HCC QME Exam Concepts
An employer has an MPN then what can be pre-designated? - Correct Answer
✔️✔️1. MD
2. DO
3. Medical Group
NOT a Chiropractor
A violation of LC139(a) conflict of interest referral is a misdemeanor subject to
civil penalties up to $_________ per offense. - Correct Answer ✔️✔
️$5,000
If an IW is not being treated in an MPN or HCO and did not predesignate, they
may switch to a new doctor one time ___________ - Correct Answer ✔️✔
️During the First 30 Days
Non-MPN upon request of the employee for a change of physicians, the
maximum amount of time permitted by law for the employer or insurance
,carrier to provide the employee with an alternate physician or if requested by
the employee, a chiropractor or acupuncturist is ___________ working days
from the date of the request - Correct Answer ✔️✔️5 working days
A worker is injured on June 24, 2008, his vocational rehab benefits are? -
Correct Answer ✔️✔️Replaced by a supplemental job displacement
benefit.
The employee who has designated a personal physician may change personal
physicians how often Prior to an injury? - Correct Answer ✔️✔️At any
time
Presumptions for fire fighters, forestry officers, peace officers, and correctional
employees cover conditions that manifest or develop during the period of active
service and following termination of service for up to_____ years? - Correct
Answer ✔️✔️5 years
California passed its first workers' compensation act (voluntary) in - Correct
Answer ✔️✔️1911
,Following request for additional information, the UR decision must then be
made within __________________ from the date of first receipt of the RFA -
Correct Answer ✔️✔️14 days
If the request for IMR is made by a provider of emergency medical treatment,
the deadline for filing the application for IMR is within___________ of receipt of
the UR decision? - Correct Answer ✔️✔️30 days
A claims administrator must submit all records within_____________ days of
the IMR request? - Correct Answer ✔️✔️15 days
Original signature of the medical legal report is mailed to the _____? - Correct
Answer ✔️✔️The Claims Administrator
Factors of Disability are only required for medical legal reports before _____? -
Correct Answer ✔️✔️01/01/2005
When an injured worker is unrepresented the QME serves the report on who? -
Correct Answer ✔️✔️1. DEU
2. Employee
3. Claims Administrator
, Where does the DEU rater find the wage information of the IW? - Correct
Answer ✔️✔️DEU 101 Request for Summary Rating with Records
Occasional, Intermittent, Constant, and Frequent are terms called? - Correct
Answer ✔️✔️Words of Art
What did the 1913 Boynton Act require? - Correct Answer ✔️✔️That most
employers have workers' compensation coverage
For injuries on or after January 1, 1994 and Before 01/01/04 most workers will
be limited to a ___________________ cap on Vocational Rehabilitation benefits
under that plan? - Correct Answer ✔️✔️$16,000
Medical providers who request authorization in writing for a specific course of
treatment for an injured worker must receive a prompt response within
________________ working days of receipt of the report and not to exceed
______________ days? - Correct Answer ✔️✔️5 days and 14 days
What 3 requirements constitutes an aggravation of a pre-existing, non-industrial
condition in WC cases? - Correct Answer ✔️✔️(1) Causes a temporary or
permanent increase in disability
(2) Creates a new need for medical treatment
An employer has an MPN then what can be pre-designated? - Correct Answer
✔️✔️1. MD
2. DO
3. Medical Group
NOT a Chiropractor
A violation of LC139(a) conflict of interest referral is a misdemeanor subject to
civil penalties up to $_________ per offense. - Correct Answer ✔️✔
️$5,000
If an IW is not being treated in an MPN or HCO and did not predesignate, they
may switch to a new doctor one time ___________ - Correct Answer ✔️✔
️During the First 30 Days
Non-MPN upon request of the employee for a change of physicians, the
maximum amount of time permitted by law for the employer or insurance
,carrier to provide the employee with an alternate physician or if requested by
the employee, a chiropractor or acupuncturist is ___________ working days
from the date of the request - Correct Answer ✔️✔️5 working days
A worker is injured on June 24, 2008, his vocational rehab benefits are? -
Correct Answer ✔️✔️Replaced by a supplemental job displacement
benefit.
The employee who has designated a personal physician may change personal
physicians how often Prior to an injury? - Correct Answer ✔️✔️At any
time
Presumptions for fire fighters, forestry officers, peace officers, and correctional
employees cover conditions that manifest or develop during the period of active
service and following termination of service for up to_____ years? - Correct
Answer ✔️✔️5 years
California passed its first workers' compensation act (voluntary) in - Correct
Answer ✔️✔️1911
,Following request for additional information, the UR decision must then be
made within __________________ from the date of first receipt of the RFA -
Correct Answer ✔️✔️14 days
If the request for IMR is made by a provider of emergency medical treatment,
the deadline for filing the application for IMR is within___________ of receipt of
the UR decision? - Correct Answer ✔️✔️30 days
A claims administrator must submit all records within_____________ days of
the IMR request? - Correct Answer ✔️✔️15 days
Original signature of the medical legal report is mailed to the _____? - Correct
Answer ✔️✔️The Claims Administrator
Factors of Disability are only required for medical legal reports before _____? -
Correct Answer ✔️✔️01/01/2005
When an injured worker is unrepresented the QME serves the report on who? -
Correct Answer ✔️✔️1. DEU
2. Employee
3. Claims Administrator
, Where does the DEU rater find the wage information of the IW? - Correct
Answer ✔️✔️DEU 101 Request for Summary Rating with Records
Occasional, Intermittent, Constant, and Frequent are terms called? - Correct
Answer ✔️✔️Words of Art
What did the 1913 Boynton Act require? - Correct Answer ✔️✔️That most
employers have workers' compensation coverage
For injuries on or after January 1, 1994 and Before 01/01/04 most workers will
be limited to a ___________________ cap on Vocational Rehabilitation benefits
under that plan? - Correct Answer ✔️✔️$16,000
Medical providers who request authorization in writing for a specific course of
treatment for an injured worker must receive a prompt response within
________________ working days of receipt of the report and not to exceed
______________ days? - Correct Answer ✔️✔️5 days and 14 days
What 3 requirements constitutes an aggravation of a pre-existing, non-industrial
condition in WC cases? - Correct Answer ✔️✔️(1) Causes a temporary or
permanent increase in disability
(2) Creates a new need for medical treatment
