QME Exam Prep p2 QUESTIONS &
ANSWERS(RATED A+)
How is the disability rating made? - ANSWERQMEs rate the impairment (NOT
DISABILITY), and then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of
permanent impairment? - ANSWERPsych cases and cases prior to 1/1/2005 (the latter
use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time
devoted to direct clinical practice? - ANSWER1) if the QME has been an AME at least 8
times in the past year
2) if the QME is retired or a teaching physician
Can acupuncturists issue opinions on permanent disability? - ANSWERNo
What are the limitations to apportionment? - ANSWER1) Apportionment applies only to
permanent disability and is based on causation
2) only permanent disability is apportioned, never treatment, work restrictions, etc.
What is the signing date for QME reports? - ANSWERthe date the report is completed,
not the evaluation date. include the county of the report
What are the five major categories of QME disciplinary action? - ANSWER1) consistent
late reports
2) lack of availability
3) ex parte communications
4) self-referral
5) reports do not meet DWC minimum standards
What must be included with the HPI? - ANSWERA discussion of the mechanism of
injury
What are the 5 main types of workers comp benefits? - ANSWER1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? - ANSWERRequires CA employees to have worker's
comp insurance
, what is the definition of a medical-legal report? - ANSWERto prove or disprove an
aspect of a contested claim
What is the impairment rating? - ANSWERRates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? - ANSWERAOE: arising out of employment
COE: through the course of employment
What is ex parte communication? - ANSWEROccurs when a party to a case
communicates with one side only. a QME CANNOT do this (but can speak with the
treating MD if questions arise)
What is the difference between exacerbation and aggravation? -
ANSWERExacerbation: temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. -
ANSWERPermanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury? - ANSWERNo
Define apportionment - ANSWEREstimate of the % of permanent disability was caused
by work-related injury
What are temporary disability payments? - ANSWER2/3 of average weekly pay, limited
to 104 weeks (2 years)
when are supplemental job displacement benefits offered? - ANSWERif the employer
doesn't offer a RTW (return to work), a voucher can be offered to the IW, but must be
used within 2 years of offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? - ANSWERNon-psych: if 1% or
more of the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? - ANSWER1) Firefighters &
peace officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues
if >5 years work
What are the medical treatment utilization schedule (MTUS) guidelines? -
ANSWERODG: chronic pain / post-surgical
ACOEM: everything else
ANSWERS(RATED A+)
How is the disability rating made? - ANSWERQMEs rate the impairment (NOT
DISABILITY), and then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of
permanent impairment? - ANSWERPsych cases and cases prior to 1/1/2005 (the latter
use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time
devoted to direct clinical practice? - ANSWER1) if the QME has been an AME at least 8
times in the past year
2) if the QME is retired or a teaching physician
Can acupuncturists issue opinions on permanent disability? - ANSWERNo
What are the limitations to apportionment? - ANSWER1) Apportionment applies only to
permanent disability and is based on causation
2) only permanent disability is apportioned, never treatment, work restrictions, etc.
What is the signing date for QME reports? - ANSWERthe date the report is completed,
not the evaluation date. include the county of the report
What are the five major categories of QME disciplinary action? - ANSWER1) consistent
late reports
2) lack of availability
3) ex parte communications
4) self-referral
5) reports do not meet DWC minimum standards
What must be included with the HPI? - ANSWERA discussion of the mechanism of
injury
What are the 5 main types of workers comp benefits? - ANSWER1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? - ANSWERRequires CA employees to have worker's
comp insurance
, what is the definition of a medical-legal report? - ANSWERto prove or disprove an
aspect of a contested claim
What is the impairment rating? - ANSWERRates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? - ANSWERAOE: arising out of employment
COE: through the course of employment
What is ex parte communication? - ANSWEROccurs when a party to a case
communicates with one side only. a QME CANNOT do this (but can speak with the
treating MD if questions arise)
What is the difference between exacerbation and aggravation? -
ANSWERExacerbation: temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. -
ANSWERPermanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury? - ANSWERNo
Define apportionment - ANSWEREstimate of the % of permanent disability was caused
by work-related injury
What are temporary disability payments? - ANSWER2/3 of average weekly pay, limited
to 104 weeks (2 years)
when are supplemental job displacement benefits offered? - ANSWERif the employer
doesn't offer a RTW (return to work), a voucher can be offered to the IW, but must be
used within 2 years of offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? - ANSWERNon-psych: if 1% or
more of the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? - ANSWER1) Firefighters &
peace officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues
if >5 years work
What are the medical treatment utilization schedule (MTUS) guidelines? -
ANSWERODG: chronic pain / post-surgical
ACOEM: everything else
