QME Legal and Injury Questions and answers all verified
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Qme
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Qme
QME Legal and Injury Questions and answers all verified
The law specifies an order of medical evidence standards - what is that order?
1. The guidelines, including the drug formulary adopted by the administrative director pursuant to section 5307.27 (MTUS)
2. Peer reviewed scientific and medica...
QME Questions and answers all verified
The law specifies an order of medical evidence standards - what is that order?
1. The guidelines, including the drug formulary adopted by the administrative director
pursuant to section 5307.27 (MTUS)
2. Peer reviewed scientific and medical evidence regarding the effectiveness of the
disputed service.
3. Nationally recognized professional standards
4Expert opinion. Generally accepted standards of medical practice
A
5.
VI
The employer provides workers compensation benefits regardless of fault.
The employer provides workers compensation benefits regardless of fault.
TU
If the injury is outside of the QME's scope of practice and they have advised and
serviced the parties in writing on what form
IS
QME Findings Summary Form 111
Serve a copy of your report on the Medical Unit of DWC
OM
What is the AMA Guides Upper Extremity WPI Maximum
60% Whole Person Impairment
What is the AMA Guides Lower Extremity WPI Maximum
NA
40% Whole Person Impairment
To convert Upper Extremity to WPI what do you do?
JP
Multiply UE x 60%
To convert Lower Extremity to WPI what do you do?
Multiply LE x 40%
How do you convert a Hand to UE?
Multiply Hand by 90%
,What are the values of each digit in regard to the Hand?
Thumb = 40%
Index and Middle Fingers = 20%
Ring and Little Fingers = 10%
How do you convert a foot to Lower Extremity?
Multiply Foot by 70%
A
VI
In the AMA 5th Edition what page does the combination chart start on?
Page 604
TU
The first number in a DEU Rating represents What?
The Chapter Number in the AMA Guides
IS
The Second number in a DEU Rating Represents What?
The Part of the Body
OM
The first % in the DEU Rating represents What?
The AMA Impairment Rating
NA
The Last set of % in the DEU Rating represents What?
The DEU Disability Rating
JP
ACOEM
-American College of Occupational and Environmental Medicine.
-A Guideline for EBM
-Treatment Guidelines
Definition of Chronic Pain
Lasting 3 or More months from initial onset of pain
A
Evidence-Based Medicine (EBM)
Systematic approach to making clinical decisions which allow the integration of the best
VI
available research evidence with clinical expertise and patient values.
EBM = BARE + CE + PV
TU
Define Functional Improvement
1. Clinically Significant improvement in ADL's (or)
2. Reduction in work restrictions as measured during history and physical exam,
performed and documented as part of the medical evaluation and treatment (and)
IS
3. Reduction in the Dependency on continued medical treatment
OM
Medical Treatment
Care which is reasonably required to Cure or Relieve
Medical Treatment Guidelines
NA
Most Current Version of Written recommendations which are systematically developed
by a multidisciplinary process. Reviewed and updated within the last FIVE (5) years.
JP
Nationally Recognized
Peer-reviewed medical journal or
developed, endorsed & disseminated by a national organization with affiliates based in 2
or more US States and the most current version.
ODG
Official Disability Guidelines
Contains EBM tx guidelines
, Peer Reviewed
Evaluated and Approved PRIOR to Publication by an editorial board of qualified experts
Scientifically Based Evidence
Scientific Literature evaluated and used as a basis to support a recommendation
A
Strength of Evidence
Establishes relative weight that shall be given to scientifically based evidence
VI
If the QME signs the medical legal report on any date other than the date of the
examination what must be done?
TU
Enter the DATE the Report IS Signed NEXT to or NEAR the Signature on the Report
What does CCR stand for?
IS
California Code of Regulations
OM
If the QME finds the IW at P&S what forms should the QME complete
- Physician's Report of Permanent and Stationary Status
- Work Capacity (DWC-AD Form 10133.36)
NA
What does the QME do with the Physicians Report of Permanent and Stationary Status
and Work Capacity (DWC-AD Form 10133.36)?
Serve it on the Claims Administrator along with the Medical Report
JP
If there is a disputed medical issue - outside of the evaluator's scope of practice and area
of clinical competency what must be done?
At earliest opportunity and no later than date report is served advise the parties - in
writing
CCR Sections that cover Scope of Practice problems
- 4062.1
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