Module2_Flashcards_Part3

Question 1

Front

Answer 1

Back

Question 2

When must a QME report address work restrictions?

Answer 2

Whenever the injury limits the worker’s physical or mental job functions.

Question 3

What is the role of vocational experts in workers’ comp?

Answer 3

They assess employability and earning capacity when disability affects job prospects.

Question 4

What is the purpose of functional capacity evaluation (FCE)?

Answer 4

To objectively measure a worker’s physical abilities and job-related limitations.

Question 5

What is an Agreed Medical Evaluator (AME) vs. QME reporting standard?

Answer 5

AMEs follow the same medical-legal reporting standards as QMEs under DWC rules.

Question 6

What can cause delays in QME scheduling?

Answer 6

Specialty availability, panel disputes, late record delivery, or cancellations.

Question 7

What is the rule for QME report service?

Answer 7

Report must be served on all parties and the DWC within 30 days of the exam unless extended.

Question 8

What must be disclosed in QME conflict-of-interest statements?

Answer 8

Relationships with parties, financial interests, or prior treatment of the worker.

Question 9

How can a QME withdraw from a case?

Answer 9

By notifying the DWC and parties promptly if conflict or inability to complete report arises.

Question 10

What is the purpose of utilization review (UR) in workers’ comp?

Answer 10

To determine medical necessity of proposed treatment under evidence-based guidelines.

Question 11

What is independent medical review (IMR)?

Answer 11

A state process to resolve disputes about denied treatment recommendations after UR.

Question 12

What is the time limit for IMR request after UR denial?

Answer 12

Usually within 30 days of UR denial notice.

Question 13

Who oversees IMR in California?

Answer 13

The California Department of Industrial Relations (DIR).

Question 14

What is the difference between apportionment and causation?

Answer 14

Apportionment divides disability between causes; causation determines if work caused the condition.

Question 15

What happens if a QME repeatedly files inadequate reports?

Answer 15

They may face DWC discipline, up to decertification.

Question 16

What is the purpose of the DEU (Disability Evaluation Unit)?

Answer 16

It rates permanent disability based on medical reports to determine benefits.

Question 17

Who can request a DEU rating?

Answer 17

Parties, judges, or the DWC to help settle disputes on disability level.

Question 18

What is PD rating string in California?

Answer 18

A formula showing whole person impairment %, age, occupation, and adjustments to reach permanent disability %.

Question 19

What are work restrictions examples a QME may assign?

Answer 19

Lifting limits, no repetitive bending, sit/stand options, mental stress limits.

Question 20

What is a rebuttal to a DEU rating?

Answer 20

Parties can challenge DEU rating by presenting additional evidence or legal arguments.

Question 21

What is the purpose of the Qualified Interpreter Program?

Answer 21

To ensure non-English-speaking workers have certified interpreters at exams.

Question 22

What must QME do about interpreter accuracy concerns?

Answer 22

Note concerns in report and may request replacement if communication is inadequate.

Question 23

When must a QME comment on future medical care?

Answer 23

Whenever the worker may require continued treatment for the industrial injury.

Question 24

What is substantial cause under CA Labor Code 4663?

Answer 24

Work injury must contribute at least 35–40% to disability for apportionment purposes.

Question 25

What is whole person impairment conversion?

Answer 25

Combining multiple regional impairments into a single whole person impairment %.

Question 26

When must QME address job retraining?

Answer 26

If permanent restrictions make the worker unable to return to usual occupation.

Question 27

What is a panel strike in QME selection?

Answer 27

Each party may strike one name from the 3-doctor panel before final selection.

Question 28

When can a party request a replacement QME panel?

Answer 28

If QME has conflict, unavailable within required time, or incorrect specialty listed.

Question 29

What happens if all panel QMEs are unavailable?

Answer 29

DWC issues a new panel with replacement doctors.

Question 30

What is the purpose of the Panel QME process?

Answer 30

To provide a neutral, fair list of certified physicians for dispute resolution.

Question 31

What is the physician’s declaration in QME reports?

Answer 31

A signed statement affirming the report is true, complete, and in compliance with DWC regulations.