QME Exam Preparation – Recommended Topics

AMA Guidelines & Permanent Disability

• AMA Guides to the Evaluation of Permanent Impairment, 6th Edition
  • Rondinelli’s Introduction to AMA Guides
• International Classification of Functioning, Disability and Health (ICF)
• Permanent Disability
  • Permanent Disability Rating Schedule (PDRS)
    • DEU’s FAQ on Applying Permanent Disability Rating Schedule (PDRS) 
  • State of California’s Schedule for Rating Permanent Disabilities
  • California Labor Code Section 4662 and 4664
  • DEU Impairment Ratings
    • Subchapter 1.6. Permanent Disability Rating Determination 
  • Impairment Rating
    • Whole Person Impairment (WPI)
    • Disability (work & non-work)
    • Associated Limitations in terms of Activities of Daily Living (ADLs) / Functional Loss
    • Work Restrictions / Limitations
  • ICF Codes
    • Functioning and Disability
    • Contextual Factors

Almaraz-Guzman

• DEU Application of Almaraz-Guzman

AME and QME Evaluation Regulations & Forms

• QME/AME Process & Agenda 
• Chapter 1. Division of Workers’ Compensation – Qualified Medical Evaluator Regulations. Article 3. Assignment of Qualified Medical Evaluators, Evaluation Procedure. 
  • QME Panel Section
  • DWC Forms Required
  • AME and QME Reporting Guidelines
  • Medical Evaluation Time Frames 
• Title 8, Division 1, Chapter 1. Article 3. §36.5. Service of Comprehensive Medical/Legal Report in Claims of Injury to the Psyche 

Apportionment

• California Labor Code Section 4663
• Apportionment
  • Industrial Apportionment
  • Non-industrial Apportionment
  • Benson v. WCAB (2009)
• SB 863
  • Apportionment between pre-2013 and post-2013 injuries with overlapping injured body parts
• DWC’s Apportionment and Medical Reports: Catching Mistakes and Preventing Discrimination

Causation

• Causation of Injury
  • Industrial Causation
• Causation of Disability

Cumulative Trauma Injuries (CTs)

• State Fund v W.C.A.B. (Dorsett)
• Date of Injury in Cumulative Injury
  • California Labor Code Section 5411 and 5412c

Department of Industrial Relations (DIR) & Division of Workers’ Compensation (DWC)

• DWC’s Physician’s Guide to the Medical Practice in the California Workers’ Compensation System
• Division of Workers’ Compensation, Title 8 Regulations 
  • Medical Unit – Qualified Medical Evaluator
  • Chapter 4.5. Division of Workers’ Compensation
  • Chapter 8. Office of the Director

ICD-10 Codes and Diagnosis

• AMA ICD-10 Overview 
• AMA ICD-10 Fact Sheet, Improving your ICD-10 Diagnosis Coding

Primary Treating Physician (PTP)

• Title 8. Division 1. Chapter 4.5, Subchapter 1. Article 5. §9785. Reporting Duties of the Primary Treating Physician 

Privacy Compliance for Work Related Medical Issues and HIPAA

QME Sanction Guidelines

• DIR Sanction Guidelines for Qualified Medical Evaluators 

Rules of Self-Referrals / Cross Referrals

• Workers’ Compensation Reform Act (AB 110)
• Labor Code sections 139.3 and 139.31

Substantial Evidence of Causation Apportionment

• Title 8, California Code of Regulations, section 10606 – Physicians’ Reports as Evidence / Required Contents of QME Report 
• Workcompcentral’s Substantial Evidence of Causation Apportionment article
  • Part 1
  • Part 2 

Traumatic Brain Injury (TBI)

Worker’s Compensation Terms

• Work Comp Index – Glossary of Terms and Abbreviations 
• DWC Glossary of Workers’ Compensation Terms

 

For more general guides and resources, visit Crosspoint’s QME Exam Resources.

Email info@crosspointevaluations.com or call 800-929-4750 to speak with one of our QME Practice Managers for more information on any of these topics.