QME LATEST ACTUAL EXAM WITH COMPLETE DETAILED
QUESTIONS AND 100% VERIFIED ANSWERS ALREADY A+
GRADED
QME
Qualified Medical Examiner
permanent and stationary
When a condition reaches a state of maximal medical improvement.
Escobedo case
than not)
-These words turn the report into substantial evi-Set standard of reasonable medical probability
(standard a physician is expected to follow, that based on superior evidence, something is
probably/more likely dence
Rolda issues/Limits on compensability of psych issues
1. Did psych injury involve "actual events of employment"? (IW has burden of proof)
2. Is there >50% industrial causation (IW burden)
,3. Was there personnel action and was it lawful, non-discriminatory, and in good faith? (Defense
burden)
4. Were personnel actions the substantial (>35-40%) cause of the psych injury. (defense burden)
Granado case
-Set standard that medical tx (MT) is not apportionable
Benson case
-Clarified parsing out impairment to different injury dates
-If they can't be parceled out, you can say they are "inextricably intertwined."
Guzman case/Almaraz-Guzman standard
-Alternative rating of disability (when case is complex/extraordinary and AMA good doesn't accurately
reflect the persons impairment)
-WPI rating can be made if it's accurate and based on AMA guides (fairness is not allowed anymore)
Blackledge v BofA
WCAB defined roles for:
-physician
-DEU rater
-parties
-Work comp judge
,Blackledge case: physician requirements
1. Compare medical findings
2. List WPI for each med condition
3. Select impairment in the range based on impact on ADLs
4. ADL analogies
-Role of evaluator is to assess WPI % by a report that sets forth facts and reasoning to support
conclusions and are in line with AMA & case law
Alternative rating under Almaraz/Guzman
1. Begin w strict rating found in the chapter address the injured body part
2. Explain what specific facts require an alternative rating
3. Provide analysis as to why alternative rating is more accurate
4. Set forth how Dr arrived at alt rating
5. State position with reasonable medical probability
Original intent of WC
-Provide minimum level of benefits promptly
-To prevent IW from becoming a burden on others and help IW return to work thru rehab
-Help dependents if IW dies
-MT for job related injuries/illness
-TD benefits for lost wages
-PD benefits for finished ability to compete in open labor market
, Boyton act
-1913: required most employers to have WC coverage
-Later expanded to include provision that when rating disability, persons diminished ability to compete
in open job market should be considered
Historic compromise
-Trade-off of rights and benefits
-Employee gives up right to sue for lots of $ and gets protection from legal system against discrimination
-Employer provides benefits regardless of fault in exchange for protection from lawsuits
-3 components
1. No fault
2. Exclusive remedy
3. Assured and fixed benefits
No Fault & exceptions
-Employer pays benefits no matter who caused injury, as long as it occurred during employment
*Exceptions
-self inflicted injury
-injury from serious/willful misconduct by employee: benefits reduced by half unless employee died or
has PD of 70% or more
-injury from failure of employer to comply with health and safety reg
-employee was under 16yo
QUESTIONS AND 100% VERIFIED ANSWERS ALREADY A+
GRADED
QME
Qualified Medical Examiner
permanent and stationary
When a condition reaches a state of maximal medical improvement.
Escobedo case
than not)
-These words turn the report into substantial evi-Set standard of reasonable medical probability
(standard a physician is expected to follow, that based on superior evidence, something is
probably/more likely dence
Rolda issues/Limits on compensability of psych issues
1. Did psych injury involve "actual events of employment"? (IW has burden of proof)
2. Is there >50% industrial causation (IW burden)
,3. Was there personnel action and was it lawful, non-discriminatory, and in good faith? (Defense
burden)
4. Were personnel actions the substantial (>35-40%) cause of the psych injury. (defense burden)
Granado case
-Set standard that medical tx (MT) is not apportionable
Benson case
-Clarified parsing out impairment to different injury dates
-If they can't be parceled out, you can say they are "inextricably intertwined."
Guzman case/Almaraz-Guzman standard
-Alternative rating of disability (when case is complex/extraordinary and AMA good doesn't accurately
reflect the persons impairment)
-WPI rating can be made if it's accurate and based on AMA guides (fairness is not allowed anymore)
Blackledge v BofA
WCAB defined roles for:
-physician
-DEU rater
-parties
-Work comp judge
,Blackledge case: physician requirements
1. Compare medical findings
2. List WPI for each med condition
3. Select impairment in the range based on impact on ADLs
4. ADL analogies
-Role of evaluator is to assess WPI % by a report that sets forth facts and reasoning to support
conclusions and are in line with AMA & case law
Alternative rating under Almaraz/Guzman
1. Begin w strict rating found in the chapter address the injured body part
2. Explain what specific facts require an alternative rating
3. Provide analysis as to why alternative rating is more accurate
4. Set forth how Dr arrived at alt rating
5. State position with reasonable medical probability
Original intent of WC
-Provide minimum level of benefits promptly
-To prevent IW from becoming a burden on others and help IW return to work thru rehab
-Help dependents if IW dies
-MT for job related injuries/illness
-TD benefits for lost wages
-PD benefits for finished ability to compete in open labor market
, Boyton act
-1913: required most employers to have WC coverage
-Later expanded to include provision that when rating disability, persons diminished ability to compete
in open job market should be considered
Historic compromise
-Trade-off of rights and benefits
-Employee gives up right to sue for lots of $ and gets protection from legal system against discrimination
-Employer provides benefits regardless of fault in exchange for protection from lawsuits
-3 components
1. No fault
2. Exclusive remedy
3. Assured and fixed benefits
No Fault & exceptions
-Employer pays benefits no matter who caused injury, as long as it occurred during employment
*Exceptions
-self inflicted injury
-injury from serious/willful misconduct by employee: benefits reduced by half unless employee died or
has PD of 70% or more
-injury from failure of employer to comply with health and safety reg
-employee was under 16yo
