Legal Foundations for QMEs: Case Law and WCAB Reasoning
Disability Impairment Rating (DIR – 4 hours)
How To Rate Spinal Impairments – DRE Categories Part 1
According to the AMA Guides, 5th Edition, providing an accurate a spinal impairment rating involves utilizing one of two rating methods: the Range of Motion (ROM) method or the Diagnosis-Related Estimates (DRE) method. Although these methods appear to be straight-forward to use, we must remember and be aware of many important facts and issues before rating an Applicant for spinal impairment. In this presentation, we will take an in-depth look at the DRE method as we explore the rationale for its use and many examples as they apply when providing a correct spinal impairment rating.
Creative and Innovative Impairment Ratings
It's time to break free from the shackles of the strict application of the AMA Guides. By thinking outside the box of the standard definitions of impairments provided in the charts and tables of the AMA Guides, QMEs can more accurately and thoroughly describe their examinee's actual impairment. Today's Live Video explains the use of 1) the ranges of values provided in most of the charts and tables, and 2) using analogies of your examinee's condition or impairment, to other conditions or impairments that are listed in the AMA Guides. Open up your thinking, and let your creative juices flow!
Almaraz/Guzman Impairment Ratings
In this Live ZOOMinar sponsored by SullivanonComp, well known and highly respected QME Steve Feinberg M.D. joins us to explain exactly HOW to incorporate alternative impairment ratings into your final conclusions for an accurate description of the examinee's actual impairment, and loss of function for activities of daily living. Here, we review actual examples of alternative impairment ratings for 1) headaches, 2) upper extremity, and 3) lower extremity and, we explain how to support your opinion for an alternative impairment rating with substantial medical evidence.
Medical Legal Report Writing
12 Hour Report Writing Course - Session 2
In this session of the program we review what the law, what the 2016 Physician's Guide, and what the AMA Guides have to say about what topics, items, and issues need to be included and discussed in today's QME Report and, we create a hybrid Template that includes all of the required elements specific to California Workers Compensation.
12 Hour Report Writing Course - Session 4
This session begins a 3 parts series entitled "The Language of Reports." In these next 3 session we begin to develop the new vocabulary you will be using and mastering in the completion of your QME Reports. In this session, we trace the flow of the QME Report through the workers compensation system, all the way to a successful resolution of the claim/case.
12 Hour Report Writing Course - Session 5
This is the second video in the 3 part series "The Language of Reports." In this session, we review the 4 laws that govern your "Review of Records", we review how to compose the "Occupational History section of your Report, and we review the AMA Guides and the many diagnostic tests and studies that are required in the evaluation of Permanent Impairments.
Anti-Bias Training (ABT – 2 hours)
Combatting Bias in the QME Evaluation 5
The first domino falls in the war against bias in the medical legal evaluation with the recent passage of SB 788 but then, strangely, it was vetoed by Governor Newsome. Now, the burden for eliminating bias to prohibit Apportionment to race, religious creed, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation falls squarely on the shoulders of the DWC. In Todays Live Video, we review the good intentions of SB 788 as well as two actual cases that involved 1) gender discrimination, and 2) national origin discrimination.
• Combatting Bias in the QME Evaluation 6
Black and Hispanic workers suffer frequent industrial injury because these groups are disproportionately represented in high injury risk occupations - such as construction labor. However, statistics indicate that these groups of injured workers received fewer workers compensation disability benefits than their white colleagues in the same industry for the same severity of injury. Here we receive two actual workers compensation studies that reveal that racial bias results in inaccurate (translation = low) monetary benefits for minority injured workers.
Workers’ Compensation Case Law
The En Banc Decision of Nunez v. DMV
When the WCAB issues an en banc decision, it is a big deal. This signals a significant and controversial legal decision that is now binding on all workers compensation judges, and all Appeals Board Panels. In Nunes vs. The Department of Motor Vehicles, the controversial issue revolved around - guess what - Apportionment, and its application to the vocational evidence supporting a 100% loss of future earning capacity for Ms. Nunes. This raises the question, "What is the difference between 'medical apportionment", and "vocational apportionment?'"
Causation, Case Law and the QME – Session 5
In Today's Live Video we review several actual cases that involve unique situations and scenarios involving difficult and disputed AOE determinations. In most of the cases, the injury itself was not disputed but rather, industrial causation (AOE) for the injury was the dispute that brought the case to the Judge, the WCAB, or even the Court of Appeals
Workers’ Compensation Case Law
The QME Top 10 – “You Make the Call”
Recent case law gives us as Qualified Medical Evaluators tremendous authority in rendering opinions and conclusions on our examinees. History supports even preposterious opinions as long as those opinions qualify as "substantial medical evidence." Here we briefly review 5 cases that demonstrate the QME's omnipotence, and, how decisions are handled when an opinion is, or is NOT "substantial."
The QME’s Expert Deposition – Part 5
QME's CANNOT just throw out opinions and conclusions as if God has spoken. No - nowadays, there has to be some "substance" behind the opinion. There have to be relevant facts that support your reasoning. In today's Live Video, we review 3 actual cases. In 2 of the cases, the QME failed to qualify his/her opinions as "substantial medical evidence" and, as a result, the WCAB ruled HEAVILY in favor of the defense. In the 3rd case, the QME got it right and the Applicant came away with a BIG WIN under Almarez/Guzman.
Fee Schedule (MLFS – 1 hour)
Independent Bill Review 1
This is part 1 in a 3 Part Series that educates QME evaluators in the State of California the process of forcing the Claims Administrator to finally pay your bill when push comes to shove. This is important process to understand because you will certainly have to rely on as cheap, penny pinching Claims Administrators attempt to ignore, delay, and deny your otherwise properly authorized and documents billings.
The Accurate Apportionment – The Hikida Effect
There are many many scenarios whereby injured workers suffer increased Permanent Disability above and beyond that due simply to the injury. Many times, the medical treatment itself causes a compensable consequence injury that then fails to resolve to pre-injury condition. In the event that this leads to a Permanent Impairment rating, the Apportionment of this Impairment has an EXACT handling - known as "The Hikida Effect."
Online course examination
Legal Foundations & WCAB Reasoning Package
Final Course Examination
25 Questions | Passing Score: 70% (18 correct)
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