moadule 8 part 2

Question 1

What does “substantial cause” mean in psych claims?

Answer 1

Workplace events must be at least 51% responsible for the psychiatric condition compared to all other factors combined.

Question 2

What percentage applies if caused by a violent act?

Answer 2

A lower bar — work must be ≥35% the cause if the psychiatric injury stems from a violent act.

Question 3

Mnemonic for cause thresholds

Answer 3

“51 for normal, 35 for harm.”

Question 4

What is a “good faith personnel action” (GFPA)?

Answer 4

A lawful, non-discriminatory, and non-retaliatory employer action (e.g., transfer, discipline, evaluation) that can bar psych claims if it’s the predominant cause.

Question 5

GFPA as defense?

Answer 5

If the psychiatric injury was caused mainly (>51%) by GFPA, the claim is usually non-compensable.

Question 6

Mnemonic for GFPA

Answer 6

“Good Faith = Claim Fade.”

Question 7

What is the 6-month employment rule for psych claims?

Answer 7

Worker must generally have 6+ months employment to file a psych claim.

Question 8

Exception to 6-month rule?

Answer 8

If the injury results from a sudden and extraordinary event, the six-month requirement does not apply.

Question 9

How is “sudden and extraordinary” defined?

Answer 9

An unexpected, uncommon, and unusual event (e.g., workplace violence, explosion, sudden traumatic accident).

Question 10

What is a “compensable consequence” psych injury?

Answer 10

A psychiatric disorder that develops secondary to an accepted physical work injury.

Question 11

Burden of proof for compensable consequence?

Answer 11

Easier — work physical injury already accepted; must show psych condition flows from that injury.

Question 12

What are typical triggers for compensable consequence psych injuries?

Answer 12

Chronic pain, disability, loss of function, financial stress, stigma, or difficult recovery.

Question 13

Why is documentation crucial for psych causation?

Answer 13

History of work events, timelines, and stressors must be well documented to establish AOE/COE.

Question 14

What are common non-industrial contributors to psych injury?

Answer 14

Personal trauma, family conflict, substance abuse, financial hardship, pre-existing disorders.

Question 15

Mnemonic for non-industrial contributors

Answer 15

“LIFE” — Life stressors Impact Factoring Evidence.

Question 16

How should QME handle mixed causation?

Answer 16

Discuss each factor (work vs personal), weigh relative contribution, and state if work ≥51% (or ≥35% violent).

Question 17

Can QME apportion psychiatric impairment?

Answer 17

Yes — apportion between industrial and non-industrial causes of permanent impairment.

Question 18

How are psych permanent disability ratings done?

Answer 18

Using GAF (Global Assessment of Functioning) → convert to WPI → then PD under CA schedule.

Question 19

Mnemonic for psych PD

Answer 19

“GAF → WPI → PD.”

Question 20

Why is GAF controversial?

Answer 20

It’s subjective and no longer in DSM-5, but still required under CA WC for PD conversion.

Question 21

What are typical medical records to review?

Answer 21

Personnel records, prior mental health records, injury reports, witness statements, performance reviews.

Question 22

Importance of temporal relationship?

Answer 22

Onset or worsening of psych symptoms shortly after work stressor strongly supports causation.

Question 23

How do layoffs/discipline impact claims?

Answer 23

Often central to GFPA defense; must assess if action was lawful, non-discriminatory, and good faith.

Question 24

What is IME/QME’s key report duty?

Answer 24

Provide clear causation analysis, apportionment, GAF/WPI rating, treatment recommendations, and response to legal standards.

Question 25

Why are psych claims heavily litigated?

Answer 25

High subjectivity, mixed causes, employer defenses (GFPA, personal stress), and cost implications.