QME Exam Questions and Complete
Answers
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 Ans-ASSURED AND FIXED BENEFIT
deliberately self-inflicted injuries are excluded from coverage ✔️✔️Correct Ans-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 Ans-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 time of in-jury ✔️✔️Correct Ans-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 Ans-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 Ans-WHAT MEASURES WERE
ENACTED IN 2013
1911, SEVENTEEN DAYS AFTER THE DEVISTATING FIRE AT THE TRIANGLE SHIRTWAIST COMPANY
FACTORY IN NEW YORK TOOK 146 LIVES ✔️✔️Correct Ans-when was the 1st work comp act passed?
1. NO FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT ✔️✔️Correct Ans-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 Ans-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 Ans-EXCLUSIVE REMEDY
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 Ans-
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 Ans-WHAT ARE THE KEY COMPONENTS OF COMPENCABILITY
Answers
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 Ans-ASSURED AND FIXED BENEFIT
deliberately self-inflicted injuries are excluded from coverage ✔️✔️Correct Ans-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 Ans-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 time of in-jury ✔️✔️Correct Ans-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 Ans-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 Ans-WHAT MEASURES WERE
ENACTED IN 2013
1911, SEVENTEEN DAYS AFTER THE DEVISTATING FIRE AT THE TRIANGLE SHIRTWAIST COMPANY
FACTORY IN NEW YORK TOOK 146 LIVES ✔️✔️Correct Ans-when was the 1st work comp act passed?
1. NO FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT ✔️✔️Correct Ans-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 Ans-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 Ans-EXCLUSIVE REMEDY
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 Ans-
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 Ans-WHAT ARE THE KEY COMPONENTS OF COMPENCABILITY
