Module3_Flashcards_Part3 (1)

Question 1

Front

Answer 1

Back

Question 2

What are the consequences of QME bias or advocacy?

Answer 2

Report can be excluded, QME may face discipline or decertification.

Question 3

What documentation is critical for apportionment?

Answer 3

Clear explanation of percentage split between industrial and non-industrial causes.

Question 4

What if QME report is ambiguous?

Answer 4

Parties may request clarification or supplemental report.

Question 5

What is required when describing subjective complaints?

Answer 5

List patient’s pain and function complaints, note consistency with findings.

Question 6

What is a comprehensive medical-legal evaluation?

Answer 6

Initial full exam addressing all disputed issues.

Question 7

What is a follow-up medical-legal evaluation?

Answer 7

Re-exam or review after initial to address new or unresolved issues.

Question 8

What is a supplemental medical-legal evaluation?

Answer 8

Written response to new records or questions, no new exam.

Question 9

What defines a ‘substantial medical evidence’ report?

Answer 9

Adequate history, exam, reasoning; based on reasonable medical probability.

Question 10

What is included in disability determination?

Answer 10

Impairment %, apportionment, future care, work restrictions.

Question 11

What is the time frame for serving comprehensive evaluation reports?

Answer 11

30 days from exam unless extended for good cause.

Question 12

What is an impairment rating addendum?

Answer 12

An updated rating when condition changes or errors found.

Question 13

What must a QME consider when using AMA Guides?

Answer 13

Use correct chapter, tables, combine values properly, explain adjustments.

Question 14

What is rebuttal evidence in disability rating?

Answer 14

Evidence challenging DEU rating using alternative data or analysis.

Question 15

What if injured worker fails to attend QME exam?

Answer 15

QME notes no-show; case may be delayed or rescheduled, possible fee issues.

Question 16

How to handle incomplete work duty info?

Answer 16

Request clarification or assume standard duties with rationale.

Question 17

What is required for neurological impairment rating?

Answer 17

Motor, sensory, reflex exams with grade & % per AMA Guides.

Question 18

What are activities of daily living (ADLs) in AMA Guides?

Answer 18

Self-care, mobility, communication, physical activity, sleep, etc.

Question 19

What is the Combined Values Chart?

Answer 19

AMA tool to combine multiple impairment ratings into one WPI %.

Question 20

What is a future medical care recommendation?

Answer 20

Forecast of likely needed treatment, meds, therapy after MMI.

Question 21

What must QME say about psychiatric injury in work comp?

Answer 21

Whether work events were predominant cause (≥51%) of psychiatric injury.

Question 22

When is a psychiatric QME required?

Answer 22

When mental health injury or stress claim is alleged.

Question 23

What is the difference between impairment and disability?

Answer 23

Impairment = medical loss; Disability = impact on work/life earning capacity.

Question 24

Who may dispute DEU ratings?

Answer 24

Either party may challenge by presenting rebuttal evidence to WCAB.

Question 25

What is the role of WCAB in med-legal disputes?

Answer 25

WCAB judges decide adequacy and weight of reports in hearings.

Question 26

What if multiple QMEs are involved?

Answer 26

Use panel rules; WCAB resolves disputes on which report controls.

Question 27

When must a QME describe job modifications?

Answer 27

Whenever restrictions affect ability to perform essential job functions.

Question 28

What is vocational apportionment?

Answer 28

Allocation of earning capacity loss between work and other factors.

Question 29

Who regulates QME training and certification?

Answer 29

The California DWC Medical Unit.

Question 30

What does Labor Code 4061 cover?

Answer 30

Disputes over permanent disability after MMI.

Question 31

What does Labor Code 4062 cover?

Answer 31

Other med-legal disputes (treatment, temporary disability, etc.).