10 Topics to know for the QME exam

We get many requests for QME exam study materials.  Since all our courses can be read for free online, we recommend browsing through some of our QME CE courses to familiarize oneself with what topics could be covered on the QME exam.  Here’s a list of topics that we think are important and what the DWC recommends to study:

  • QME exam format and best practices
  • SB863 and its effect on pain impairment evaluation
  • The role of the QME in the disability evaluation process
  • Important court decisions influencing the QME process
  • Industrial Medical Council Physician’s Guide
  • California Labor Code (most importantly Section 4663/4664)
  • Report-writing under AMA Guides to the Evaluation of Permanent Impairment
  • Special focus of Chapters 1, 2, and 18 of the AMA Guides
  • Workers’ compensation terminology
  • Dates of injury and historical changes

Important court decisions influencing the QME process

Milpitas Unified School District v. Workers’ Comp. Appeals Bd. (2010)

Department of Rehabilitation v. Workers’ Comp. Appeals Bd. (2003)

General Foundry Service v. Workers’ Comp. Appeals Bd. (1986)

State Comp Ins. Fund v. Workers’ Comp. Appeals Bd. (2008)

Ismael Navarro v. City of Montebello (2014)

SB863 and its effect on pain impairment evaluation

The entire bill text can be found here: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201120120SB863

A less lengthy overview provided by the California DWC can be found here:

http://www.dir.ca.gov/dwc/SB863/SB863_Overview.htm

Since SB 863, the QME will not be specifically addressing treatment issues in dispute or make binding treatment recommendations. That is now the purview of UR (Utilization Review) and the IMR (Independent Medical Review). Even so, having an understanding of the appropriate assessment and treatment of chronic pain is still essential in determining whether or not an applicant is Permanent and Stationary (condition is stabilized for rating presumably after receiving appropriate treatment). One may be faced with a chronic pain patient who has had little appropriate treatment per accepted guidelines (as reviewed in this course). Although the QME will not make treatment decisions that are automatically approved, he or she can certainly decide that the P and S status has not been reached (due to a lack of appropriate treatment) or has been reached (after appropriate treatment). Either way, knowing what constitutes an appropriate course of treatment for chronic pain is essential.