Module 1 – Workers’ Compensation System (Flashcards 71 – 105)

Question 2

Who enforces Labor Code 132a penalties?

Answer 2

WCAB (Workers’ Compensation Appeals Board).

Question 3

Time limit to file a 132a claim?

Answer 3

One year from employer’s discriminatory act.

Question 4

Mnemonic

Answer 4

“132a = 1-yr anti-retaliation clock.”

Question 5

What is a serious & willful (S&W) misconduct claim worth?

Answer 5

Up to 50% increase in compensation (not to exceed $250,000).

Question 6

Who investigates WC fraud?

Answer 6

DWC Fraud Division & DA’s Office.

Question 7

Define WCAB.

Answer 7

Workers’ Compensation Appeals Board — hears disputes, appeals, and petitions.

Question 8

Filing a Declaration of Readiness (DOR) does what?

Answer 8

Requests a hearing to resolve a WC dispute.

Question 9

Mnemonic

Answer 9

“DOR = Door to court.”

Question 10

What is a Status Conference?

Answer 10

First hearing; checks readiness, discovery status, settlement potential.

Question 11

What is a Mandatory Settlement Conference (MSC)?

Answer 11

Last attempt to settle before trial; parties exchange exhibits & stipulations.

Question 12

Mnemonic

Answer 12

“MSC = Must Settle (before trial).”

Question 13

Trial decision appeal timeline?

Answer 13

20 days to petition WCAB for reconsideration.

Question 14

What is a Compromise & Release (C&R)?

Answer 14

Lump-sum settlement closing future medical & wage loss rights.

Question 15

Mnemonic

Answer 15

“C&R = Cash & Release.”

Question 16

What is Stipulated Award?

Answer 16

Parties agree to PD %; future medical stays open.

Question 17

Difference C&R vs Stips

Answer 17

C&R = final / no future care; Stips = keep future care.

Question 18

Who approves settlements?

Answer 18

WCAB judge reviews adequacy & fairness.

Question 19

Define Vocational Return-to-Work Supplement.

Answer 19

Extra $5,000 state voucher if SJDB issued.

Question 20

When can PD advance payments stop?

Answer 20

After total paid equals rating or C&R approved.

Question 21

Define LC 5814 penalty.

Answer 21

Up to 25% of delayed/denied benefit (capped at $10k) for unreasonable delay.

Question 22

Mnemonic

Answer 22

“5814 = pay late, pay extra.”

Question 23

Purpose of QME deposition?

Answer 23

Clarify report, challenge opinions, preserve testimony.

Question 24

Time to depose QME after receiving report?

Answer 24

50 days (represented) / 20 days (unrepresented) to object or depose.

Question 25

Mnemonic

Answer 25

**“50 w/attorney, 20 alone.”**

Question 26

Role of **AME vs QME** in dispute resolution?

Answer 26

**AME = both agree; QME = panel chosen when no agreement.**

Question 27

Explain **future medical care** in WC.

Answer 27

Employer pays reasonable medical tied to industrial injury **for life** unless C&R ends it.

Question 28

What is **UR appeal path**?

Answer 28

UR denial → **IMR** → WCAB if IMR illegal or improper.

Question 29

Mnemonic

Answer 29

**“UR → IMR → WCAB.”**

Question 30

What is **PD add-on** for sleep/sexual disorders?

Answer 30

Up to **3% WPI each** if tied to injury.

Question 31

Define **catastrophic injury exception** (psych claims).

Answer 31

Allows psych claim from **catastrophic physical injury** despite 6-mo employment rule.

Question 32

Mnemonic

Answer 32

**“Catastrophic breaks the 6-month wall.”**

Question 33

When is psych injury **non-compensable**?

Answer 33

If from **lawful, good-faith personnel action** (e.g., discipline, evals).

Question 34

Who decides PD % adjustments (age/occupation)?

Answer 34

**DEU raters** use AMA + occupational tables.

Question 35

What’s a **QME rebuttal**?

Answer 35

Treating or opposing expert challenges **QME WPI or apportionment** with data.

Question 36

How long to object to QME specialty?

Answer 36

**10 days** (rep) / **15 days** (unrep) from panel receipt.

Question 37

Define **expedited hearing**.

Answer 37

Quick WCAB hearing for **medical treatment or TD issues**.

Question 38

Mnemonic

Answer 38

**“Expedite = emergency med/wage.”**

Question 39

Attorney fee % in CA WC?

Answer 39

Usually **9–15%** of award, approved by WCAB.

Question 40

Who pays QME fees?

Answer 40

**Requesting party** or **split if AME**; DWC fee schedule applies.

Question 41

Can employee sue employer in civil court?

Answer 41

Rarely; only if **no WC coverage** or intentional harm.

Question 42

Exclusive remedy rule means?

Answer 42

WC benefits are **sole remedy** for workplace injuries (with narrow exceptions).

Question 43

Mnemonic

Answer 43

**“Exclusive remedy = WC only.”**