QME FINAL EXAM WITH DETAILED QUESTIONS AND
VERIFIED CORRECT ANSWERS/ALREADY GRADED A++
Causation - ANSWER ...is whether the occupational illness or injury arose
out of employment (AOE). In other words, the physician is asked to indicate
whether it is "more likely than not" (in other words, there is at least a 51%
likelihood) that the work exposure or incident played a significant role in
producing the pathological condition or disability that the physician
described.
Impairment - ANSWER ...is defined as loss, loss of use, or derangement of
any body part, organ system or organ function.
Apportionment - ANSWER ...represents a distribution or allocation of
causation among multiple factors that caused or significantly contributed to
the injury or disease resulting in impairment.
Arising Out of Employment (AOE) - ANSWER ...means that an injury or
illness was work related in whole or in part. It is a medical determination
based on the information collected by a physician in obtaining a history
related to the injury or illness.
Compensable - ANSWER For a condition to be considered a compensable
injury there must be physical or psychological harm to an individual who is
employed, suffered while the individual was performing a service that was
part of and was incidental to the individual's employment.
Cumulative Trauma - ANSWER An injury that was caused by repeated
events or repeated exposures at work.
Date of Injury (DOI) - ANSWER The date when an employee was hurt or
became ill.
Specific Injury - ANSWER occurs as the result of a single incident or
exposure.
Occupational Disease - ANSWER ...is a disease that in whole or in part
was caused by work.
,Denied Claim - ANSWER ...is in which the insurance company believes an
employee's injury or illness is not covered by workers' compensation and
has notified the employee of the decision.
Disability - ANSWER A physical or mental impairment that limits an
employee's life activities. A condition that makes engaging in physical,
social, and work activities difficult.
Dispute - ANSWER A disagreement about the employee's right to
payments, services or other benefits, or medical treatment services.
Work Ergonomics - ANSWER The study of how to improve the fit between
the physical demands of the workplace and the employees who perform
the work. That means considering the variability in human capabilities when
selecting, designing or modifying equipment, tools, work tasks, and the
work environment.
Ex-parte Communication - ANSWER Generally a private communication
with a judge, arbitrator, AME, or QME regarding a disputed matter without
the other party being present or copied with correspondence.
Future Medical Care - ANSWER Treatment that is anticipated at some time
in the future and is reasonably required to cure or relieve the employee of
the effects of the injury
Ghostwriting - ANSWER A medical report is ghostwritten if it is prepared in
whole or in part by an individual or entity other than the physician who
performed the actual evaluation. Ghostwriting is prohibited
Impairment Rating - ANSWER A percentage estimate of how much normal
use of the worker's injured body parts has been lost. It is determined based
on guidelines published by the AMA.
Maximal Medical Improvement (MMI) - ANSWER The injured worker's
condition is well stabilized and unlikely to change substantially in the next
year, with or without medical treatment.
Non-Compensable Injury - ANSWER An injury that resulted from the use of
alcohol or illicit drugs, was intentionally self-inflicted (including suicide), was
due to an altercation in which the injured person physically initiated the
,altercation, or arose while the injured person was committing a felony for
which the injured person was, or could be convicted, or related to off-duty
recreational activity participation in which was not required as work related,
or an injury claimed after the notice to the worker of termination or layoff.
Party/Parties - ANSWER Normally this includes the insurance company,
the employer, attorneys, and any other person with an interest in the
injured employee's claim (doctors or hospitals that have not been paid).
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" ).
VERIFIED CORRECT ANSWERS/ALREADY GRADED A++
Causation - ANSWER ...is whether the occupational illness or injury arose
out of employment (AOE). In other words, the physician is asked to indicate
whether it is "more likely than not" (in other words, there is at least a 51%
likelihood) that the work exposure or incident played a significant role in
producing the pathological condition or disability that the physician
described.
Impairment - ANSWER ...is defined as loss, loss of use, or derangement of
any body part, organ system or organ function.
Apportionment - ANSWER ...represents a distribution or allocation of
causation among multiple factors that caused or significantly contributed to
the injury or disease resulting in impairment.
Arising Out of Employment (AOE) - ANSWER ...means that an injury or
illness was work related in whole or in part. It is a medical determination
based on the information collected by a physician in obtaining a history
related to the injury or illness.
Compensable - ANSWER For a condition to be considered a compensable
injury there must be physical or psychological harm to an individual who is
employed, suffered while the individual was performing a service that was
part of and was incidental to the individual's employment.
Cumulative Trauma - ANSWER An injury that was caused by repeated
events or repeated exposures at work.
Date of Injury (DOI) - ANSWER The date when an employee was hurt or
became ill.
Specific Injury - ANSWER occurs as the result of a single incident or
exposure.
Occupational Disease - ANSWER ...is a disease that in whole or in part
was caused by work.
,Denied Claim - ANSWER ...is in which the insurance company believes an
employee's injury or illness is not covered by workers' compensation and
has notified the employee of the decision.
Disability - ANSWER A physical or mental impairment that limits an
employee's life activities. A condition that makes engaging in physical,
social, and work activities difficult.
Dispute - ANSWER A disagreement about the employee's right to
payments, services or other benefits, or medical treatment services.
Work Ergonomics - ANSWER The study of how to improve the fit between
the physical demands of the workplace and the employees who perform
the work. That means considering the variability in human capabilities when
selecting, designing or modifying equipment, tools, work tasks, and the
work environment.
Ex-parte Communication - ANSWER Generally a private communication
with a judge, arbitrator, AME, or QME regarding a disputed matter without
the other party being present or copied with correspondence.
Future Medical Care - ANSWER Treatment that is anticipated at some time
in the future and is reasonably required to cure or relieve the employee of
the effects of the injury
Ghostwriting - ANSWER A medical report is ghostwritten if it is prepared in
whole or in part by an individual or entity other than the physician who
performed the actual evaluation. Ghostwriting is prohibited
Impairment Rating - ANSWER A percentage estimate of how much normal
use of the worker's injured body parts has been lost. It is determined based
on guidelines published by the AMA.
Maximal Medical Improvement (MMI) - ANSWER The injured worker's
condition is well stabilized and unlikely to change substantially in the next
year, with or without medical treatment.
Non-Compensable Injury - ANSWER An injury that resulted from the use of
alcohol or illicit drugs, was intentionally self-inflicted (including suicide), was
due to an altercation in which the injured person physically initiated the
,altercation, or arose while the injured person was committing a felony for
which the injured person was, or could be convicted, or related to off-duty
recreational activity participation in which was not required as work related,
or an injury claimed after the notice to the worker of termination or layoff.
Party/Parties - ANSWER Normally this includes the insurance company,
the employer, attorneys, and any other person with an interest in the
injured employee's claim (doctors or hospitals that have not been paid).
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" ).
