module 10 part 1

Question 2

What is the primary ethical duty of a QME?

Answer 2

To remain objective and impartial, providing accurate, evidence-based opinions regardless of who pays or benefits.

Question 3

Why is impartiality critical for QMEs?

Answer 3

QME opinions influence benefits and legal outcomes; bias can invalidate reports and damage credibility.

Question 4

Mnemonic for QME duty

Answer 4

“FAIR FACTS FIRST.”

Question 5

What does conflict of interest mean for QMEs?

Answer 5

Any personal, financial, or professional tie that could influence objectivity (e.g., treating the patient, working for employer).

Question 6

What must a QME do if a conflict of interest exists?

Answer 6

Disclose it and recuse if it might compromise impartiality.

Question 7

Can a QME treat the same worker they evaluate?

Answer 7

Generally no — treatment creates a conflict; QME should avoid dual roles.

Question 8

What is the QME’s duty of confidentiality?

Answer 8

Protect patient records and info; release only with proper authorization or legal requirement.

Question 9

Mnemonic for confidentiality

Answer 9

“HIPAA = Hold Info Private, Ask Authorization.”

Question 10

How does HIPAA apply to QMEs?

Answer 10

QMEs must safeguard medical info and only share with authorized parties (insurer, WCAB) as legally allowed.

Question 11

When can a QME disclose patient info without consent?

Answer 11

When required by law (e.g., subpoena, WCAB order, reporting fraud/abuse).

Question 12

What is ex parte communication?

Answer 12

Unauthorized contact with one party in a case outside the other party’s knowledge; generally prohibited.

Question 13

Why avoid ex parte communication?

Answer 13

It can invalidate the QME report and raise ethical/legal violations.

Question 14

Mnemonic for ex parte rule

Answer 14

“NO SOLO TALK.”

Question 15

What should a QME do if one side sends undisclosed records?

Answer 15

Disclose receipt, copy the other party, and document actions in the report.

Question 16

What is the QME’s obligation in testimony?

Answer 16

Be truthful, objective, and base answers on medical evidence and expertise; avoid speculation.

Question 17

How should a QME prepare for deposition?

Answer 17

Review records/report, stay within expertise, and remain calm/neutral under questioning.

Question 18

What is the duty to the court?

Answer 18

Provide honest, unbiased medical opinions to assist WCAB/judge in deciding case fairly.

Question 19

What is misrepresentation in med-legal reporting?

Answer 19

Falsifying or exaggerating findings, hiding evidence, or tailoring report to one party.

Question 20

Consequences of misrepresentation?

Answer 20

Sanctions, decertification as QME, civil liability, and possible criminal fraud charges.

Question 21

Mnemonic for honesty

Answer 21

“FACT OVER FAVOR.”

Question 22

Why must QMEs document thoroughly?

Answer 22

Clear, defensible notes protect against legal challenge and support credibility in deposition.

Question 23

What should be included in a defensible med-legal report?

Answer 23

History, exam, records reviewed, objective findings, reasoning, and clear causation/apportionment opinions.

Question 24

How should QMEs handle patient dissatisfaction with findings?

Answer 24

Stay professional, explain scope of QME role, and avoid advocacy; opinion must remain objective.

Question 25

Can a QME act as an **advocate** for the patient?

Answer 25

No — QME’s role is to evaluate objectively, **not advocate** for either side.

Question 26

Mnemonic for QME role

Answer 26

**“NEUTRAL NOT ADVOCATE.”**

Question 27

Why avoid casual comments or jokes in deposition/report?

Answer 27

They may be misinterpreted and undermine credibility or perceived impartiality.