QME testing 9 Flashcards
(15 cards)
If a QME evaluates a case with overlapping symptoms from industrial and non-industrial sources, what must be addressed?
Clear apportionment supported by medical reasoning that separates industrial from non-industrial contributions.
What case established that a physician must provide the basis for apportioning disability to non-industrial factors?
Escobedo v. Marshalls (2005).
What is the correct QME response if a patient exaggerates symptoms without matching objective findings?
Document inconsistencies, consider validity testing, and provide a reasoned opinion on functional impairment and credibility.
Can a QME rely solely on the patient’s subjective complaints to assign impairment?
No. Impairment ratings must be based on objective findings, functional history, and diagnostic tests as outlined in AMA Guides.
What is the appropriate action if the QME’s specialty is clearly unrelated to the injured body part?
The QME should decline the case or refer back to the DWC Medical Unit for reassignment.
How should a QME address inconsistencies between their report and treating physician’s findings?
Acknowledge differences, explain the basis for the QME’s conclusions, and cite supporting evidence or rationale.
When are combined values used in impairment rating?
When multiple impairments in different body parts contribute to overall whole person impairment (WPI).
What if the QME finds a new diagnosis not previously identified in the claim?
Include it in the report with clinical justification and recommend evaluation for compensability if appropriate.
What does it mean to ‘rebut the rating schedule’ under Almaraz-Guzman II?
Use a non-standard method of rating impairment if it more accurately reflects the injured worker’s impairment, with supporting rationale.
What is the main requirement to use an Almaraz-Guzman rebuttal?
The alternative method must result in a more accurate reflection of the injured worker’s functional loss, with strong justification.
What if an attorney sends a letter to the QME with questions before the eval and doesn’t send it to the other party?
This is ex parte communication; the QME must disclose it and may decline to proceed with the evaluation.
How should a QME handle unclear or contradictory medical records?
Document the inconsistencies, request clarification if possible, and base conclusions on the most reliable data available.
What is a common procedural error that invalidates QME panel selection?
Requesting a panel before properly objecting to a treating physician’s report within the required timeframe.
What happens if a QME fails to serve their report on all parties?
The report may be considered incomplete or invalid, and the QME may face disciplinary action for failure to follow procedure.
Can a QME issue a new MMI date if prior reports indicated the patient was not yet at MMI?
Yes, if clinical findings now support it. The QME must document and justify the change based on medical evidence.
