California Orthopaedic Association

Disclaimer: The answers to these questions can be found in the audio recording, in the course handouts, and represent the opinion of the speakers.  They do not necessarily represent COA’s opinion or policy on the issue.

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1. Contact Information (Required.)

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2. Test Date (Required.)

Date

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3. How many district offices does the CA Workers' Compensation System have? (Required.)

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4. How many Workers’ Compensation hearings occur in CA each month? (Required.)

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5. The total number of CA Workers’ Compensation claims in 2021 was approximately: (Required.)

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6. Average medical payments per claim with more than 7 days of lost time has been approximately stable since 2015. (Required.)

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7. The total number of Independent Medical Review (IMR) applications for treatment issues has declined almost ________ between 2019 and 2021. (Required.)

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8. The % of IMR claims deemed ineligible remained fairly constant between 2019-2021. (Required.)

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9. Reasons for ineligibility include: (Required.)

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10. The evaluator may use the COA Medical-Legal template as a checklist to help ensure completeness of their report. (Required.)

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11. IMR upheld UR decisions regarding surgery approximately _____ of the time. (Required.)

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12. The new Medical Legal Fee Schedule (MLFS) became effective: (Required.)

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13. The new Medical-Legal Fee Schedule added several new complexity factors to the billing process. (Required.)

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14. The Division of Workers' Compensation has developed an instructional course for QMEs. (Required.)

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15. The new Medical-Legal Fee Schedule increased reimbursement for medical legal testimony in depositions. (Required.)

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16. The new Medical-Legal Fee Schedule created a new mediation system for disagreements about payment for missed appointments. (Required.)

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17. When reporting the number of pages reviewed for a ML 201 medical legal report, include in the count: (Required.)

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18. What records can be provided to the QME? (Required.)

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19. Are post-termination claims allowed under California's Workers' Compensation system? (Required.)

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20. An AME musculoskeletal evaluation is billed at 25% more than a QME evaluation. (Required.)

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21. If a deposition is canceled less than 8 calendar days before it is to occur, the QME may still bill for a minimum of 2 hours. (Required.)

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22. Review of medical records is not important under the definition of substantial medical evidence. (Required.)

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23. It is sufficient for the QME to only state the conclusions of their evaluation of the injured worker in their Medical-Legal report? (Required.)

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24. An orthopaedic evaluator is required to spend at least 20 minutes in the evaluation of an injured worker. (Required.)

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25. Can the evaluator contact the treating physician to receive missing medical records? If records are received, the evaluator must also provide the records to all parties. (Required.)

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26. Can an attorney or their staff attend and record the evaluation? Their attendance must be documented in the Medical-Legal report. If this is the case, may the evaluator also record the session to avoid any discrepancies? (Required.)

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27. Another health care provider can perform the hands-on evaluation of the injured worker? (Required.)

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28. Substantial medical evidence means that conclusions are based on clinical judgements that are: (Required.)

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29. Cumulative Trauma
One definition of a Cumulative Trauma (CT) injury date is the date: (Required.)

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30. Under the Guzman cases there is no need to calculate the strict impairment under the AMA Guides 5th edition because it is inaccurate. (Required.)

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31. An objective diagnosis in the CA Workers’ Compensation system is one using metrics confirmed by: (Required.)

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32. How many kinds of causation are there in CA Workers’ Compensation cases? (Required.)

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33. Apportionment
Apportionment in CA Workers’ Compensation is focused on: (Required.)

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34. Given that injured workers cannot choose their parents, can genetic factors be used to apportion impairment? (Required.)

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35. In the Lindh case the Court of Appeals ruled that apportionment was valid for preexisting risk factors. (Required.)

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36. The Justice case concluded that “directly caused” means that “indirect causes” cannot be used for analyzing causation. (Required.)

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37. To maintain consistency, it is appropriate for orthopedic QMEs to use the same apportionment in their disability reports as was used by an internist regarding the same injured worker. (Required.)

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38. Bias
Bias is defined as a tendency for a physician to favor one viewpoint over another without medical facts to back up the conclusion. (Required.)

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39. Unconscious bias can be impacted by the order in which the medical information is presented in the patient's record. (Required.)

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40. Other common types of bias in medical evaluations include anchoring bias, confirmation bias, and momentum bias. (Required.)

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41. Assessment of impairment in the hand and upper limb requires the evaluating physician to confine his/her assessment to the tables and figures in Chapter 16 of the AMA Guides before considering the combination chart. (Required.)

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42. Which other impairments can be combined with impairment for Carpal Tunnel Syndrome? (Required.)

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