QME Exam Questions with complete
solutions
For injuries that result from the serious and willful misconduct of the employer, the employee's
compensation is increased by half ✔️✔️Correct Ans-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 ✔️✔️Correct Ans-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. ✔️✔️Correct Ans-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. ✔️✔️Correct Ans-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 ✔️✔️Correct Ans-
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 ✔️✔️Correct Ans-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
• Any reaction to or side effect from preventive health care the employer provides to health-care
workers (Labor Code § 3208.05). ✔️✔️Correct Ans-the Labor Code defines an injury as:
1 cause disability
2 result in a need for medical treatment. ✔️✔️Correct Ans-In order for a condition to be considered
an injury, it must:
any one-time treatment and any follow-up visit for the purpose of ob-servation of minor scratches,
cuts, burns, splinters, and so forth, which do not ordinarily require medical care ✔️✔️Correct Ans-First
aid is defined as:
is a disease that in whole or in part was caused by work. ✔️✔️Correct Ans-occupational disease
Treatment rendered for pesticide poisoning or a condi-tion suspected as pesticide poisoning can
never be considered first aid ✔️✔️Correct Ans-I treatment for pesticide poisoning considered first aid?
• Injuries caused by the employee's use of alcohol or illegal controlled substances (if it can be shown
that the injury would not have occurred otherwise, which is often difficult to sub-stantiate)
• Intentionally self-inflicted injuries
• Suicide
• Injuries resulting from altercations, in which the injured employee is the "initial physical ag-
gressor"
solutions
For injuries that result from the serious and willful misconduct of the employer, the employee's
compensation is increased by half ✔️✔️Correct Ans-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 ✔️✔️Correct Ans-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. ✔️✔️Correct Ans-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. ✔️✔️Correct Ans-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 ✔️✔️Correct Ans-
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 ✔️✔️Correct Ans-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
• Any reaction to or side effect from preventive health care the employer provides to health-care
workers (Labor Code § 3208.05). ✔️✔️Correct Ans-the Labor Code defines an injury as:
1 cause disability
2 result in a need for medical treatment. ✔️✔️Correct Ans-In order for a condition to be considered
an injury, it must:
any one-time treatment and any follow-up visit for the purpose of ob-servation of minor scratches,
cuts, burns, splinters, and so forth, which do not ordinarily require medical care ✔️✔️Correct Ans-First
aid is defined as:
is a disease that in whole or in part was caused by work. ✔️✔️Correct Ans-occupational disease
Treatment rendered for pesticide poisoning or a condi-tion suspected as pesticide poisoning can
never be considered first aid ✔️✔️Correct Ans-I treatment for pesticide poisoning considered first aid?
• Injuries caused by the employee's use of alcohol or illegal controlled substances (if it can be shown
that the injury would not have occurred otherwise, which is often difficult to sub-stantiate)
• Intentionally self-inflicted injuries
• Suicide
• Injuries resulting from altercations, in which the injured employee is the "initial physical ag-
gressor"
