EZ QME CONTINUING EDUCATION PRESENTS
WHAT IS AN "INJURY?"
Qualified Medical Evaluators are often called upon to render opinions on the presence of an industrial injury. This is referred to as the "CAUSATION" (AOE/COE) determination. This is a difficult decision and it absolutely has to be CORRECT. In this Program, learn how to get it right - every single time!
Pacific Employers vs. Division of Industrial Accidents
AOE Denied!
An important concept in establishing compensable industrial injury is that the injury does not need to be of the kind anticipated by the employer or peculiar to the employment. Here, we have two cases that illustrate the opposite ends of the spectrum - one case succeeded, and the other case failed.
In our first case, even though injured in the course of employment (COE), this injury was not compensable because the injury did not arise out of employment (AOE).
Larson vs. Industrial Accident Commission
AOE Proven
In this case the employer argued that the deaths and injuries to employees did not arise out of employment but, the courts saw things differently.
SESSION 1 - DEFINING "INJURY" IN CALIFORNIA WORKER'S COMPENS
Establishing what qualifies as an injury is critical before even understanding what qualifies as an "industrial injury." Here, we outline the essential components of what an "injury" looks like first in regular life, and then in California Worker's Compensation.
Session 2 - The Conditions of Compensation Liability
Kobe vs. City of Los Angeles
One of the affirmative defenses that the Claims Administrator, or the Defense Attorney may use to defeat a claim for industrial injury has to do with the "initial physical aggressor." Injuries sustained in an altercation by the "initial physical aggressor" are not compensable. In this case, the employer who started an argument, was found NOT to be the "initial physical aggressor" and therefore, his injuries were compensable and he received benefits.
Session 2 "Is this Injury Compensable?"
Labor Code section 3600 give us the conditions under which an injury is deemed compensable, and those conditions under which an injury is NOT compensable. Here we review concepts related to "injury" and then we explore the nuances of LC 3600.
Session 3 - The Post Termination Defense
Section 10 of LC 3600 tells us that the law bars, bans, and prohibits claims that are filed after the separation of employee from employer. However, there are exceptions to this rule that are designed to protect persons actually injured at work but, for whatever reason, they failed to file a claim for injury until they no longer actually worked for the employer. Here we explore those 4 specific exceptions and, we discuss how the QME can handle these cases.
Session 4 - Proper Reporting of an Injury
Your examinee tells you that they had their brother phone and leave a voice mail message at the employer to report the injury, or, the examinee says that they left a post-it note on the desk of the off-duty supervisor to report the injury. Do these examples constitute "proper" and "legal" reporting of the injury? You might be surprised!
Session 5 - Causation, Case Law, and The QME
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.
Session 6 - The Scope of the AOE Evaluation
Now that all the foundational principles regarding injury, AOE, cumulative trauma dates of injury, post employments claims, etc. have been established through the first 5 session of this Program, we not bring these ideas into practical application to review the specific sequence of steps in the examinee interview, and in the face to face evaluation, that will provide you with the data you need to provide an accurate and correct AOE industrial causation determination - every single time!
COURSE EXAMINATION
"WHAT IS AN INJURY?"
The Course requires 70% correct answers for a passing grade. When you achieve 70% correct, you will be allowed to print your Certificate of Completion and..... you're done!
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