QME Test Questions with Correct Answers
The definition of a medical-legal cost is found in which California Labor Code Section?
4622
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?
5 years
The law specifies an order of medical evidence standards, what is the order?
1. The guidelines, including drug formulary, adopted by the administrative director pursuant
to Section 5307.27 (MTUS)
2. Peer-reviewed scientific and medical evidence regarding the effectiveness of the disputed
service
3. Nationally recognized professional standards
4. Expert opinions
5. Generally accepted standards of medical practice
6. Treatments that are likely to provide a benefit to a patient for conditions for which other
treatments are not clinically efficacious
For psychiatric injuries that result from a violent act or from direct exposure to a
significant violent act, the actual events of employment must have been a "substantial
cause" of the injury, in that they contributed at least _______ per cent of the causation
from all sources combined?
35%
5 day Rule
, UR rule to respond to PTP within 5 to 14 days
There are _______ district DWC offices and satellites located around the state, also
called Workers' Compensation Appeals Boards (WCABs) or "boards"
24
45 day Rule
Requirement to pay medical claims
Appeal from a local WCAB is available by_________________ to a statewide panel of
commissioners
Petition for Reconsideration
Requirement for employer to deny liability
90 day rule
Distinct from the local "boards", the WCAB is a judicial body consisting of _______
commissioners, appointed by the governor and confirmed by the Senate.
7
ACOEM
American College of Occupational and Environmental Medicine
Which DWC Unit assures proper benefits are delivered accurately and timely to injured
workers?
Audit Unit
AMA
American Medical Association
The definition of a medical-legal cost is found in which California Labor Code Section?
4622
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?
5 years
The law specifies an order of medical evidence standards, what is the order?
1. The guidelines, including drug formulary, adopted by the administrative director pursuant
to Section 5307.27 (MTUS)
2. Peer-reviewed scientific and medical evidence regarding the effectiveness of the disputed
service
3. Nationally recognized professional standards
4. Expert opinions
5. Generally accepted standards of medical practice
6. Treatments that are likely to provide a benefit to a patient for conditions for which other
treatments are not clinically efficacious
For psychiatric injuries that result from a violent act or from direct exposure to a
significant violent act, the actual events of employment must have been a "substantial
cause" of the injury, in that they contributed at least _______ per cent of the causation
from all sources combined?
35%
5 day Rule
, UR rule to respond to PTP within 5 to 14 days
There are _______ district DWC offices and satellites located around the state, also
called Workers' Compensation Appeals Boards (WCABs) or "boards"
24
45 day Rule
Requirement to pay medical claims
Appeal from a local WCAB is available by_________________ to a statewide panel of
commissioners
Petition for Reconsideration
Requirement for employer to deny liability
90 day rule
Distinct from the local "boards", the WCAB is a judicial body consisting of _______
commissioners, appointed by the governor and confirmed by the Senate.
7
ACOEM
American College of Occupational and Environmental Medicine
Which DWC Unit assures proper benefits are delivered accurately and timely to injured
workers?
Audit Unit
AMA
American Medical Association
