6. A(n) _____________ report, written by an AME, QME, or AQME, does not involve a face-to-face evaluation of an Applicant. - correct answer Supplemental
7. In the workers' compensation system, "Injury" is defined as: - correct answer Incident or exposure that causes disability or need for medical treatment.

Where a prior injury (be it industrial or non-industrial) is "exacerbated," it means ______________; Where a prior injury (be it industrial or non-industrial) is "aggravated," it means ________________. - correct answer There is a temporary increase in symptoms but then a return to baseline causing no additional Permanent Disability (PD); There is an increase in symptoms with an increase in PD, and it is considered a new injury.

9. Non-compensable injuries include those caused by intoxication, injuries that are self-inflicted, injuries resulting from incidents where Applicant is an initial aggressor, injuries sustained while committing a crime, death by suicide, injuries caused by off-duty recreational activities not required by employment, and __________: - correct answer Post-termination psychiatric injuries.
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. - correct answer 1% or more; greater than 50%
11. In order to claim psychiatric injury, an employee must have been - correct 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: - correct 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 - correct 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 - correct 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 - correct 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 ______________ - correct answer c. Injured Worker; Employer
17. Under Blackledge, a report will be considered ___________ if the reasoning behind a physician's opinion is not adequately explained. - correct answer Lacking as "substantial medical evidence"
18. Under the QME Regulations, a QME must maintain records as follows: - correct 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 - correct 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).

20. Under Labor Code 4628, a report must - correct 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? - correct answer Treatment indicated, including past, continuing, and future medical care
22. QME reports may be read and utilized by: - correct 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 __________________. - correct 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? - correct answer Acupuncturist
25. May a QME provide medical treatment within the workers' compensation system? - correct 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 information where it is - correct answer Relevant to a legal claim where the injured worker has placed his or her medical history in issue.
27. Defense and Applicant sides must each serve ________________ to the other party at least 20 days prior to the date of the QME evaluation. - correct answer All the records they plan on providing to the QME
28. Under the regulations, "nonsubstantial matters" like scheduling issues do not constitute ex parte communications for _________ but there is no such rule that applies to ______________. - correct answer AMEs; QMEs
29. In CA workers' compensation cases, all medical decisions must be based on the _______________ standard, which requires medical evidence from a physician. - correct answer Substantial Medical Evidence
30. Under Escobedo, a medical opinion must be predicated on _____________; must not be speculative; must be based on pertinent facts, adequate exam, and history; and must set forth the reasoning in support of its conclusions. - correct answer Reasonable Medical Probability
31. The measure for Reasonable Medical Probability is - correct answer "More likely than not."
32. Under Labor Code 4628, a QME report must include: - correct answer The name and qualifications of each person who performed any non-clerical services in connection with the report (for example, diagnostic studies).

33. Where there is failure to comply with the requirements of Labor Code 4628, - correct answer The report is inadmissible; There is no liability for med-legal expenses incurred in connection with the report; There is a possible civil penalty up to $1,000; There is possible QME disciplinary action; and There is possible contempt per WCAB judicial powers.
34. The most recent version of the QME regulations went into effect on - correct answer February 17,
36. Under the QME regulations: - correct answer A non-psyche report must be served on the injured worker, the applicant attorney, and the defense attorney.
37. A QME need not provide a copy of their psyche report to an injured worker where - correct answer There is a substantial risk of significant adverse or detrimental medical consequences to the injured worker seeing or receiving a copy of part or all of the report that contains a mental health record.
38. Under the QME regulations, _________________ are due within 30 days after the evaluation; A(n)___________ is due within 60 days after request for such report. - correct answer Initial and Follow-up Reports; Supplemental Report
39. Under QME regulation §40, an injured worker may discontinue an evaluation where there is "Good cause," which includes - correct answer Discriminatory conduct by the evaluator based on race, sex, national origin, religion, or sexual preference; Abusive, hostile, or rude behavior by the physician; and Instances where the evaluator requests the injured worker to submit to unnecessary exams or

procedures.

39. Under the current system, a QME should consult the - correct answer 5th Edition of the AMA Guides to Impairment.
40. Under Almaraz/Guzman analysis, where a strict WPI rating from the AMA Guides does not accurately describe the effects of impairment on an injured worker's functioning, the evaluator: - correct answer May consult alternative tables or chapters that the evaluator feels will provide a more accurate rating of the injured worker's impairment.
41. For disability rating, the following are conclusively presumed to be 100% total in character: - correct answer Loss of both eyes or the sight thereof; Loss of both hands or the use thereof; Practically total paralysis; incurable mental incapacity or insanity.
42. Under Labor Code 4662, apportionment of permanent disability shall be based on - correct answer Causation of permanent disability or impairment.
43. If an applicant has received a prior award of permanent disability: ????? - correct answer ????? It shall be conclusively presumed that the prior permanent disability exists at the time of any subsequent industrial injury.
44. A(n)___________ must be served within 5 business days from setting a QME evaluation date. - correct answer Appointment Notification Form
45. Only ____________________ may cancel a QME evaluation due to failure to receive

medical record in advance. - correct answer Psychologists and Psychiatrists

46. Where an evaluator fills out a Notice of Unavailability for periods of unavailability longer than 14 days, the evaluator may - correct answer Be denied subsequent reappointment if his or her period of unavailability exceeds 90 total days in one year.
47. A QME certificate must be: - correct answer Displayed in a conspicuous manner at the applicable office location at all times during the period of QME appointment at that location.
48. The direct examination of a medical witness: - correct answer Will not be received at trial in CA workers' comp cases except upon a showing of good cause.
49. A request for extension of time to serve a report must be filed - correct answer At least 5 days prior to the due date.
50. The required Labor Code § 4628 disclosure at the end of every report: - correct answer Is made under penalty of perjury.