8 Review Quiz (1-2 hrs.) Flashcards
Review your knowledge
P&S means that residual impairment or disability exists (True/False)
FALSE, there may be impairment or no impairment
Discharged as cured means the condition has resolved (True/False)
TRUE
Pre-injury status means the condition has resolved (True/False)
TRUE
The standard to prove causation is not medical certainty, but a reasonable medical probability (True/False)
TRUE
Any doctor/acupuncturist who has treated the worker cannot be the QME (True/False)
TRUE
Is there a limit to temporary disability benefits (TTD)?
Yes, 2 years
A QME or AME should not:
Use a PR-3 (PTP, P&S Report - Permanent Disability Report - Pre 2005 injuries)
Use a PR-4 (PTP, P&S Report - Permanent Impairment Report - Post 2005 injuries)
Solicit the worker to become a patient
Make the patient wait more than an hour to be seen
How long does Future Medical care last?
Forever.
Per Labor Code 4600 what medical/hospital treatment is provided by the employer?
Medical, chiropractic, surgical and acupuncture care
Hospital treatment including nursing
Medicines, medical and surgical supplies
Crutches, apparatuses, including orthotic and prosthetic devices and services
In the California Workers’ Compensation System, a physician is?
M.D., D.C., D.O.
D.P.M, Ph.D., D.D.S.
L. Ac., O.D.
Impairment is considered permanent when it has reached MMI (True/False)
TRUE
Permanent and stationary (P&S) means that the condition will never change (True/False)
TRUE
Which reports are admissible at the WCAB?
Reports from the PTP
Reports from the QME or AME
100% total disability is presumed to exist in which of the following injuries?
Loss of both of the worker’s eyes or the sight thereof
Loss of both of the worker’s hands or use thereof
Practically total paralysis
A brain injury resulting in incurable mental incapacity or insanity
QMEs are limited to 10 locations to evaluate injured workers (True/False)
TRUE
QME panels are picked within geographic region of the worker’s home residence OR work (True/False)
TRUE
In which of the settings below must interpreting services, be provided to an injured worker who does not speak or understand English?
A deposition
Appeals Board hearing
Medical-legal examination
Medical treatment appointment
The initial appointment location can never be moved; however subsequent evaluations can be done at another office as long as the QME has it listed with the DWC-Medical Unit (True/False)
TRUE
Each new PTP must complete a Doctor’s First Report of Occupational Injury or Illness (Form DLSR 5021) following the initial examination. (True/False)
TRUE
Medical treatment is designed to cure or relieve the effects of the industrial injury. (True/False)
TRUE
If an injured worker’s claim is not accepted or denied within 90 days of the worker giving the completed Claim Form (DWC Form 1) to the employer, the claim is presumed to be industrial. And, the claims administrator is liable for up to $10,000 in treatment under the medical treatment guidelines, while considering the claim. (True/False)
TRUE
Workers’ compensation benefits are the only exclusive remedy for injuries suffered on the job when the employer is properly insured. If the employer is illegally uninsured, the worker can file a civil action against the employer, in addition to filing a workers’ compensation claim. (True/False)
TRUE
A medical provider network (MPN) is a group of healthcare providers set up by the employer’s insurance company and approved by the DWC’s administrative director to treat workers injured on the job. (True/False)
TRUE
The 24-visit cap on chiropractic care, physical therapy and occupational therapy, does not apply to dates of injury before 1-1-04. (True/False)
TRUE
Temporary Disability payments provided to an injured worker for a date of injury on/after 1-19-04 are limited to 104 weeks. For certain injuries, temporary disability shall not last for more than 240 weeks. Those injuries include:
- Acute and chronic hepatitis B and C
- Amputations
- Severe burns
- Human immunodeficiency virus (HIV)
- High-velocity eye injuries
- Chemical burns to the eyes
- Pulmonary fibrosis
- Chronic lung disease.
The Labor Code (3600) specifically excludes from compensation 7 types of injuries contained in the Physician’s Guide. Those include:
- 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)
- Intentionally self-inflicted injuries
- Suicide, if willful and deliberate
- 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
- Injuries resulting from off-duty recreational activities, where participation in the activities does not constitute part of the employee’s work-related duties, and where the activity is not an expressed or implicit condition of employment
- Psychiatric injuries claimed after notice of termination/layoff unless certain conditions exist
CC&R 9768.10 indicates that IMR doctors can be an MD, DO or DPM. (True/False)
TRUE
A ‘Secondary Physician’ is any physician other than the primary treating physician who examines or provides treatment to the employee, but is not primarily responsible for continuing management of the care of the employee. (True/False)
TRUE
A medical-legal report shall contain a declaration by the physician signing the report, under penalty of perjury, stating, “I declare under penalty of perjury that the information contained in this report and its attachments, if any, is true and correct to the best of my knowledge and belief, except as to information that I have indicated I received from others. As to that information, I declare under penalty of perjury that the information accurately describes the information provided to me and, except as noted herein, that I believe it to be true.” The foregoing declaration shall be dated and signed by the reporting physician and shall indicate the county wherein it was signed. (True/False)
TRUE
A QME who has not paid their recertification fees or let their QME certification lapse, cannot perform a re-evaluation of the patient, however, can perform a supplemental report, where the worker is not examined. (True/False)
TRUE
A QME may obtain a consultation from any physician as a reasonable and necessary expense. (True/False)
FALSE
The evaluator and the employee’s treating physician(s) may consult as necessary to produce a complete and accurate report. (True/False)
TRUE
All communications by the parties with the medical-legal evaluator shall be in writing and sent simultaneously to the opposing party when sent to the medical evaluator. (True/False)
TRUE
Represented parties who have selected an Agreed Medical Evaluator or an Agreed Panel QME shall, as part of their agreement, agree on what information is to be provided to the AME or Agreed PQME. (True/False)
TRUE
An evaluator shall not request or accept any compensation or thing of value from any source that does or could create a conflict with his or her duties as an evaluator. (True/False)
TRUE
No physician reporting as an AME or QME shall accept gifts that have a total fair market value in the aggregate of $360 or more, from any single source that handles California workers’ compensation matters, in the course of any consecutive 12 months. The sources include, but are not limited to, 1 or more attorneys, physicians, employers, claims administrators, medical or health care or insurance or utilization review business entities. (True/False)
TRUE
“Primary treating physician’ is the physician who is primarily responsible for managing the care of an employee, and who has examined the employee at least once for the purpose of rendering or prescribing treatment and has monitored the effect of the treatment thereafter. (True/False)
TRUE
“Released from care” means a determination by the PTP that the employee’s condition has reached a permanent and stationary status with no need for continuing or future medical treatment. (True/False)
TRUE
“Future medical treatment” is treatment which is anticipated at some time in the future and is reasonably required to cure or relieve the employee from the effects of the injury. (True/False)
TRUE
“Continuing medical treatment” is occurring or presently planned treatment that is reasonably required to cure or relieve the employee from the effects of the injury. (True/False)
TRUE
An employee shall have no more than 1 primary treating physician at a time. (True/False)
TRUE
Secondary treating physicians, physical therapists, and other health care providers to whom the employee is referred shall report to the PTP in the manner required by the PTP. (True/False)
TRUE
When continuing medical treatment is provided, a progress report (Form PR-2) shall be made no later than 45 days from the last report. (True/False)
TRUE
The QME or AME evaluates an injured worker, however, there is not enough time to finish the evaluation and the employee is asked to return to the office on another date to complete the process. The 30 days to serve the report on the parties starts on the first day the worker was seen. (True/False)
TRUE