QME Exam Correctly Answered
Occupational disease- ✅✅ Is a disease that in whole or in part was caused by
work.
Is treatment for pesticide poisoning considered first aid? - ✅✅ Treatment
rendered for pesticide poisoning or a condition suspected as pesticide poisoning
can never be considered first aid
Excluded injuries- ✅✅
• Injuries caused by the employee's use of alcohol or illegal controlled substances
(if it can be shown that the injury would not have occurred otherwise, which is
often difficult to substantiate)
• Intentionally self-inflicted injuries
• Suicide
• Injuries resulting from altercations, in which the injured employee is the "initial
physical aggressor"
• Injuries resulting from the employee's commission of a felony, for which the
employee has been convicted (this includes "wobbly felonies," which are crimes
that may be prosecuted as misdemeanors or felonies)
• Injuries resulting from off-duty recreational activities, in which participation in
the activities does not constitute part of the employee's work-related duties and the
activity is not an expressed or implicit condition of employment
• Psychiatric injuries claimed after notice of termination/layoff unless certain
conditions exist.
What Is a Compensable Injury? - ✅✅ An employer must provide compensation,
without regard to negligence, for "any injury sustained by his or her employees
arising out of and in the course of the employment."
Employers are prohibited from: - ✅✅• Discriminating against workers for their
health and safety activities or for filing a workers' compensation claim
• Terminating an injured worker during the period of temporary disability, unless
the employer can prove that the termination was due to a "business necessity"
• an employer cannot refuse to reinstate an injured worker, unless the worker can
no longer perform the essential functions of the job or based on a medical opinion
that provides reasonable fear of re-injury.
, Insurance carriers and claims administrators' role - ✅✅ providing a
communication conduit between the parties
How much medical treatment can be authorized in one day after claim filed? -
✅✅ Employers have an obligation to authorize medical treatment up to $10,000
within one working day after the claim is filed.
Temporary disability is not paid for how many days of missed work? - ✅✅
Temporary disability is not paid to injured workers for the first three days of
missed work unless they are hospitalized or miss more than 14 days of work.
How many days till payments begin after employer knows of the claim? - ✅✅
Payments must begin within 14 days of the employer's knowledge of the claim and
disability, unless the employer contests the claim. The employer has 90 days from
the notification of the injury to contest the claim.
When was the 1st work comp act passed? - ✅✅1911, seventeen days after the
devastating fire at the Triangle Shirtwaist Company factory in New York took 146
lives
What are the 3 components of the work comp system? - ✅✅1. No fault
2. Exclusive remedy
3. Assured fixed benefit
E employer is required to pay benefits no matter who caused the injury, as long as
the injury arose out of or occurred in the course of employment. - ✅✅ no fault
Less the employer is uninsured, the worker cannot pursue other forms of recovery
from the employer, even if the employer was grossly negligent. - ✅✅ exclusive
remedy
What type of injuries are excluded? - ✅✅ Deliberately self-inflicted injuries are
excluded from coverage
What happens if the injury is due to serious misconduct of the employer? - ✅✅
For injuries that result from the serious and willful misconduct of the employer, the
employee's compensation is increased by half
Occupational disease- ✅✅ Is a disease that in whole or in part was caused by
work.
Is treatment for pesticide poisoning considered first aid? - ✅✅ Treatment
rendered for pesticide poisoning or a condition suspected as pesticide poisoning
can never be considered first aid
Excluded injuries- ✅✅
• Injuries caused by the employee's use of alcohol or illegal controlled substances
(if it can be shown that the injury would not have occurred otherwise, which is
often difficult to substantiate)
• Intentionally self-inflicted injuries
• Suicide
• Injuries resulting from altercations, in which the injured employee is the "initial
physical aggressor"
• Injuries resulting from the employee's commission of a felony, for which the
employee has been convicted (this includes "wobbly felonies," which are crimes
that may be prosecuted as misdemeanors or felonies)
• Injuries resulting from off-duty recreational activities, in which participation in
the activities does not constitute part of the employee's work-related duties and the
activity is not an expressed or implicit condition of employment
• Psychiatric injuries claimed after notice of termination/layoff unless certain
conditions exist.
What Is a Compensable Injury? - ✅✅ An employer must provide compensation,
without regard to negligence, for "any injury sustained by his or her employees
arising out of and in the course of the employment."
Employers are prohibited from: - ✅✅• Discriminating against workers for their
health and safety activities or for filing a workers' compensation claim
• Terminating an injured worker during the period of temporary disability, unless
the employer can prove that the termination was due to a "business necessity"
• an employer cannot refuse to reinstate an injured worker, unless the worker can
no longer perform the essential functions of the job or based on a medical opinion
that provides reasonable fear of re-injury.
, Insurance carriers and claims administrators' role - ✅✅ providing a
communication conduit between the parties
How much medical treatment can be authorized in one day after claim filed? -
✅✅ Employers have an obligation to authorize medical treatment up to $10,000
within one working day after the claim is filed.
Temporary disability is not paid for how many days of missed work? - ✅✅
Temporary disability is not paid to injured workers for the first three days of
missed work unless they are hospitalized or miss more than 14 days of work.
How many days till payments begin after employer knows of the claim? - ✅✅
Payments must begin within 14 days of the employer's knowledge of the claim and
disability, unless the employer contests the claim. The employer has 90 days from
the notification of the injury to contest the claim.
When was the 1st work comp act passed? - ✅✅1911, seventeen days after the
devastating fire at the Triangle Shirtwaist Company factory in New York took 146
lives
What are the 3 components of the work comp system? - ✅✅1. No fault
2. Exclusive remedy
3. Assured fixed benefit
E employer is required to pay benefits no matter who caused the injury, as long as
the injury arose out of or occurred in the course of employment. - ✅✅ no fault
Less the employer is uninsured, the worker cannot pursue other forms of recovery
from the employer, even if the employer was grossly negligent. - ✅✅ exclusive
remedy
What type of injuries are excluded? - ✅✅ Deliberately self-inflicted injuries are
excluded from coverage
What happens if the injury is due to serious misconduct of the employer? - ✅✅
For injuries that result from the serious and willful misconduct of the employer, the
employee's compensation is increased by half
