module 6 part 2

Question 1

Question Answer

Question 2

What is the QME’s duty regarding substantial medical evidence? Provide detailed reasoning backed by records

Answer 2

exam findings

Question 3

Mnemonic for substantial medical evidence “REAL” — Records

Answer 3

Exam

Question 4

How should QMEs treat prior awards of permanent disability? A prior WCAB award creates a presumption that the % is non-industrial unless medical evidence shows further industrial aggravation.

Question 5

What is rebutting LC §4664 presumption? Providing medical evidence showing the current injury is new or worsened beyond the previously awarded % PD.

Question 6

Can a QME apportion to risk factors like smoking? No — apportionment must be to actual pathology or disability

Answer 6

not just risk exposure.

Question 7

How does apportionment affect rating strings? The WPI % is first calculated

Answer 7

then apportionment is applied to reduce the industrial % of permanent disability.

Question 8

Mnemonic for apportionment calculation “RCA” — Rate impairment

Answer 8

Combine if multiple

Question 9

What if QME cannot determine exact % apportionment? Must still give best medical estimate based on probability; cannot say “cannot apportion” without explanation.

Question 10

Why is temporal relationship important in apportionment? Onset before injury or worsening after injury helps differentiate pre-existing vs industrial contribution.

Question 11

What role do diagnostic imaging studies play? Show pre-existing degeneration/pathology supporting non-industrial apportionment.

Question 12

Example: Preexisting lumbar degeneration + new strain. QME may assign 40% preexisting (degeneration)

Answer 12

60% new work-related strain if supported by imaging and history.

Question 13

Can “psychological vulnerability” alone justify apportionment? No — must be tied to documented pre-existing psychiatric diagnosis or functional impairment.

Question 14

Mnemonic for apportionment report intro “HOD” — History

Answer 14

Objective findings

Question 15

What is the combined apportionment approach? Splitting PD among several factors (e.g.

Answer 15

40% work

Question 16

When is no apportionment appropriate? Only when work is the sole cause of permanent impairment and no credible non-industrial contributors exist.

Question 17

Why must QMEs avoid speculative apportionment? WCAB will strike opinions not based on reasonable medical probability and evidence.

Question 18

How to apportion in cumulative trauma? Identify percentage of PD from each job period and pre-existing degeneration; requires careful work history timeline.

Question 19

Can apportionment exceed 100% total? No — all contributing percentages must combine to 100% of the permanent disability.

Question 20

What is the “lighting up” vs “direct cause” distinction? Lighting up = work activates latent condition; Direct cause = new pathology entirely due to work.

Question 21

Mnemonic for cumulative trauma apportionment “DATE” — Duties timeline

Answer 21

Activities

Question 22

What is pathological apportionment? Attributing part of disability to pre-existing structural disease

Answer 22

even if asymptomatic before the industrial event.

Question 23

How does return-to-work ability affect apportionment? It doesn’t directly change % but helps gauge functional loss from work injury vs prior disability.

Question 24

What if prior condition was asymptomatic but measurable? Still apportionable if medical evidence shows it contributed to PD after work injury.

Question 25

Why is MMI timing crucial for apportionment? PD should be apportioned once the condition is permanent and stationary

Answer 25

avoiding premature or changing percentages.

Question 26

Mnemonic for final apportionment section “RATE” — Rationale

Answer 26

Allocation %