module 8 part 5

Question 2

What is the legal standard for apportionment in psych claims?

Answer 2

Separate the % of permanent impairment caused by work vs non-industrial factors, with clear rationale and evidence.

Question 3

Mnemonic for apportionment

Answer 3

“SPLIT” — Separate, Percent, Link, Industrial, Total.

Question 4

Why document pre-injury function?

Answer 4

Establishes baseline mental health and ADL level to measure industrial aggravation.

Question 5

What if claimant had therapy before injury?

Answer 5

QME should describe pre-existing disorder severity and note if work caused additional impairment.

Question 6

How should QME address childhood trauma?

Answer 6

Identify as non-industrial factor; estimate % contribution to current impairment if medically supportable.

Question 7

Can personality disorders be apportionment factors?

Answer 7

Yes — if pre-existing and medically linked to impairment level, but must explain evidence.

Question 8

Why must QME avoid speculation in apportionment?

Answer 8

Unsupported % splits can be overturned; must cite records, history, and clinical reasoning.

Question 9

What is GAF 41–50 significance?

Answer 9

Serious symptoms or serious impairment in social/occupational functioning — often mid-range PD.

Question 10

GAF 31–40 significance?

Answer 10

Major impairment in several areas — higher PD rating potential.

Question 11

GAF >60 significance?

Answer 11

Mild impairment — usually minimal or no PD.

Question 12

Why give functional examples for GAF?

Answer 12

Supports score with observable ADL limits (e.g., panic attacks at work, isolation).

Question 13

Mnemonic for GAF rationale

Answer 13

“SEE” — Symptoms, Examples, Employment impact.

Question 14

What is treatment recommendation section for?

Answer 14

Guides future care (therapy, meds); not tied to PD % but required in QME report.

Question 15

Why avoid “permanent and total disability” language casually?

Answer 15

It’s a legal conclusion; QME should describe functional impairment, not declare total disability.

Question 16

When is total PD (100%) accepted in psych?

Answer 16

Severe, treatment-resistant disorders preventing any competitive employment with clear evidence.

Question 17

What is vocational evidence role?

Answer 17

Can rebut scheduled PD % if actual earning loss differs; QME may review but does not calculate.

Question 18

Why include objective test scores in report?

Answer 18

Strengthens credibility and defense against malingering allegations.

Question 19

Are neurocognitive tests used in psych WC?

Answer 19

Sometimes — if memory, attention, or brain injury issues are alleged.

Question 20

What is secondary gain and its impact?

Answer 20

Perceived benefit (financial, legal) may bias reporting; QME should discuss but remain objective.

Question 21

Why use consistent terminology (“industrial injury”)?

Answer 21

Avoids confusion; must clearly label work-related vs non-industrial causes.

Question 22

What is SB 863 impact on psyche PD again?

Answer 22

Bars routine psych PD add-ons for post-2013 physical claims unless catastrophic or violent act.

Question 23

How to document catastrophic injury exception?

Answer 23

Describe objective severity (e.g., amputation, paralysis) and explain why meets statutory exception.

Question 24

What if psych claim is denied initially?

Answer 24

Applicant may request QME; clear medical causation analysis can help overturn denial.

Question 25

Why is **timely reporting** of psych symptoms important?

Answer 25

Delayed reporting weakens causation presumption; insurers may argue intervening non-work causes.

Question 26

Mnemonic for timely report

Answer 26

**“FAST” — Fast Action Supports Trust.”**

Question 27

What role do supervisors/HR records play?

Answer 27

Show work events, complaints, performance issues — crucial for causation and GFPA defense.