QME Exam Questions And Answers Rated A+ New Update Assured Satisfaction
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Course
QME
Institution
QME
it is a diagnosed mental disorder that causes disability or need for medical treat-ment, and the employee
can demonstrate that the events of employment were the "predominant cause" of the injury. - A
psychiatric injury is compensable if
e employer is required to pay benefits no matter who caused...
QME Exam
it is a diagnosed mental disorder that causes disability or need for medical treat-ment, and the employee
can demonstrate that the events of employment were the "predominant cause" of the injury. - A
psychiatric injury is compensable if
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. - 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. - 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. - ASSURED AND FIXED BENEFIT
deliberately self-inflicted injuries are excluded from coverage - 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 - 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 - 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. - 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. - 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 - 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 - 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
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