Report-Writing Virtual Course 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. Question Title * 1. Contact Information Full Name and Title * Email Address * Phone Number Question Title * 2. Test Date Date Date Question Title * 3. Only physicians as defined by the Labor Code can be a QME. A physician is defined as an M.D., D.O., Psychologist, Acupuncturist, Dentist, Podiatrist, Chiropractor, or Optometrist. A) True B) False Question Title * 4. It's the QME's primary responsibility to resolve disputes without being biased towards the defense or the applicant? A) True B) False Question Title * 5. A Qualified Medical Evaluation must be performed in an office location that has been approved for QME examinations by the California Division of Workers' Compensation (DWC)? A) True B) False Question Title * 6. The employer has the burden of proving any apportionment of the impairment. A) True B) False Question Title * 7. A Physician Assistant may perform all tasks in a Qualified Medical Evaluation, with the exception of the physical examination and the decision determining causation and Permanent and Stationary status? A) True B) False Question Title * 8. With appropriate physician supervision, a Nurse Practitioner in a QME's office may sign a QME report? A) True B) False Question Title * 9. Impairment and associated disability related to activities performed outside of work may be included in a QME report? A) True B) False Question Title * 10. It is inappropriate to question the integrity of the injured worker; however, inconsistencies in the history of complaints presented by the injured worker during the evaluation should be addressed and explained in the QME report. A) True B) False Question Title * 11. Rules regarding Ex Parte communication, means that you cannot talk to the patient after the examination is completed and the applicant has left the office? A) True B) False Question Title * 12. The standard for medical decision-making in a QME evaluation is reasonable medical probability? A) True B) False Question Title * 13. An evaluating physician is permitted to change their mind, after generating a QME report, upon reviewing new evidence or performing further research? A) True B) False Question Title * 14. A QME may ignore the injured worker's past medical history if they feel it is not relevant to the injury? A) True B) False Question Title * 15. A QME may decline to consider a Permanent & Stationary rating pending tests or imagining studies that were requested by the QME and have not been completed or reported in the medical record. A) True B) False Question Title * 16. If conflicting information comes from the insured vs the injured worker, the QME should provide their opinions according to both presentations and let the WCAB judge decide the correct one. A) True B) False Question Title * 17. What was the major goal for using the AMA Guides to evaluate impairment for injured workers in California? A) It was simple, even a doctor could do it. B) It would reduce payments to injured workers and help C) Many states already used the AMA Guides. D) It would provide improved uniformity when calculating disability awards. Question Title * 18. Subjective complaints can not be considered for impairment assignment and disability awards in California. A) True B) False Question Title * 19. Apportionment should be discussed in all QME reports, including cases that have not yet become permanent and stationary? A) True B) False Question Title * 20. Causation of disability is a complexity factor that must be addressed in all QME reports? A) True B) False Question Title * 21. Upper ExtremityImpairment in the upper limb for absence of body parts, loss of joint range of motion, and neurological impairment. Impairment for subjective complaints associated with inflammation, circulatory insufficiency, joint instability or pain, are not considered by the Guides. A) True B) False Question Title * 22. 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. A) True B) False Question Title * 23. When considering an upper limb injury and an associated head injury, the impairment values for the hand, elbow, and shoulder are added and then combined with the impairment associated with the head injury. A) True B) False Question Title * 24. Lower ExtremityWhen a physician is rating an impairment, there are situations where more than one method can be used to describe the injured worker’s impairment. If more than one method can be used, the evaluating physician should choose the following method: A) Choose the method that gives the lowest impairment rating. B) Choose the method that is the most complicated to describe. C) Choose the method that gives the highest impairment rating. D) Choose the method that is simplest to describe. E) Choose the method that comes earliest in the AMA Guides. Question Title * 25. When converting a lower extremity impairment to a whole person impairment, how is the conversion calculated? A) Multiply the whole person impairment by 0.4. B) Multiply the lower extremity impairment by 0.4. C) Multiply the lower extremity impairment by 0.5. D) Divide the lower extremity impairment by 0.4. Question Title * 26. When rating a lower extremity impairment using the gait derangement method using table 17-2, what considerations are important? A) Gait derangement is always secondary to another condition. B) An impairment rating by gait derangement should be supported by pathology findings. C) Gait derangement impairments are for persons who are dependent on assistive devices. D) Gait derangement does not apply to subjective factors. E) All of the above. Question Title * 27. When rating lower extremity impairment using the ankylosis method in the same joint, how should the impairment for malposition be combined with the impairment for ankylosis in optimal position? A) The impairment for malposition should be combined, using the Combined Values Chart, with the impairment for ankylosis in optimal position. B) Select the impairment that is higher; impairment for malposition, or impairment for ankylosis in optimal position. C) Select the impairment that is lower; impairment for malposition, or impairment for ankylosis in optimal position. D) The impairment for malposition should be added to the impairment for ankylosis in optimal position. E) Add the impairments for the various malpositions that may be present. Compare that to the impairment for ankylosis in optimal position. Then select the value that is higher. Question Title * 28. When rating impairment for the lower extremity, how does the evaluating physician select, or combine the impairment calculated from the various impairment methods? A) The impairments should all be added together. B) Choose the single method that provides the highest impairment rating. C) The impairments should all be combined using the Combined Values Chart. D) The cross-usage chart, Table 17-2, Guide to the Appropriate Combination of Evaluation Methods, should be utilized to determine which methods may be combined. E) Choose the single method that provides the lowest impairment rating. Question Title * 29. In a cumulative trauma case, symptoms that have been present for a year without being reported and a claim initiated, are no longer eligible for a Workers' Compensation claim? A) True B) False Other (please specify) Question Title * 30. Rating IssuesCervical Spine Injury: Fusions at C3-4 and C4-5. How would you rate this using Chapter 15 of the AMA Guides? A) Cervical DRE Category III B) Cervical DRE Category IV C) ROM Method D) Cervical DRE IV or the ROM Method, whichever one rates higher. Question Title * 31. Lumbar Spine injury: Muscle spasm on examination, non-verifiable radicular complaints. Some difficulty with ADLs. Which DRE category do you use? A) Lumbar DRE Category I. B) Lumbar DRE Category II. C) Lumbar DRE Category III. Question Title * 32. Which of these are necessary components of a Spinal ROM Method rating? A) ROM measurements B) Diagnosis and values per table 15-7, AMA Guides Page 404 C) Spinal nerve deficits per AMA guides Pages 423-424 D) All of the above Question Title * 33. Which other impairments can be combined with impairment for Carpal Tunnel Syndrome? A) Grip Loss B) Loss of wrist motion C) None of the above. Question Title * 34. Per Table 17-2, AMA Guides Page 526, which of these impairment can be combined with a partial medial menisectomy of a knee? A) Arthritis of the knee B) Decreased ROM of the knee C) Muscle strength impairment of the knee D) Muscle Atrophy E) None of the above Question Title * 35. An Almarez-Guzman analysis allows the Qualified Medical Evaluator to determine the final impairment or the injured worker, regardless of the impairment assigned by the AMA Guides. A) True B) False Question Title * 36. An Almarez-Guzman analysis requires the evaluating physician to first calculate the impairment assigned by the standard and customary use of the AMA Guides and then assign an alternative impairment if that Is more favorable to the injured worker. A) True B) False Question Title * 37. The evaluating physician considering an Almarez-Guzman analysis must use some portion of the AMA Guides when offering an alternative calculation of impairment that he/she feels is more accurate for the presentation of the patient. A) True B) False Question Title * 38. The combined values chart in the AMA Guides compresses multiple impairment calculations in order to avoid assigning duplicative impairments that may exceed 100% of whole person Impairment. A) True B) False Question Title * 39. In some cases, impairment assigned to more than one body part may have a synergistic effect, but increased impairment may not be considered by a QME. A) True B) False Question Title * 40. Treatment for a non-industrial condition may be recommended by the QME if this treatment is necessary to deliver the required treatment for the industrial Injury. A) True B) False Question Title * 41. TimelinesInjured worker has 10 days to select a QME from a list of 3 provided by the DWC. A) True B) False Question Title * 42. If the injured worker fails to select QME, employer will then have 10 days to select QME. A) True B) False Question Title * 43. QME has 30 days from the date of the evaluation to submit their report. A) True B) False Question Title * 44. The appointment with the QME must be scheduled within 90 days of the request. A) True B) False Question Title * 45. QME may request an extension from the DWC to submit their report. Two 15-day extensions may be granted for good cause. Good cause would include verifiable physical illness of the QME or damage to the QME's office. A) True B) False Done
