QME EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
1911, SEVENTEEN DAYS AFTER THE DEVISTATING FIRE AT THE TRIANGLE
SHIRTWAIST COMPANY FACTORY IN NEW YORK TOOK 146 LIVES - correct
answer when was the 1st work comp act passed?
1. NO FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT - correct answer WHAT ARE THE 3 COMPONENTS OF
THE WORK COMP SYSTEM
e employer is required to pay benefits no matter who caused the injury, as long as the
injury arose out of or occurred in the course of employment. - correct answer NO
FAULT
less the employer is uninsured, the worker cannot pursue other forms of recovery from
the employer, even if the employer was grossly negligent. - correct answer EXCLUSIVE
REMEDY
The workers' compensation system establishes defined benefits, which must be paid for
by the employer. Workers' compensation awards are typically far less than comparable
negligence awards in a civil suit. For example, although the maximum workers'
compensation death benefit may be far less than the possible award in a civil wrongful
death suit, a civil action may take years to resolve while a death claim can be re-solved
in as little as a few months. Additional recoveries are available to employees for an
employer's serious and willful misconduct and unlawful discrimination (Labor Code §
132a and § 4553). Although group health coverage may include arbitrary limits on the
extent of treatment covered, workers' compensation is a statutory benefit with no
arbitrary limits on the frequency, duration, or extent of services. - correct answer
ASSURED AND FIXED BENEFIT
deliberately self-inflicted injuries are excluded from coverage - correct answer WHAT
TYPE OF INJYURIES ARE EXCLUDED
For injuries that result from the serious and willful misconduct of the employer, the
employee's compensation is increased by half - correct answer WHAT HAPPENS IF
THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE EMPLOYER?
For injuries that result from the serious and willful misconduct of the injured employee,
benefits are reduced by half, unless the injury resulted in death or a per-manent
, disability of 70% or more; the injury resulted from failure of the employer to comply with
the law or safety and health regulations; or the employee was under 16 years old at the
QUESTIONS WITH COMPLETE
time of in-jury -
SOLUTIONS
correct answer WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS
MISCONDUCT OF THE EMPLOYEE?
measures were enacted that allowed employers (1) to establish medical pro-vider
networks—from which injured workers are required to select treating doctors, (2) to
conduct utilization review to ensure that medical care was consistent with evidence-
based guidelines, and (3) to limit the amount of physical therapy and chiropractic
treatment. These measures also affect-ed permanent disability ratings and benefit
payments to injured workers. An evidence-based medi-cal treatment utilization schedule
(MTUS), or set of guidelines, was also adopted. - correct answer WHAT MEASURES
WERE ENACTED IN 2003 AND 2004
In 2013, measures were enacted that made wide-ranging changes, which included (1)
increasing permanent disability paid to injured workers and simplifying the permanent
disability rating meth-od, (2) resolving medical treatment disagreements through
independent medical review and bill payment disputes through independent bill review,
(3) improving medical provider networks, and (4) updating the Official Medical Fee
Schedule and establishing fee schedules for copy services, in-terpreters, vocational
experts, and in-home health care. - correct answer WHAT MEASURES WERE
ENACTED IN 2013
Which unit investigates complaints filed against QMEs con-cerning violations of the
Labor Code and regulations as well as other statutes for misconduct com-mitted in the
QME process - correct answer MEDICAL UNIT
• How to Take a Complete Occupational History
• How to Define:
o An Injury
o First Aid
• Aggravation
• Recurrence
• Arising Out of Employment (AOE)
• Occurring in the Course of Employment (COE)
• Causation
• Presumptions
• Psychiatric Injuries - correct answer WHAT ARE THE KEY COMPONENTS OF
COMPENCABILITY
• Any injury or disease arising out of employment (Labor Code § 3208)
• Any "derivative" injury caused by the treatment of an injury arising out of employment
COMPLETE SOLUTIONS
1911, SEVENTEEN DAYS AFTER THE DEVISTATING FIRE AT THE TRIANGLE
SHIRTWAIST COMPANY FACTORY IN NEW YORK TOOK 146 LIVES - correct
answer when was the 1st work comp act passed?
1. NO FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT - correct answer WHAT ARE THE 3 COMPONENTS OF
THE WORK COMP SYSTEM
e employer is required to pay benefits no matter who caused the injury, as long as the
injury arose out of or occurred in the course of employment. - correct answer NO
FAULT
less the employer is uninsured, the worker cannot pursue other forms of recovery from
the employer, even if the employer was grossly negligent. - correct answer EXCLUSIVE
REMEDY
The workers' compensation system establishes defined benefits, which must be paid for
by the employer. Workers' compensation awards are typically far less than comparable
negligence awards in a civil suit. For example, although the maximum workers'
compensation death benefit may be far less than the possible award in a civil wrongful
death suit, a civil action may take years to resolve while a death claim can be re-solved
in as little as a few months. Additional recoveries are available to employees for an
employer's serious and willful misconduct and unlawful discrimination (Labor Code §
132a and § 4553). Although group health coverage may include arbitrary limits on the
extent of treatment covered, workers' compensation is a statutory benefit with no
arbitrary limits on the frequency, duration, or extent of services. - correct answer
ASSURED AND FIXED BENEFIT
deliberately self-inflicted injuries are excluded from coverage - correct answer WHAT
TYPE OF INJYURIES ARE EXCLUDED
For injuries that result from the serious and willful misconduct of the employer, the
employee's compensation is increased by half - correct answer WHAT HAPPENS IF
THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE EMPLOYER?
For injuries that result from the serious and willful misconduct of the injured employee,
benefits are reduced by half, unless the injury resulted in death or a per-manent
, disability of 70% or more; the injury resulted from failure of the employer to comply with
the law or safety and health regulations; or the employee was under 16 years old at the
QUESTIONS WITH COMPLETE
time of in-jury -
SOLUTIONS
correct answer WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS
MISCONDUCT OF THE EMPLOYEE?
measures were enacted that allowed employers (1) to establish medical pro-vider
networks—from which injured workers are required to select treating doctors, (2) to
conduct utilization review to ensure that medical care was consistent with evidence-
based guidelines, and (3) to limit the amount of physical therapy and chiropractic
treatment. These measures also affect-ed permanent disability ratings and benefit
payments to injured workers. An evidence-based medi-cal treatment utilization schedule
(MTUS), or set of guidelines, was also adopted. - correct answer WHAT MEASURES
WERE ENACTED IN 2003 AND 2004
In 2013, measures were enacted that made wide-ranging changes, which included (1)
increasing permanent disability paid to injured workers and simplifying the permanent
disability rating meth-od, (2) resolving medical treatment disagreements through
independent medical review and bill payment disputes through independent bill review,
(3) improving medical provider networks, and (4) updating the Official Medical Fee
Schedule and establishing fee schedules for copy services, in-terpreters, vocational
experts, and in-home health care. - correct answer WHAT MEASURES WERE
ENACTED IN 2013
Which unit investigates complaints filed against QMEs con-cerning violations of the
Labor Code and regulations as well as other statutes for misconduct com-mitted in the
QME process - correct answer MEDICAL UNIT
• How to Take a Complete Occupational History
• How to Define:
o An Injury
o First Aid
• Aggravation
• Recurrence
• Arising Out of Employment (AOE)
• Occurring in the Course of Employment (COE)
• Causation
• Presumptions
• Psychiatric Injuries - correct answer WHAT ARE THE KEY COMPONENTS OF
COMPENCABILITY
• Any injury or disease arising out of employment (Labor Code § 3208)
• Any "derivative" injury caused by the treatment of an injury arising out of employment
