QME EXAM NEWEST 2024 ACTUAL EXAM COMPLETE
350 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
when was the 1st work comp act passed? - ANSWER: 1911, SEVENTEEN DAYS AFTER
THE DEVISTATING FIRE AT THE TRIANGLE SHIRTWAIST COMPANY FACTORY IN NEW
YORK TOOK 146 LIVES
WHAT ARE THE 3 COMPONENTS OF THE WORK COMP SYSTEM - ANSWER: 1. NO
FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT
NO FAULT - ANSWER: 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.
EXCLUSIVE REMEDY - ANSWER: less the employer is uninsured, the worker cannot
pursue other forms of recovery from the employer, even if the employer was grossly
negligent.
ASSURED AND FIXED BENEFIT - ANSWER: The workers' compensation system
establishes defined benefits, which must be paid for by the employer. Workers'
compensation awards are typically far less than comparable negligence awards in a
civil suit. For example, although the maximum workers' compensation death benefit
may be far less than the possible award in a civil wrongful death suit, a civil action
may take years to resolve while a death claim can be re-solved in as little as a few
months. Additional recoveries are available to employees for an employer's serious
and willful misconduct and unlawful discrimination (Labor Code § 132a and § 4553).
Although group health coverage may include arbitrary limits on the extent of
treatment covered, workers' compensation is a statutory benefit with no arbitrary
limits on the frequency, duration, or extent of services.
WHAT TYPE OF INJYURIES ARE EXCLUDED - ANSWER: deliberately self-inflicted
injuries are excluded from coverage
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE
EMPLOYER? - ANSWER: For injuries that result from the serious and willful
misconduct of the employer, the employee's compensation is increased by half
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE
EMPLOYEE? - ANSWER: For injuries that result from the serious and willful
misconduct of the injured employee, benefits are reduced by half, unless the injury
resulted in death or a per-manent disability of 70% or more; the injury resulted from
, failure of the employer to comply with the law or safety and health regulations; or
the employee was under 16 years old at the time of in-jury
WHAT MEASURES WERE ENACTED IN 2003 AND 2004 - ANSWER: measures were
enacted that allowed employers (1) to establish medical pro-vider networks—from
which injured workers are required to select treating doctors, (2) to conduct
utilization review to ensure that medical care was consistent with evidence-based
guidelines, and (3) to limit the amount of physical therapy and chiropractic
treatment. These measures also affect-ed permanent disability ratings and benefit
payments to injured workers. An evidence-based medi-cal treatment utilization
schedule (MTUS), or set of guidelines, was also adopted.
WHAT MEASURES WERE ENACTED IN 2013 - ANSWER: In 2013, measures were
enacted that made wide-ranging changes, which included (1) increasing permanent
disability paid to injured workers and simplifying the permanent disability rating
meth-od, (2) resolving medical treatment disagreements through independent
medical review and bill payment disputes through independent bill review, (3)
improving medical provider networks, and (4) updating the Official Medical Fee
Schedule and establishing fee schedules for copy services, in-terpreters, vocational
experts, and in-home health care.
MEDICAL UNIT - ANSWER: Which unit investigates complaints filed against QMEs
con-cerning violations of the Labor Code and regulations as well as other statutes for
misconduct com-mitted in the QME process
WHAT ARE THE KEY COMPONENTS OF COMPENCABILITY - ANSWER: • How to Take a
Complete Occupational History
• How to Define:
o An Injury
o First Aid
• Aggravation
• Recurrence
• Arising Out of Employment (AOE)
• Occurring in the Course of Employment (COE)
• Causation
• Presumptions
• Psychiatric Injuries
the Labor Code defines an injury as: - ANSWER: • Any injury or disease arising out of
employment (Labor Code § 3208)
• Any "derivative" injury caused by the treatment of an injury arising out of
employment
• Any reaction to or side effect from preventive health care the employer provides to
health-care workers (Labor Code § 3208.05).
In order for a condition to be considered an injury, it must: - ANSWER: 1 cause
disability
350 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
when was the 1st work comp act passed? - ANSWER: 1911, SEVENTEEN DAYS AFTER
THE DEVISTATING FIRE AT THE TRIANGLE SHIRTWAIST COMPANY FACTORY IN NEW
YORK TOOK 146 LIVES
WHAT ARE THE 3 COMPONENTS OF THE WORK COMP SYSTEM - ANSWER: 1. NO
FAULT
2. EXCLUSIVE REMEDY
3. ASSURED FIXED BENEFIT
NO FAULT - ANSWER: 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.
EXCLUSIVE REMEDY - ANSWER: less the employer is uninsured, the worker cannot
pursue other forms of recovery from the employer, even if the employer was grossly
negligent.
ASSURED AND FIXED BENEFIT - ANSWER: The workers' compensation system
establishes defined benefits, which must be paid for by the employer. Workers'
compensation awards are typically far less than comparable negligence awards in a
civil suit. For example, although the maximum workers' compensation death benefit
may be far less than the possible award in a civil wrongful death suit, a civil action
may take years to resolve while a death claim can be re-solved in as little as a few
months. Additional recoveries are available to employees for an employer's serious
and willful misconduct and unlawful discrimination (Labor Code § 132a and § 4553).
Although group health coverage may include arbitrary limits on the extent of
treatment covered, workers' compensation is a statutory benefit with no arbitrary
limits on the frequency, duration, or extent of services.
WHAT TYPE OF INJYURIES ARE EXCLUDED - ANSWER: deliberately self-inflicted
injuries are excluded from coverage
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE
EMPLOYER? - ANSWER: For injuries that result from the serious and willful
misconduct of the employer, the employee's compensation is increased by half
WHAT HAPPENS IF THE INJURY IS DUE TO SERIOUS MISCONDUCT OF THE
EMPLOYEE? - ANSWER: For injuries that result from the serious and willful
misconduct of the injured employee, benefits are reduced by half, unless the injury
resulted in death or a per-manent disability of 70% or more; the injury resulted from
, failure of the employer to comply with the law or safety and health regulations; or
the employee was under 16 years old at the time of in-jury
WHAT MEASURES WERE ENACTED IN 2003 AND 2004 - ANSWER: measures were
enacted that allowed employers (1) to establish medical pro-vider networks—from
which injured workers are required to select treating doctors, (2) to conduct
utilization review to ensure that medical care was consistent with evidence-based
guidelines, and (3) to limit the amount of physical therapy and chiropractic
treatment. These measures also affect-ed permanent disability ratings and benefit
payments to injured workers. An evidence-based medi-cal treatment utilization
schedule (MTUS), or set of guidelines, was also adopted.
WHAT MEASURES WERE ENACTED IN 2013 - ANSWER: In 2013, measures were
enacted that made wide-ranging changes, which included (1) increasing permanent
disability paid to injured workers and simplifying the permanent disability rating
meth-od, (2) resolving medical treatment disagreements through independent
medical review and bill payment disputes through independent bill review, (3)
improving medical provider networks, and (4) updating the Official Medical Fee
Schedule and establishing fee schedules for copy services, in-terpreters, vocational
experts, and in-home health care.
MEDICAL UNIT - ANSWER: Which unit investigates complaints filed against QMEs
con-cerning violations of the Labor Code and regulations as well as other statutes for
misconduct com-mitted in the QME process
WHAT ARE THE KEY COMPONENTS OF COMPENCABILITY - ANSWER: • How to Take a
Complete Occupational History
• How to Define:
o An Injury
o First Aid
• Aggravation
• Recurrence
• Arising Out of Employment (AOE)
• Occurring in the Course of Employment (COE)
• Causation
• Presumptions
• Psychiatric Injuries
the Labor Code defines an injury as: - ANSWER: • Any injury or disease arising out of
employment (Labor Code § 3208)
• Any "derivative" injury caused by the treatment of an injury arising out of
employment
• Any reaction to or side effect from preventive health care the employer provides to
health-care workers (Labor Code § 3208.05).
In order for a condition to be considered an injury, it must: - ANSWER: 1 cause
disability
