QME EXAM QUESTIONS AND ANSWERS
(ALREADY RATED A+)
1. Workers' Compensation laws in California originated with the _______________
which was passed in ________________. - ANSWER-Boynton Act; 1913
2. The "Grand Bargain" of the workers compensation system involves
employers agreeing to pay assured and fixed benefits for industrial injuries
and workers agreeing to: - ANSWER-Not sue their employer in civil court for an
industrial injury.
3. The five basic categories of workers' compensation benefits are called: - ANSWER-
Medical Treatment, Temporary Disability Benefits, Permanent
Disability Benefits, Death Benefits, Supplemental Job Displacement
Benefits.
4. Temporary Disability Benefits are paid at the rate of _____________ and are
usually limited by a ______________ time cap. - ANSWER-2/3 of average "weekly"
wages; 2 year
5. Supplemental Job Displacement Benefits are available where: - ANSWER-The date
of injury is AFTER "1/1/13" and the employer does not offer
Return-to-Work.
6. A(n) _____________ report, written by an AME, QME, or AQME, does not involve
a face-to-face evaluation of an Applicant. - ANSWER-Supplemental
7. In the workers' compensation system, "Injury" is defined as: - ANSWER-Incident or
exposure that causes disability or need for medical
treatment.
Where a prior injury (be it industrial or non-industrial) is "exacerbated," it
means ______________; Where a prior injury (be it industrial or non-industrial)
is "aggravated," it means ________________. - ANSWER-There is a temporary
increase in symptoms but then a return
to baseline causing no additional Permanent Disability (PD); There
is an increase in symptoms with an increase in PD, and it is
considered a new injury.
9. Non-compensable injuries include those caused by intoxication, injuries that
are self-inflicted, injuries resulting from incidents where Applicant is an
initial aggressor, injuries sustained while committing a crime, death by
suicide, injuries caused by off-duty recreational activities not required by
, employment, and __________: - ANSWER-Post-termination psychiatric injuries.
10. Non-psychological injuries are considered compensable if ________ of the
injury was industrially caused; Subject to a few exceptions, psychological
injuries are considered compensable if ______ of the injury was industrially
caused . - ANSWER-1% or more; greater than 50%
11. In order to claim psychiatric injury, an employee must have been - ANSWER-
Employed for at least 6 months, except where psychiatric injury
was caused by a "sudden and extraordinary event."
12. "Permanent Disability" is calculated by: - ANSWER-A special "Rater" taking the
physician's "impairment rating," and
then adjusting based on nature of injury, age, and occupation
13. "Permanent and Stationary" or "P+S" status is achieved when - ANSWER-The
condition has "reached a plateau," meaning that the
applicant's condition is well stabilized and unlikely to change
substantially in the next year with or without medical treatment.
(P & S status may also be referred to as "MMI- Maximal Medical
Improvement" ).
14. "Apportionment" refers to the notion that - ANSWER-An employer is only liable for
the percentage of permanent
disability that was directly caused by an injury arising out of and
occurring in the course of employment. (Apportionment does not
reduce benefits owed as treatment or work restrictions).
15. Under Benson , where there is more than one Date of Injury (DOI), one must
apportion Permanent Disability (PD) amongst the various dates of injury and
must be done for each body part. If this cannot be done with reasonable
medical certainty, then the physician may opine that the DOI and the
impairment are all - ANSWER-"Inextricably intertwined."
16. In CA workers' compensation, the burden of proof (by a "preponderance of
the evidence") for injury is on the _____________ and the burden of proof for
apportionment is on the ______________ - ANSWER-c. Injured Worker; Employer
17. Under Blackledge, a report will be considered ___________ if the reasoning
behind a physician's opinion is not adequately explained. - ANSWER-Lacking as
"substantial medical evidence"
18. Under the QME Regulations, a QME must maintain records as follows: - ANSWER-
Reports must be kept for 5 years; bills must be kept for 3 years.
19. Under Labor Code 139.2, an initial QME report is due within 30 days of the
(ALREADY RATED A+)
1. Workers' Compensation laws in California originated with the _______________
which was passed in ________________. - ANSWER-Boynton Act; 1913
2. The "Grand Bargain" of the workers compensation system involves
employers agreeing to pay assured and fixed benefits for industrial injuries
and workers agreeing to: - ANSWER-Not sue their employer in civil court for an
industrial injury.
3. The five basic categories of workers' compensation benefits are called: - ANSWER-
Medical Treatment, Temporary Disability Benefits, Permanent
Disability Benefits, Death Benefits, Supplemental Job Displacement
Benefits.
4. Temporary Disability Benefits are paid at the rate of _____________ and are
usually limited by a ______________ time cap. - ANSWER-2/3 of average "weekly"
wages; 2 year
5. Supplemental Job Displacement Benefits are available where: - ANSWER-The date
of injury is AFTER "1/1/13" and the employer does not offer
Return-to-Work.
6. A(n) _____________ report, written by an AME, QME, or AQME, does not involve
a face-to-face evaluation of an Applicant. - ANSWER-Supplemental
7. In the workers' compensation system, "Injury" is defined as: - ANSWER-Incident or
exposure that causes disability or need for medical
treatment.
Where a prior injury (be it industrial or non-industrial) is "exacerbated," it
means ______________; Where a prior injury (be it industrial or non-industrial)
is "aggravated," it means ________________. - ANSWER-There is a temporary
increase in symptoms but then a return
to baseline causing no additional Permanent Disability (PD); There
is an increase in symptoms with an increase in PD, and it is
considered a new injury.
9. Non-compensable injuries include those caused by intoxication, injuries that
are self-inflicted, injuries resulting from incidents where Applicant is an
initial aggressor, injuries sustained while committing a crime, death by
suicide, injuries caused by off-duty recreational activities not required by
, employment, and __________: - ANSWER-Post-termination psychiatric injuries.
10. Non-psychological injuries are considered compensable if ________ of the
injury was industrially caused; Subject to a few exceptions, psychological
injuries are considered compensable if ______ of the injury was industrially
caused . - ANSWER-1% or more; greater than 50%
11. In order to claim psychiatric injury, an employee must have been - ANSWER-
Employed for at least 6 months, except where psychiatric injury
was caused by a "sudden and extraordinary event."
12. "Permanent Disability" is calculated by: - ANSWER-A special "Rater" taking the
physician's "impairment rating," and
then adjusting based on nature of injury, age, and occupation
13. "Permanent and Stationary" or "P+S" status is achieved when - ANSWER-The
condition has "reached a plateau," meaning that the
applicant's condition is well stabilized and unlikely to change
substantially in the next year with or without medical treatment.
(P & S status may also be referred to as "MMI- Maximal Medical
Improvement" ).
14. "Apportionment" refers to the notion that - ANSWER-An employer is only liable for
the percentage of permanent
disability that was directly caused by an injury arising out of and
occurring in the course of employment. (Apportionment does not
reduce benefits owed as treatment or work restrictions).
15. Under Benson , where there is more than one Date of Injury (DOI), one must
apportion Permanent Disability (PD) amongst the various dates of injury and
must be done for each body part. If this cannot be done with reasonable
medical certainty, then the physician may opine that the DOI and the
impairment are all - ANSWER-"Inextricably intertwined."
16. In CA workers' compensation, the burden of proof (by a "preponderance of
the evidence") for injury is on the _____________ and the burden of proof for
apportionment is on the ______________ - ANSWER-c. Injured Worker; Employer
17. Under Blackledge, a report will be considered ___________ if the reasoning
behind a physician's opinion is not adequately explained. - ANSWER-Lacking as
"substantial medical evidence"
18. Under the QME Regulations, a QME must maintain records as follows: - ANSWER-
Reports must be kept for 5 years; bills must be kept for 3 years.
19. Under Labor Code 139.2, an initial QME report is due within 30 days of the
