module 7 part 6

Question 1

What is PD cap for injuries <70%?

Answer 1

Maximum number of weeks of indemnity payments based on PD %, set by statute.

Question 2

Mnemonic for PD payout

Answer 2

“% → Weeks → $.”

Question 3

Why must QME document pre-injury status?

Answer 3

Establishes baseline function to show industrial impact and support rating accuracy.

Question 4

Can PD ever exceed 100%?

Answer 4

No — 100% represents total permanent disability (TPD).

Question 5

What is Total Permanent Disability (TPD)?

Answer 5

Inability to compete in open labor market; statutory lifetime benefits if PD = 100%.

Question 6

Mnemonic for TPD

Answer 6

“Full = Forever Pay.”

Question 7

What is life pension in CA WC?

Answer 7

Additional weekly payment after PD >70% but <100% once indemnity runs out.

Question 8

Why is WPI clarity vital for life pension eligibility?

Answer 8

PD % drives whether worker crosses the 70% threshold for life pension.

Question 9

What is apportionment’s final step in PD?

Answer 9

Subtract non-industrial % from total PD to get industrial PD for benefits.

Question 10

Mnemonic for final step

Answer 10

“PD minus Non = Pay.”

Question 11

What if QME fails to discuss apportionment?

Answer 11

WCAB may default to 100% industrial PD and employer pays full award.

Question 12

Why are add-ons (sleep, sexual, pain) scrutinized?

Answer 12

Often litigated; must meet strict AMA Guides criteria to be valid.

Question 13

How should QME describe assistive device use?

Answer 13

State if device is permanent/medically necessary; can increase impairment.

Question 14

Can QME assign work preclusion categories (e.g., semi-sedentary)?

Answer 14

No — that’s a vocational/legal issue, not medical impairment.

Question 15

Why describe overlapping impairments clearly?

Answer 15

Prevents double counting when combining values.

Question 16

Mnemonic for overlap

Answer 16

“NO DOUBLE DIP.”

Question 17

What is rating string transparency?

Answer 17

Showing every step (WPI → DFEC → Age/Occ → Apportion) to allow DEU/judge to verify.

Question 18

Why must QME give narrative clarity?

Answer 18

Poorly worded reports lead to misratings, depositions, and delays.

Question 19

What if condition improves after MMI rating?

Answer 19

Supplemental report may revise WPI/PD if medically justified.

Question 20

Can WPI increase after surgery?

Answer 20

Yes, if surgery worsens function; QME must issue updated rating.

Question 21

What is return-to-work impact on PD?

Answer 21

Return to work does not change rating but may affect vocational evidence for DFEC rebuttal.

Question 22

Why avoid vague pain descriptions?

Answer 22

Pain add-on requires detailed ADL impact to be valid under AMA Guides.

Question 23

Mnemonic for pain doc

Answer 23

“PAIN = Prove ADL Impact Needed.”

Question 24

What is vocational rebuttal?

Answer 24

Using vocational expert to show scheduled PD doesn’t reflect true earning loss.

Question 25

Why is vocational rebuttal outside QME scope?

Answer 25

QME provides medical impairment; vocational experts address labor market/earning capacity.

Question 26

What is Guzman flexibility for unusual injuries?

Answer 26

Allows QME to pick alternative AMA chapter if standard table underestimates impairment with full explanation.

Question 27

Mnemonic for Guzman use

Answer 27

“GUIDE ALT.”

Question 28

Why is final PD % critical legally?

Answer 28

Determines benefit duration, possible life pension, and settlement value.