QME testing 11 Flashcards
(15 cards)
What is a clinical red flag that may suggest non-organic pain behavior?
Waddell’s signs, inconsistent examination findings, or pain out of proportion to physical findings.
Why must a QME avoid over-reliance on subjective complaints for impairment ratings?
Because impairment must be supported by objective findings and functional limitations per AMA Guides.
What legal risk arises if a QME fails to address apportionment in a permanent disability case?
The report may be deemed inadmissible, incomplete, or legally insufficient under Labor Code §4663.
What is the risk of not identifying all disputed body parts in a QME report?
The report may be considered incomplete, and treatment or benefits could be improperly denied or delayed.
What is the risk of using non-standard rating methods without justification?
The rating may be rejected by WCAB or IMR unless properly supported under Almaraz-Guzman II principles.
What common documentation error can undermine an impairment rating?
Failing to document range of motion measurements, missing diagnostic correlation, or inconsistent use of charts.
What red flag may indicate an over-treated or exaggerated claim?
Prolonged passive care, multiple failed modalities, or symptom magnification without corresponding pathology.
What legal consequence arises if a QME accepts ex parte communication without disclosure?
The QME report may be excluded, and the QME may be sanctioned or removed from the DWC panel.
What is one way a QME can detect malingering?
Inconsistency in effort-dependent tasks, non-anatomic sensory deficits, or findings unsupported by imaging or exam.
What must a QME do if records arrive late or after the exam is complete?
Review the records and issue a supplemental report if they materially affect the prior conclusions.
What legal rule requires physicians to determine percentages of causation for disability?
Labor Code §4663.
What is the consequence of failing to submit a QME report on time without a valid extension?
The panel may be replaced, and the QME may face administrative discipline from the DWC.
What error might cause a permanent disability rating to be considered inflated or unreliable?
Combining impairments improperly, duplicating ratings, or using pain as a standalone rating.
Why is it important to distinguish pre-existing pathology from new industrial injury?
To determine proper apportionment and avoid attributing non-industrial conditions to the work injury.
How should a QME approach a case with prior surgery and new symptoms in the same area?
Document history, compare prior function to current findings, and assess whether new disability is from work or prior condition.
