QME Exam Prep Questions with
Correct Answers
3 factors to establish in making a causation determination - Answer- (1) Presence of
pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - Answer- (1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
Direct causation - Answer- Work exposures are directly responsible for the health
outcomes
Contributing causation - Answer- Several factors led to the disease; work exposure is
one of these factors
Acceleration - Answer- Disease process is accelerated by virtue of work exposure. The
date of the onset of the disease is much sooner than it would have been in the absence
of the exposure
Precipitation - Answer- Work exposure *precipitates* the manifestation of the illness.
For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest
Aggravation - Answer- A medical condition may be present already, but work exposure
makes it worse
Principle of "taking employees as you find them" - Answer- The employer cannot avoid
liability for an occupational injury by claiming that the injury would not have happened if
the worker had been in a different physical or emotional condition before the accident
Criteria for compensation of psychiatric injuries - Answer- (1) Diagnosed mental
disorder
AND
(2) Causes disability or need for medical treatment
AND
, (3) Employee can demonstrate that events of employment were predominant cause of
the injury
Limits for claims of psychiatric injury - Answer- (1) Actual events of employment were
the predominant cause (> 50%) among all combined causes of the psychiatric injury
(except if the injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act or from direct exposure to a significant violent
act, the actual events of employment must have been a substantial cause of the injury
(contributed >= 35% of the causation from all sources combined)
(3) Employee was employed by employer >= 6 months (not continuously), unless the
injury was caused by a sudden and extraordinary employment condition
(4) Injury was not substantially (>=35%) caused by "lawful, nondiscriminatory, good faith
personnel actions" (e.g., being passed over for promotion or being transferred to
another department)
(5) Claim cannot be filed after notification of termination or layoff
Perception is not disability - Answer- Disability is not based on how much stress should
have been felt by employee, but rather how much stress is felt by an individual worker
reacting uniquely to the work environment. Stress must have proximately caused the
injury.
Proximate cause - Answer- Causal connection between injury and employment.
*Employment need not be sole cause of injury, just a contributing cause
Criteria for compensability of psychiatric claims after notice of termination/layoff -
Answer- (1) Injury was the result of sudden and extraordinary events of employment
(2) Employer had notice of the injury before the notice of termination or layoff.
(3) Medical records existing before the notice of termination/layoff contain evidence of
treatment of the psychiatric injury
(4) Contractual, administrative, regulatory, or judicial trier of fact has found that there
was sexual or racial harassment
(5) There is evidence that the DOI is subsequent to the date of notice of termination, but
before the effective date of the termination. (Allows post-termination claims for
cumulativeinjuries or occupational illnesses that do not manifest themselves until after
the employee has left the job)
First right to request a QME examination to determine compensability - Answer- Injured
worker, regardless of representation
First right to specify specialty of the QME panel - Answer- Injured worker, regardless of
representation
Admissible reports before a WCJ to resolve the issue of compensability - Answer- (1)
Properly acquired QME (2) Primary treating physician
Permanent disability rating (determination) - Answer- (1) The disability evaluation
Correct Answers
3 factors to establish in making a causation determination - Answer- (1) Presence of
pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - Answer- (1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
Direct causation - Answer- Work exposures are directly responsible for the health
outcomes
Contributing causation - Answer- Several factors led to the disease; work exposure is
one of these factors
Acceleration - Answer- Disease process is accelerated by virtue of work exposure. The
date of the onset of the disease is much sooner than it would have been in the absence
of the exposure
Precipitation - Answer- Work exposure *precipitates* the manifestation of the illness.
For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest
Aggravation - Answer- A medical condition may be present already, but work exposure
makes it worse
Principle of "taking employees as you find them" - Answer- The employer cannot avoid
liability for an occupational injury by claiming that the injury would not have happened if
the worker had been in a different physical or emotional condition before the accident
Criteria for compensation of psychiatric injuries - Answer- (1) Diagnosed mental
disorder
AND
(2) Causes disability or need for medical treatment
AND
, (3) Employee can demonstrate that events of employment were predominant cause of
the injury
Limits for claims of psychiatric injury - Answer- (1) Actual events of employment were
the predominant cause (> 50%) among all combined causes of the psychiatric injury
(except if the injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act or from direct exposure to a significant violent
act, the actual events of employment must have been a substantial cause of the injury
(contributed >= 35% of the causation from all sources combined)
(3) Employee was employed by employer >= 6 months (not continuously), unless the
injury was caused by a sudden and extraordinary employment condition
(4) Injury was not substantially (>=35%) caused by "lawful, nondiscriminatory, good faith
personnel actions" (e.g., being passed over for promotion or being transferred to
another department)
(5) Claim cannot be filed after notification of termination or layoff
Perception is not disability - Answer- Disability is not based on how much stress should
have been felt by employee, but rather how much stress is felt by an individual worker
reacting uniquely to the work environment. Stress must have proximately caused the
injury.
Proximate cause - Answer- Causal connection between injury and employment.
*Employment need not be sole cause of injury, just a contributing cause
Criteria for compensability of psychiatric claims after notice of termination/layoff -
Answer- (1) Injury was the result of sudden and extraordinary events of employment
(2) Employer had notice of the injury before the notice of termination or layoff.
(3) Medical records existing before the notice of termination/layoff contain evidence of
treatment of the psychiatric injury
(4) Contractual, administrative, regulatory, or judicial trier of fact has found that there
was sexual or racial harassment
(5) There is evidence that the DOI is subsequent to the date of notice of termination, but
before the effective date of the termination. (Allows post-termination claims for
cumulativeinjuries or occupational illnesses that do not manifest themselves until after
the employee has left the job)
First right to request a QME examination to determine compensability - Answer- Injured
worker, regardless of representation
First right to specify specialty of the QME panel - Answer- Injured worker, regardless of
representation
Admissible reports before a WCJ to resolve the issue of compensability - Answer- (1)
Properly acquired QME (2) Primary treating physician
Permanent disability rating (determination) - Answer- (1) The disability evaluation
