QME Examination Test Questions FINAL
"Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of
a crime and may be subject to imprisonment in the state prison for up to ____ years or a fine of up to
$50,000 or both - ANSWER-five (5) years
"Disability = Impairment + Loss earning capacity + Occupational title + Age" - ANSWER-Formula for
PD
1911 - California adopted - ANSWER-The development of the State Compensation Insurance Fund
(SCIF)
A check or Money Order is pain by the Physician for the IBR fee in the amount of - ANSWER-$195 ??
A copy of the notice to request time extension to file a QME report must be sent to - ANSWER-
Medical Unit at DWC
A local work comp Judge's decisions may be appealed by a part to - ANSWER-WCAB Commissioners
A PTP has fulfilled his or her reporting duties by sending ___ copy of a required report to the claims
administrator - ANSWER-one (1)
A trade-off between Employers and Employees is referred to as - ANSWER-The Historic Compromise
A violation of L.C. 139(a) conflict of interest referral is a misdemeanor subject to civil penalties up to
$____ per offense - ANSWER-$5,000
A worker who is nor represented by an attorney is referred to as - ANSWER-an unrepresented worker
An application for IBR (DWC form IBR-1) can be completed and submitted electronically by
registering as a user on the ___ IBR tracking system - ANSWER-Maximus Federal
An attorney or a court reporter may NOT be present at ___ exams - ANSWER-Psychiatric
An employer must report injuries to Cal/OSHA of any death or serious injury within _____ - ANSWER-
24 hours
An employer with an MPN which of the following CANNOT be pre-designated - ANSWER-D.C.
An injured worker may not be kept waiting for more than ___ after the scheduled appointment time
- ANSWER-one (1) hour
Apportionment is included in which of the following reports - ANSWER-PR-4
California passed its first workers' compensation act (voluntary) in ___ - ANSWER-1911
California passed its first workers' compensation act after a devastating fire at the ____ in New York
City claimed the lives of 146 young workers - ANSWER-Triangle Shirtwaist Company
Chronic Pain Guidelines went into effect ___ - ANSWER-07/18/2009
Death benefits are payments to a spouse, the children, or other dependents, including reasonable
burial expenses, not exceeding $____ for injuries before 01/01/2013 and $_____ for injuries on or
after 01/01/2013 - ANSWER-Before 01/01/2013 $5,000
After 01/01/2013 $10,000
Disputes over medical treatment for all dates of injury are now resolved by physicians through ____ -
ANSWER-IMR
, QME Examination Test Questions FINAL
Electronic bills are paid within ___ days of receipt of the bill and supporting documentation -
ANSWER-15 days
Employers are not required to pay for .... - ANSWER-Self Inflicted injuries
Ex Parte communication with an agreed Medical Evaluator or s QME selected from a panel .... -
ANSWER-Is PROHIBITED
Factors of Disability include the following - ANSWER-Subjective Factors
Objective Factors
Work Restrictions
Loss Pre-Injury Capacity
Failure to file a DFR could delay benefits to patients, prevent payment to physician, and could result
in a civil penalty of not less than $___ - ANSWER-$50
For a QME evaluation for compensability only (AOE/COE), DO NOT send the QME report to the
following Part(ies)? - ANSWER-Local DEU
For dates of injuyr AFTER 01/01/2005, a QME must use - ANSWER-American Medical Association
Guide to the Evaluation of Permanent Impairment, 5th edition
For DOI after 01/01/1990 or DOI after 01/01/2003, DISABLED MINORS receive benefits - ANSWER-
For life
For DOI on or after 01/01/2005 the PTP final report must include the information on the ___ Form -
ANSWER-PR-4
For injuries on or after January 1, 1994 and before 01/01/2004 most workers will be limited to a
_____ cap on Vocational Rehabilitation benefits under that plan - ANSWER-$16,000
For paper billing forms for health care providers, the physician must use - ANSWER-CMS 1500 forms
For psychiatric injuries that result from a violent act, or from direct exposure to a significant violent
act, the actual events of employment must have been a "substantial cause" of the injury, in that they
contributed at least ___ % of the causation from all sources combined - ANSWER-35%
For treatment guidelines California's Evidence-Based Guidelines is the ____ - ANSWER-MTUS
From January 1, 2008, to the present, TD may last up to ___ weeks within five years from the DOI -
ANSWER-104
IBR applies to any medical bill for which the date of service is on or after - ANSWER-01/01/2013
If full wages are paid, an IW may still receive TD benefits - ANSWER-FALSE
If IW is unrepresented, the QME serves the QME report on the _____ - ANSWER-DEU, Employee &
Claims Administrator
If the claims administrator denies treatment recommended by the PTP, the IW may request ___ using
the request form included with the claims administrator's written decision to deny treatment -
ANSWER-IMR
"Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of
a crime and may be subject to imprisonment in the state prison for up to ____ years or a fine of up to
$50,000 or both - ANSWER-five (5) years
"Disability = Impairment + Loss earning capacity + Occupational title + Age" - ANSWER-Formula for
PD
1911 - California adopted - ANSWER-The development of the State Compensation Insurance Fund
(SCIF)
A check or Money Order is pain by the Physician for the IBR fee in the amount of - ANSWER-$195 ??
A copy of the notice to request time extension to file a QME report must be sent to - ANSWER-
Medical Unit at DWC
A local work comp Judge's decisions may be appealed by a part to - ANSWER-WCAB Commissioners
A PTP has fulfilled his or her reporting duties by sending ___ copy of a required report to the claims
administrator - ANSWER-one (1)
A trade-off between Employers and Employees is referred to as - ANSWER-The Historic Compromise
A violation of L.C. 139(a) conflict of interest referral is a misdemeanor subject to civil penalties up to
$____ per offense - ANSWER-$5,000
A worker who is nor represented by an attorney is referred to as - ANSWER-an unrepresented worker
An application for IBR (DWC form IBR-1) can be completed and submitted electronically by
registering as a user on the ___ IBR tracking system - ANSWER-Maximus Federal
An attorney or a court reporter may NOT be present at ___ exams - ANSWER-Psychiatric
An employer must report injuries to Cal/OSHA of any death or serious injury within _____ - ANSWER-
24 hours
An employer with an MPN which of the following CANNOT be pre-designated - ANSWER-D.C.
An injured worker may not be kept waiting for more than ___ after the scheduled appointment time
- ANSWER-one (1) hour
Apportionment is included in which of the following reports - ANSWER-PR-4
California passed its first workers' compensation act (voluntary) in ___ - ANSWER-1911
California passed its first workers' compensation act after a devastating fire at the ____ in New York
City claimed the lives of 146 young workers - ANSWER-Triangle Shirtwaist Company
Chronic Pain Guidelines went into effect ___ - ANSWER-07/18/2009
Death benefits are payments to a spouse, the children, or other dependents, including reasonable
burial expenses, not exceeding $____ for injuries before 01/01/2013 and $_____ for injuries on or
after 01/01/2013 - ANSWER-Before 01/01/2013 $5,000
After 01/01/2013 $10,000
Disputes over medical treatment for all dates of injury are now resolved by physicians through ____ -
ANSWER-IMR
, QME Examination Test Questions FINAL
Electronic bills are paid within ___ days of receipt of the bill and supporting documentation -
ANSWER-15 days
Employers are not required to pay for .... - ANSWER-Self Inflicted injuries
Ex Parte communication with an agreed Medical Evaluator or s QME selected from a panel .... -
ANSWER-Is PROHIBITED
Factors of Disability include the following - ANSWER-Subjective Factors
Objective Factors
Work Restrictions
Loss Pre-Injury Capacity
Failure to file a DFR could delay benefits to patients, prevent payment to physician, and could result
in a civil penalty of not less than $___ - ANSWER-$50
For a QME evaluation for compensability only (AOE/COE), DO NOT send the QME report to the
following Part(ies)? - ANSWER-Local DEU
For dates of injuyr AFTER 01/01/2005, a QME must use - ANSWER-American Medical Association
Guide to the Evaluation of Permanent Impairment, 5th edition
For DOI after 01/01/1990 or DOI after 01/01/2003, DISABLED MINORS receive benefits - ANSWER-
For life
For DOI on or after 01/01/2005 the PTP final report must include the information on the ___ Form -
ANSWER-PR-4
For injuries on or after January 1, 1994 and before 01/01/2004 most workers will be limited to a
_____ cap on Vocational Rehabilitation benefits under that plan - ANSWER-$16,000
For paper billing forms for health care providers, the physician must use - ANSWER-CMS 1500 forms
For psychiatric injuries that result from a violent act, or from direct exposure to a significant violent
act, the actual events of employment must have been a "substantial cause" of the injury, in that they
contributed at least ___ % of the causation from all sources combined - ANSWER-35%
For treatment guidelines California's Evidence-Based Guidelines is the ____ - ANSWER-MTUS
From January 1, 2008, to the present, TD may last up to ___ weeks within five years from the DOI -
ANSWER-104
IBR applies to any medical bill for which the date of service is on or after - ANSWER-01/01/2013
If full wages are paid, an IW may still receive TD benefits - ANSWER-FALSE
If IW is unrepresented, the QME serves the QME report on the _____ - ANSWER-DEU, Employee &
Claims Administrator
If the claims administrator denies treatment recommended by the PTP, the IW may request ___ using
the request form included with the claims administrator's written decision to deny treatment -
ANSWER-IMR
