QME Exam Questions and Answers Already Passed

QME Exam Questions and Answers Already Passed When was the first workers' compensation law introduced? The inaugural workers' compensation statute was enacted in 1911, shortly after the catastrophic Triangle Shirtwaist Company fire in New York, which claimed 146 lives. What is meant by 'No Fault' in workers' compensation? The 'No Fault' principle means that the employer is obligated to provide benefits for workplace injuries regardless of who is at fault, as long as the injury occurred during employment. What does 'Exclusive Remedy' imply in workers' compensation? Under 'Exclusive Remedy,' workers are barred from seeking additional compensation from their employer beyond workers' compensation benefits, except if the employer lacks insurance coverage. What does 'Guaranteed Fixed Benefit' signify in workers' compensation? 'Guaranteed Fixed Benefit' refers to the predetermined benefits that employers must provide under workers' compensation, which are usually lower than what might be awarded in a 2 negligence lawsuit. However, the workers' compensation process is generally quicker. Additional claims can be made for severe misconduct by the employer or unlawful discrimination (Labor Code § 132a and § 4553). Unlike private health insurance, there are no arbitrary limits on the extent of coverage under workers' compensation. Which types of injuries are not covered by workers' compensation? Injuries that are intentionally self-inflicted are not eligible for coverage. What happens if the injury is caused by serious misconduct on the part of the employer? If an injury results from serious and deliberate misconduct by the employer, the worker’s compensation is increased by 50%. How is compensation adjusted if the injury is due to serious misconduct by the employee? When an injury is due to serious and willful misconduct by the employee, the compensation is halved, unless the injury resulted in death, a permanent disability of 70% or more, was caused by the employer’s legal or safety violations, or if the employee was under 16 years old at the time of the injury. What changes were implemented by the reforms of 2003 and 2004? 3 The 2003 and 2004 reforms introduced measures allowing employers to (1) establish medical provider networks for injured workers to select their treating doctors, (2) conduct reviews to ensure medical care adhered to evidence-based standards, and (3) impose limits on physical therapy and chiropractic treatments. These changes also affected how permanent disabilities are rated and benefits are paid. An evidence-based medical treatment utilization schedule (MTUS) was also put into place. What are the three core elements of the workers' compensation system? 1. No Fault