Important Dates

Question 1

Effective 4/19/2004 apportionment of disability shall be based on…

Answer 1

Causation

Question 2

After 1/1/2005 to determine impairment use.. (which guide)?(if IW is MMI)

Answer 2

AMA Guide 5th edition

Question 3

For P&S reports (if IW is P&S) prior to 1/1/05 use…

Answer 3

1997 PDRS schedule & rate of work restrictions

Question 4

Claims before 1.1.05 if there is no med-legal report or no report by PTP use what guide to determine PD (perm disability)?

Answer 4

AMA guides

Question 5

MPNs (medical provider networks) can be used starting…

Answer 5

1.1.05

Question 6

New rules for selection of represented worker’s injuries after.. (what date)?

Answer 6

1.1.05

Question 7

Beginning …(date), the ACOEM is presumably correct on extend & scope of medical Tx until AD adopts a new util.schedule (a book of how to Tx IW)

Answer 7

3.22.04

Question 8

ACOEM guidelines went into effect on 1.1.04. Presumption of correctness ..(date)

Answer 8

3.22.04

ACOEM is rebuttable

Question 9

All bosses must have a Utilization Review program starting… (date) and reviews must be based ACOEM or UR schedule (a book of Treatments) adopted by AD after.. (date)

Answer 9

1. 01.04

12. 01.04

Question 10

Limit on 24 PT, 24 chiro & 24 occupational therapy for DOI on or after..

Answer 10

01.01.04

Question 11

Mandatory med Tx of $10K (date)

Answer 11

4.19.04

Question 12

2ns spinal surgery opinion

Answer 12

01.01.04

Question 13

Unrep IW, rules for selection of the QME REGARDLESS of DOI begins on ..(date)

Answer 13

4.19.04

Question 14

Apportionment to causation opinion..(date)

Answer 14

4.19.04

Question 15

2005 Escobedo vs Marshalls

Answer 15

Provided guidelines addressing apportionment.
Based on causation of DISABILITY not causation of injury. What % by industrial factors & what % by others, Based on reasonable medical probability.

Question 16

TD change in max # of weeks for DOI after…

Answer 16

4.19.04

Question 17

Date of latest QME/AME regulations?

Answer 17

02.2009

Question 18

2009 Benson vs WCAB

Answer 18

If MULTIPLE injuries, QME must address apportionment of PD btw those injuries. If QME cant parcel them out, then “inextricably intertwined”. & WCAB will issue an unapportioned PD.

Question 19

Disputes over any need for med Tx are no longer among the QME disputes starting… (date) for NEW injuries and (date) for ALL injuries.

Answer 19

1. 01.2013 - new injuries

07. 01.2013 -for all

Question 20

How are disputes over need for med. Tx are resolved starting 1.1.13 for new and 7.1.13 for all injuries?

Answer 20

PTP requests Tx. If it is denied/delayed or modified—> start UR process. If that is denied then IMR.

Question 21

After what DOI a chiro can not be a PTP after the first 24 visits? (unless boss authorized it in writing)

Answer 21

01.01.2004

Question 22

DOI btw 01.01.04 - 12.31.12 who don’t RTW within 60 days after termination of TD (temp disab), may qualify for SJDB voucher UNLESS the boss offers & IW rejects or fails to accept….

Answer 22

modified work lasting min 12 months

Question 23

SJDB voucher for DOI on or after 01.01.13 is…

Answer 23

$6K

Question 24

Burial expenses are $5K for DOI before ..(date)

Answer 24

01.01.2013

Question 25

How much is burial expenses for injuries on or after Jan 1, 2013?

Answer 25

$10K

Question 26

How much is death benefit?

Answer 26

$125-325 K depending on the number of dependents.