module 8 part 6

Question 2

How should QME address layoff-related stress?

Answer 2

Evaluate if the layoff was a good faith personnel action (GFPA); if so and it’s the main cause, claim may be barred.

Question 3

What is retaliatory action in psych claims?

Answer 3

Employer actions taken in retaliation for complaints/whistleblowing; not GFPA and may support compensability.

Question 4

Why is harassment documentation vital?

Answer 4

Corroborates claimant’s report; HR complaints, witness statements, investigations strengthen work causation.

Question 5

Can performance reviews impact causation?

Answer 5

Yes — poor reviews may support GFPA defense; positive reviews may support claimant’s stress narrative.

Question 6

How should QME address substance use?

Answer 6

Clarify if substance use disorder pre-existed, worsened due to work, or is unrelated; apportion if appropriate.

Question 7

What is industrial suicide doctrine?

Answer 7

Death benefits payable if suicide stems from a work-related psychiatric injury meeting causation thresholds.

Question 8

Mnemonic for industrial suicide

Answer 8

“WORK → DESPAIR → DEATH.”

Question 9

Why must QME avoid equivocal language?

Answer 9

Ambiguity invites litigation; use clear probability language (e.g., “reasonable medical probability”).

Question 10

Standard phrase for causation opinion?

Answer 10

“Within reasonable medical probability, the industrial factors were the predominant cause (≥51%).”

Question 11

What is the burden of proof in psych WC?

Answer 11

On the employee to prove causation; employer/insurer must prove GFPA or other defenses.

Question 12

Why include detailed employment history?

Answer 12

Shows exposure duration, job duties, and changes; critical to evaluate work stress and GFPA.

Question 13

What if multiple employers contributed?

Answer 13

Apportion PD among employers if supported; list each employment period and contribution %.

Question 14

What is temporary partial disability (TPD)?

Answer 14

Wage replacement when employee can work with restrictions but earns less due to psych injury.

Question 15

Why describe work restrictions carefully?

Answer 15

Guides modified duty and return-to-work; should be functional (e.g., “no public contact”) not legal.

Question 16

Can QME recommend therapy type?

Answer 16

Yes — CBT, supportive, medication mgmt recommendations; helps guide treatment plan approval.

Question 17

Why is symptom exaggeration a key defense point?

Answer 17

Insurers often allege malingering; QME should discuss test validity and consistency.

Question 18

Mnemonic for malingering defense

Answer 18

“FAKE” — Flagged by tests, Appear inconsistent, Killed credibility, Explain.

Question 19

What is IME vs AME in psych?

Answer 19

IME = independent (party-selected), AME = agreed by both sides to avoid panel QME.

Question 20

Why may parties select an AME?

Answer 20

To avoid panel lottery and pick a mutually trusted evaluator.

Question 21

What if AME opinion conflicts with QME?

Answer 21

WCAB judge weighs credibility; AME usually given more weight if jointly agreed.

Question 22

Why discuss workplace culture?

Answer 22

Toxic or abusive culture can establish industrial stressors beyond ordinary pressure.

Question 23

How to rate sleep disturbance psych impairment?

Answer 23

Only if part of DSM-5 diagnosis (e.g., MDD with insomnia); rated through overall GAF/WPI, not as separate add-on.

Question 24

Can QME rate sexual dysfunction from psych injury?

Answer 24

Yes, if causally linked and meets DSM/AMA Guides; describe impairment in GAF/WPI.

Question 25

Why detail **treatment response**?

Answer 25

Shows stability/MMI and whether further improvement is expected (affects PD).

Question 26

Importance of **clear apportionment chart**?

Answer 26

Summarizes % industrial vs non-industrial; helps DEU/judge assign PD.

Question 27

Mnemonic for final report structure

Answer 27

**“HARD MAP” — History, ADLs, Records, Diagnosis, MMI, Apportionment, PD rating.**

Question 28

Key to defensible psych QME report?

Answer 28

**Clarity, timeline, DSM-5 diagnosis, legal thresholds, ADL impact, apportionment, objective data.**