QUESTIONS WITH CORRECT ANSWERS
A+ GRADED
Are post-termination psych claims usually acceptable for
compensation? ...ANS: No, they are usually barred
Can acupuncturists issue opinions on permanent disability? ...ANS:
No
Define apportionment ...ANS: Estimate of the % of permanent
disability was caused by work-related injury
Define permanent, temporary partial and temporary total disability.
...ANS: Permanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury? ...ANS: No
For how long must reports be kept? ...ANS: 5 years
Form 100 ...ANS: Employee's Disability Questionnaire (include
for unrepresented workers for permanent disability or
apportionment)
Form 101 ...ANS: Request for Summary Rating Determination
(include for unrepresented workers for permanent disability or
apportionment)
Form 109 ...ANS: Notice of Unavailability Form
, Form 110 ...ANS: Appointment Notification Form (QME must
send to all parties within 5 days of the appt being made)
Form 111 ...ANS: QME Findings Summaary
Form 112 ...ANS: QME Report Time Frame Extension Request
(has to be filed at least 5 days before report deadline; there is a 15
day good cause extension and 30 day extension for pending test
results)
Form 120 ...ANS: Psych IW wants the report sent to their MD
instead of themselves
Form 121 ...ANS: Send if the injured worker wants the report sent
to themself AND viewing it is a danger to them
Note: if viewing it isn't a danger to them, you can just send them the
finished report
Form 122 ...ANS: Medical Legal Declaration of Service Form
(must be included with all represented IW reports)
How is the disability rating made? ...ANS: QMEs rate the
impairment (NOT DISABILITY), and then raters use the impairment
rating to make a disability rating
How long does a first treating MD have to complete a "Doctors First
Report of Occupational Injury of Illness?" ...ANS: 5 days of the
worker's first visit
What are AOE and COE? ...ANS: AOE: arising out of employment
COE: through the course of employment