QME Exam Prep p2 Questions with
complete solutions
What must be included with the HPI? ✔️✔️Correct Ans-A discussion of the mechanism of injury
What are the 5 main types of workers comp benefits? ✔️✔️Correct Ans-1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? ✔️✔️Correct Ans-Requires CA employees to have worker's comp
insurance
what is the definition of a medical-legal report? ✔️✔️Correct Ans-to prove or disprove an aspect of a
contested claim
What is the impairment rating? ✔️✔️Correct Ans-Rates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? ✔️✔️Correct Ans-AOE: arising out of employment
COE: through the course of employment
What is ex parte communication? ✔️✔️Correct Ans-Occurs when a party to a case communicates with
one side only. a QME CANNOT do this (but can speak with the treating MD if questions arise)
What is the difference between exacerbation and aggravation? ✔️✔️Correct Ans-Exacerbation:
temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. ✔️✔️Correct 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? ✔️✔️Correct Ans-No
Define apportionment ✔️✔️Correct Ans-Estimate of the % of permanent disability was caused by
work-related injury
What are temporary disability payments? ✔️✔️Correct Ans-2/3 of average weekly pay, limited to 104
weeks (2 years)
when are supplemental job displacement benefits offered? ✔️✔️Correct Ans-if the employer doesn't
offer a RTW (return to work), a voucher can be offered to the IW, but must be used within 2 years of
offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? ✔️✔️Correct Ans-Non-psych: if 1% or more of
the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? ✔️✔️Correct Ans-1) Firefighters & peace
officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues if >5 years
work
How is the disability rating made? ✔️✔️Correct Ans-QMEs rate the impairment (NOT DISABILITY), and
then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of permanent
impairment? ✔️✔️Correct Ans-Psych cases and cases prior to 1/1/2005 (the latter use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time devoted to direct
clinical practice? ✔️✔️Correct Ans-1) if the QME has been an AME at least 8 times in the past year
2) if the QME is retired or a teaching physician
complete solutions
What must be included with the HPI? ✔️✔️Correct Ans-A discussion of the mechanism of injury
What are the 5 main types of workers comp benefits? ✔️✔️Correct Ans-1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? ✔️✔️Correct Ans-Requires CA employees to have worker's comp
insurance
what is the definition of a medical-legal report? ✔️✔️Correct Ans-to prove or disprove an aspect of a
contested claim
What is the impairment rating? ✔️✔️Correct Ans-Rates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? ✔️✔️Correct Ans-AOE: arising out of employment
COE: through the course of employment
What is ex parte communication? ✔️✔️Correct Ans-Occurs when a party to a case communicates with
one side only. a QME CANNOT do this (but can speak with the treating MD if questions arise)
What is the difference between exacerbation and aggravation? ✔️✔️Correct Ans-Exacerbation:
temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. ✔️✔️Correct 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? ✔️✔️Correct Ans-No
Define apportionment ✔️✔️Correct Ans-Estimate of the % of permanent disability was caused by
work-related injury
What are temporary disability payments? ✔️✔️Correct Ans-2/3 of average weekly pay, limited to 104
weeks (2 years)
when are supplemental job displacement benefits offered? ✔️✔️Correct Ans-if the employer doesn't
offer a RTW (return to work), a voucher can be offered to the IW, but must be used within 2 years of
offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? ✔️✔️Correct Ans-Non-psych: if 1% or more of
the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? ✔️✔️Correct Ans-1) Firefighters & peace
officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues if >5 years
work
How is the disability rating made? ✔️✔️Correct Ans-QMEs rate the impairment (NOT DISABILITY), and
then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of permanent
impairment? ✔️✔️Correct Ans-Psych cases and cases prior to 1/1/2005 (the latter use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time devoted to direct
clinical practice? ✔️✔️Correct Ans-1) if the QME has been an AME at least 8 times in the past year
2) if the QME is retired or a teaching physician
