EZ QME CONTINUING EDUCATION DWC PROVIDER # 1280

session 1-2

Up Up and Away! Cumulative trauma claims for industrial injury are on the rise, rise, rise. Qualified Medical Evaluators sometimes struggle with the concept of a cumulative trauma injury because, first of all, it can be difficult to determine if an employee is actually presenting with an "injury" and, from there, whether the "injury" is related to repetitive physically traumatic work place duties...or not. But this determination need not be so difficult. In this Live Video, we 1) review the concept of "injury" in the California Workers Compensation system, 2) differentiate between "specific" and "cumulative trauma" injuries, and 3) share how to determine if, or if not the examinee actually has a CT injury.

For both specific and cumulative trauma industrial injury claims, the date of injury is critical. But, while specific injuries have a definite statute of limitations, the statute for cumulative trauma injuries is virtually unlimited. Because the date of injury for CT claims involves the vague and poorly defined date upon which the employee first realized that their disability (and/or need for medical treatment) was due to the workplace activities, these CT claims can be reported up to years and even decades after the industrial exposure. This late reporting causes the Claims Administrator to typically deny the claim, after which the claim comes to the Qualified Medical Evaluator.

SESSION 3-4

Labor Code 3600 generally bars, bans, prevents, and prohibits the filing of a claim for industrial injury AFTER an employee has been laid off and/or terminated from employment. However, the law also simultaneously protects employees who have suffered bona fide injury but who, for a thousand reasons, failed to file the claim until after their separation from the employer. For these reasons, these claims come to Qualified Medical Evaluators as DENIED claims. In this video, learn the behind-the-scenes sequence of events that cause these cases come to you for your medical opinions - mostly on AOE and COE.

With cumulative trauma injury claims, the date of injury is EVERYTHING! The date of injury is determined under Labor Code 5412 but determining the date of injury is not always simple. It requires a thorough understanding as to what constitutes "disability", and what constitutes "knowledge" that the employee's medical condition was related to the work place duties. These are considerations of great debate and dispute among the parties and payers each of whom seeks to avoid liability for the injured employee's benefits. This is a full, detailed, and in-depth discussion. It this video, learn how the courts resolved disputes over the dates of injury for 3 cumulative trauma injury claims. This is especially valuable for the Qualified Medical Evaluator who is charged with rendering opinions and conclusions - especially on AOE/COE - in cumulative trauma injury claims, most of which come to QMEs as denied claims. The Claims Administrator typically denies these types of claims - most of which are filed post employment after the employer has separated their relationship with the employer.

SESSION 5-6

Say something interesting Claims for industrial cumulative trauma are on the rise and have increased 50% since 2008. This represents and increase of thousands and thousands of new claims filed for allegations of cumulative trauma injuries. What is responsible for this huge increase in these claims and, who is the most likely employee to file such a claim? And, once a claim for industrial cumulative trauma is filed, especially a post employment claim, the Claims Administrator reflexively in a knee jerk reaction typically denies the claim. So, how are these denied claims handled, and settled by the Courts? In this Live Video, we answer these curious questions. g about your business here.

A large percentage of the claims that are filed for cumulative trauma are denied by the Claims Administrator. This brings the evaluation to the Qualified Medical Evaluator for a compensability determination. This is one of the most difficult decisions facing the Qualified Medical Evaluator and, it has to be CORRECT in every single case or else a terrible disservice is done to one or more of the parties. In this Live Video, learn an algorithm that you can successfully in the complex medical decision making process of quickly and accurately arriving at a determination "for" or "against" industrial injury.