California QME Exam 2022 Questions
and complete solutions - Based on
ICAC Course Material
Federal, Maritime, and Railroad workers are covered under what? ✔️✔️Correct Ans-Federal Work
Comp
What 3 things was the workers' compensation system created to pay for? ✔️✔️Correct Ans-1. Medical
treatment
2. Temporary payment for lost wages
3. Permanent disability to compensate for decreased ability to compete in the open labor market
What is the Historic Compromise? ✔️✔️Correct Ans-1. Employee gives up the right to pursue legal
action in exchange for benefits.
2. Employer provides benefits, regardless of fault, in exchange for legal protection.
What are the 3 components of the Historic Compromise? ✔️✔️Correct Ans-1. No Fault
2. Exclusive Remedy
3. Assured and Fixed Benefit
The employer is required to pay for benefits, regardless of fault, as long as the injury is AOE/COE
✔️✔️Correct Ans-"No Fault" component of Historic Compromise
Worker cannot pursue other forms of recovery from the employee, even if the employer was grossly
negligent. (exception: 3rd parties may be sued). ✔️✔️Correct Ans-"Exclusive Remedy" component of
Historic Compromise
Workers compensation system established defined benefits which must be paid by the employer.
✔️✔️Correct Ans-"Assured and Fixed Benefit" component of Historic Compromise
What are two exceptions to the "No Fault" rule? ✔️✔️Correct Ans-1. Self inflicted injuries are
excluded from coverage (Labor Code 3600)
, 2. 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 time of injury (Labor Code 4551)
When can benefits be reduced by half? When can they be increased by half? ✔️✔️Correct Ans-1.
reduced when injury is result of employee serious and willful misconduct (unless result is death or
permanent disability of 70% or more)
2. increased when injury is result of employer serious and willful misconduct
In 1989 and 1993, measures were enacted to address the QME process including.... ✔️✔️Correct Ans-
1. Med Legal fee schedule
2. Physician referral
3. QME advertising
4. Compensability of psychiatric and post termination
5. Fraud deterrence
6. Benefit payments for injured workers
In 2003 and 2004, measures were enacted that allowed employers to... ✔️✔️Correct Ans-1. establish
medical provider networks (MPN)
2. Conduct utilization review to ensure that medical care is consistent with evidence based
guidelines
3. limit the amount of physical therapy and chiropractic
4. increase PD ratings and benefit payments to employees
5. require UR and MTUS guidelines
In 2013, measures were enacted... ✔️✔️Correct Ans-1. increasing PD and simplifying PD rating
method
2. Resolving medical treatment disagreements through IMR and IBR
3. Improving MPNs
4. Updating Official Medical Fee Schedule (OMFS)
5. establishing fee schedules for copy services, interpreters, vocational experts, and in-home health
care
What is the "mission" of DWC? ✔️✔️Correct Ans-to minimize the adverse impact of work-related
injuries on California employees and employers
and complete solutions - Based on
ICAC Course Material
Federal, Maritime, and Railroad workers are covered under what? ✔️✔️Correct Ans-Federal Work
Comp
What 3 things was the workers' compensation system created to pay for? ✔️✔️Correct Ans-1. Medical
treatment
2. Temporary payment for lost wages
3. Permanent disability to compensate for decreased ability to compete in the open labor market
What is the Historic Compromise? ✔️✔️Correct Ans-1. Employee gives up the right to pursue legal
action in exchange for benefits.
2. Employer provides benefits, regardless of fault, in exchange for legal protection.
What are the 3 components of the Historic Compromise? ✔️✔️Correct Ans-1. No Fault
2. Exclusive Remedy
3. Assured and Fixed Benefit
The employer is required to pay for benefits, regardless of fault, as long as the injury is AOE/COE
✔️✔️Correct Ans-"No Fault" component of Historic Compromise
Worker cannot pursue other forms of recovery from the employee, even if the employer was grossly
negligent. (exception: 3rd parties may be sued). ✔️✔️Correct Ans-"Exclusive Remedy" component of
Historic Compromise
Workers compensation system established defined benefits which must be paid by the employer.
✔️✔️Correct Ans-"Assured and Fixed Benefit" component of Historic Compromise
What are two exceptions to the "No Fault" rule? ✔️✔️Correct Ans-1. Self inflicted injuries are
excluded from coverage (Labor Code 3600)
, 2. 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 time of injury (Labor Code 4551)
When can benefits be reduced by half? When can they be increased by half? ✔️✔️Correct Ans-1.
reduced when injury is result of employee serious and willful misconduct (unless result is death or
permanent disability of 70% or more)
2. increased when injury is result of employer serious and willful misconduct
In 1989 and 1993, measures were enacted to address the QME process including.... ✔️✔️Correct Ans-
1. Med Legal fee schedule
2. Physician referral
3. QME advertising
4. Compensability of psychiatric and post termination
5. Fraud deterrence
6. Benefit payments for injured workers
In 2003 and 2004, measures were enacted that allowed employers to... ✔️✔️Correct Ans-1. establish
medical provider networks (MPN)
2. Conduct utilization review to ensure that medical care is consistent with evidence based
guidelines
3. limit the amount of physical therapy and chiropractic
4. increase PD ratings and benefit payments to employees
5. require UR and MTUS guidelines
In 2013, measures were enacted... ✔️✔️Correct Ans-1. increasing PD and simplifying PD rating
method
2. Resolving medical treatment disagreements through IMR and IBR
3. Improving MPNs
4. Updating Official Medical Fee Schedule (OMFS)
5. establishing fee schedules for copy services, interpreters, vocational experts, and in-home health
care
What is the "mission" of DWC? ✔️✔️Correct Ans-to minimize the adverse impact of work-related
injuries on California employees and employers
