module 9 part 3

Question 2

What is the “rebuttable presumption” rule?

Answer 2

Employer can overcome presumption only with substantial evidence; without it, claim stands.

Question 3

Are WC presumptions ever “conclusive”?

Answer 3

Rarely — most are rebuttable, meaning they can be overturned with strong evidence.

Question 4

Why do presumptions favor public safety?

Answer 4

Recognize increased risk/exposure inherent in firefighting, law enforcement, and emergency response.

Question 5

Mnemonic for safety rationale

Answer 5

“DANGER = COVER.”

Question 6

Can private sector workers use presumptions?

Answer 6

Generally no — most presumptions apply to public safety/government roles.

Question 7

What is the statutory presumption period?

Answer 7

The time frame after last employment in which condition remains covered (varies by presumption).

Question 8

Example: heart disease presumption period

Answer 8

Usually up to 5 years post-employment for eligible safety officers.

Question 9

Example: cancer presumption period

Answer 9

Often up to 10 years post-employment, depending on statute and exposure.

Question 10

Why time windows matter

Answer 10

They define employer liability and when presumption no longer applies.

Question 11

What is the burden-shifting effect?

Answer 11

Once presumption attaches, employer must disprove rather than worker proving work causation.

Question 12

Mnemonic for burden shift

Answer 12

“SHIFT” — Statute Hands Injury Fact To employer.

Question 13

How can employer rebut?

Answer 13

Pre-employment records, non-industrial exposures, expert medical testimony.

Question 14

What if no rebuttal evidence?

Answer 14

Presumption stands → claim accepted as industrial.

Question 15

How should QME report when rebutting?

Answer 15

Provide clear medical probability that non-industrial factors >51% cause.

Question 16

Are lifestyle risks valid rebuttals?

Answer 16

Yes — e.g., heavy smoking, obesity, family history if strongly causal.

Question 17

Can delay in treatment rebut presumption?

Answer 17

Only if delay clearly shows non-work etiology or breaks causal link.

Question 18

What is the sudden cardiac event rule?

Answer 18

For safety officers, heart events on duty presumed work-related unless proven otherwise.

Question 19

Are presumptions impacted by SB 1159 (COVID)?

Answer 19

Yes — expanded COVID-19 presumptions and reporting obligations for employers.

Question 20

Employer COVID reporting duty?

Answer 20

Must report positive tests to claims administrator within set time; failure favors presumption.

Question 21

Mnemonic for COVID presumption

Answer 21

“14 & Report” — 14-day test window + employer report duty.

Question 22

Why are presumptions costly to defend?

Answer 22

Require strong medical/legal workup and often still favor employee if evidence equivocal.

Question 23

How do presumptions affect settlement value?

Answer 23

Increase value — harder for employer to deny, so PD/medical benefits likely owed.

Question 24

Can multiple presumptions overlap?

Answer 24

Yes — e.g., firefighter with heart and cancer; each analyzed under its statute.

Question 25

Why must QME cite specific statute?

Answer 25

Each presumption has unique conditions/timeframes; citing wrong one weakens report.

Question 26

Are presumptions retroactive?

Answer 26

Usually **no** — apply to injuries during or after effective date of statute unless specified.

Question 27

Why keep up with statute updates?

Answer 27

New presumptions (e.g., PTSD, COVID) appear frequently; outdated knowledge can invalidate reports.