module 6 part 3

Question 1

What is retroactive prophylactic apportionment?

Answer 1

Not allowed — you cannot apportion PD to theoretical risk of future injury or preemptive prevention.

Question 2

Why must QME distinguish temporary disability vs permanent disability in apportionment?

Answer 2

Only permanent disability is apportioned; TD is paid regardless of cause mix while healing.

Question 3

Mnemonic for TD vs PD apportionment

Answer 3

“TP” — Temporary Paid fully, Permanent can be apportioned.

Question 4

How does industrial causation differ from apportionment?

Answer 4

Industrial causation = whether work caused the injury; apportionment = dividing permanent impairment among causes.

Question 5

Can work stress that aggravates arthritis be apportioned?

Answer 5

Yes — if underlying arthritis contributes to PD, even if work accelerated it.

Question 6

How should QME explain apportionment in cumulative trauma?

Answer 6

Provide % for each job period, describe duties, and cite objective evidence for each allocation.

Question 7

Mnemonic for cumulative trauma explanation

Answer 7

“DOT” — Duties, Onset timeline, Tests.

Question 8

Why is apportionment often litigated?

Answer 8

Impacts benefit amounts; parties challenge QME’s reasoning if unclear or unsupported.

Question 9

How to defend apportionment opinion?

Answer 9

Clear medical probability, detailed history, objective findings, records review, and literature support.

Question 10

Example: Carpal tunnel w/ diabetes.

Answer 10

QME may apportion % to diabetes if medically shown to contribute to nerve damage.

Question 11

Example: COPD w/ smoking + dust exposure.

Answer 11

Allocate % to smoking (non-industrial) and % to work dust exposure (industrial) if evidence supports.

Question 12

Mnemonic for mixed cause analysis

Answer 12

“MIX” — Medical records, Industrial duties, X-factor non-work causes.

Question 13

Can QME say “cannot apportion” if unsure?

Answer 13

No — must provide best estimate based on reasonable medical probability.

Question 14

How to document apportionment tables?

Answer 14

Include clear table with industrial vs non-industrial % for each body part/condition.

Question 15

What is combined values chart role?

Answer 15

Used to combine multiple impairments before applying apportionment to total WPI.

Question 16

Pitfall: Apportioning after combining impairments?

Answer 16

Incorrect — apportion before combining to avoid distortion of percentages.

Question 17

Mnemonic for sequence

Answer 17

“ABC” — Apportion Before Combine.

Question 18

How should QME handle psychiatric overlay?

Answer 18

Separate functional impairment due to psych condition if pre-existing; otherwise count as industrial if new.

Question 19

What if apportionment changes after new evidence?

Answer 19

QME can issue supplemental report revising % with explanation.

Question 20

Why is probability standard important?

Answer 20

Opinions must be “reasonable medical probability,” not just possible.

Question 21

Mnemonic for standard

Answer 21

“RMP” — Reasonable Medical Probability.

Question 22

Can age-related degeneration be sole apportionment factor?

Answer 22

Yes, if documented and shown to cause measurable PD.

Question 23

How should QME describe surgical outcomes?

Answer 23

Note residuals from past non-industrial surgery contributing to current impairment.

Question 24

What is pathogenesis apportionment?

Answer 24

Explaining how underlying disease process (e.g., diabetes, RA) caused part of PD.

Question 25

Can QME apportion to genetic predisposition?

Answer 25

Only if disease is present and contributing to PD; not if purely genetic risk with no disease.

Question 26

Why should QME cite medical studies?

Answer 26

Strengthens opinion and helps survive WCAB scrutiny in contested cases.