CA Certified Specialist — Workers' Compensation Law

Under Labor Code §3600(a), which of the following is NOT a required condition of compensation for a workers' compensation claim?

• AEmployer and employee are subject to the compensation provisions
• BInjury arose out of and in the course of employment (AOE/COE)
• CEmployee was performing service growing out of and incidental to the employment
• DEmployee filed a written claim with the employer within 30 days of injury

An employee is injured while on a coffee break in the employer's break room. Which doctrine most directly supports compensability?

• AThe going and coming rule
• BThe personal comfort doctrine
• CThe dual capacity doctrine
• DThe horseplay defense

Under Labor Code §3351, which of the following is generally NOT an 'employee' for workers' compensation purposes?

• AA part-time janitor paid hourly
• BA volunteer firefighter formally enrolled in the department
• CAn officer or director of a corporation receiving a salary
• DA bona fide independent contractor under the ABC test

An applicant slips and falls in the employer's parking lot 10 minutes before her shift starts. The parking lot is owned and maintained by the employer. Which rule most likely applies?

• AGoing and coming rule bars the claim
• BPremises line rule supports compensability
• CSpecial mission exception applies
• DCommercial traveler rule applies

Workers' compensation is generally the exclusive remedy against an employer under Labor Code §3602. Which of the following is a recognized exception permitting a civil tort action?

• ANegligent failure to maintain a safe workplace
• BFailure to provide adequate training
• CInjury caused by a defective product the employer manufactured and removed safety guards…
• DIntentional infliction of emotional distress through ordinary supervisory conduct

A firefighter is diagnosed with heart trouble after 5 years of service. Under Labor Code §3212, what presumption applies?

• ANo presumption applies; the firefighter must prove industrial causation
• BPresumption that the heart trouble arose out of and in the course of employment
• CConclusive presumption that the disability is total
• DPresumption that benefits are barred unless filed within 90 days

Which of the following best describes the going and coming rule?

• AInjuries sustained while traveling to and from the regular workplace are generally not co…
• BAll commuting injuries are compensable regardless of circumstances
• COnly injuries occurring within one mile of the workplace are compensable
• DCommuting injuries are compensable if the employee was wearing a uniform

An employee was directed to drive to a vendor's facility on his way home to drop off a sample. He was injured in a collision en route. Which exception to the going and coming rule applies?

• ABunkhouse rule
• BSpecial mission/errand exception
• CPersonal comfort doctrine
• DDual capacity exception

Under Labor Code §3600(a)(4), what is the effect of intoxication as a defense?

• AThe employer must show the intoxication caused the injury
• BAny blood-alcohol level above 0.04 conclusively bars the claim
• CIntoxication is irrelevant in workers' comp
• DIntoxication shifts the burden to the employee to prove sobriety

What is the statute of limitations for filing a new claim under Labor Code §5405?

• A6 months from date of injury
• B1 year from date of injury, last benefit, or last medical treatment
• C2 years from date of injury
• D5 years from date of injury

For a cumulative trauma injury, when is the date of injury under Labor Code §5412?

• AThe first day of employment
• BThe first date on which the employee suffered disability and knew or should have known th…
• CThe date the employee leaves employment
• DThe date the doctor first diagnoses an occupational disease

Under Labor Code §3600(a)(10), the post-termination defense bars certain claims filed after employment ends. Which of the following defeats the defense?

• AThe employer had actual or constructive notice of the injury before termination
• BThe employee gave notice of intent to file after termination
• CThe injury is a cumulative trauma
• DThe employee files within 30 days of termination

How is apportionment of permanent disability handled under Labor Code §4663?

• AApportionment is prohibited; the employer pays the entire PD
• BApportionment is based on causation of disability between industrial and non-industrial f…
• CApportionment is only allowed for prior industrial injuries
• DApportionment is determined solely by the applicant's attorney

Under Labor Code §4664, what is the effect of a prior award of permanent disability to the same body region?

• AThe prior PD is irrelevant to a current claim
• BThe prior PD is conclusively presumed to still exist
• CThe prior PD is conclusively presumed to exist and reduces the new award
• DThe employee must reimburse the prior award before receiving new benefits

Under Labor Code §4610, what is the standard time for a non-expedited prospective or concurrent utilization review (UR) decision once all necessary information has been received?

• A24 hours
• B72 hours
• C5 business days
• D30 calendar days

After a UR denial of medical treatment, what is the proper avenue to challenge medical necessity under Labor Code §4610.5?

• AFile a Petition for Reconsideration with the WCAB
• BRequest Independent Medical Review (IMR) within 30 days
• CFile a civil action in Superior Court
• DDemand binding arbitration through the DWC

Under SB 863 and Stevens v. Outspoken Enterprises, an IMR decision under §4610.6 may be appealed to the WCAB on which grounds?

• AAny disagreement with the medical conclusion
• BFraud, conflict of interest, bias, or material mistake of fact not subject to expert opin…
• CDe novo medical necessity review
• DInsufficient evidence supporting the IMR reviewer

A self-insured employer maintains a Medical Provider Network (MPN). Once an injured worker selects a primary treating physician within the MPN, when can the worker obtain a second opinion under the MPN?

• AOnly after 6 months of treatment
• BIf the worker disputes the treating physician's diagnosis or treatment plan
• COnly with WCAB approval
• DNever — MPN selections are binding

What is the Medical Treatment Utilization Schedule (MTUS) under Labor Code §5307.27?

• AA list of approved settlement amounts
• BThe presumptively correct standard for evidence-based medical treatment in California wor…
• CA QME fee schedule
• DA directory of authorized treating physicians

Under Labor Code §4600(d), a worker may predesignate a personal physician if which condition is satisfied?

• AThe worker has worked at least 6 months
• BThe employer offers group health coverage, the worker has a personal physician with prior…
• CThe worker is over the age of 50
• DAny time before injury, without conditions

In a non-MPN claim, how long after the date of injury does the employer generally control the choice of treating physician under Labor Code §4600?

• AFirst 7 days
• BFirst 30 days
• CFirst 90 days
• DOnly the first day

What is the role of the Primary Treating Physician (PTP)?

• AThe PTP only handles billing
• BThe PTP coordinates treatment, files reports on the PR-2, and may determine MMI and PD
• CThe PTP must be selected by the WCAB
• DThe PTP cannot issue work restrictions

When may the WCAB still review a medical-necessity dispute notwithstanding §4610.5 IMR?

• AWhenever the applicant prefers WCAB review
• BWhen the underlying UR decision is procedurally invalid (untimely, etc.) per Dubon II
• CNever — the WCAB has no jurisdiction over medical treatment
• DOnly with the carrier's consent

What is the standard for emergency or urgent medical care under Labor Code §4600?

• AEmergency care is not covered
• BEmergency care must be authorized in advance
• CReasonable emergency care is covered without prior authorization, subject to later UR if…
• DEmergency care is limited to $500

Under Labor Code §4610.5(h), an IMR request must be filed within how many days of service of the UR denial?

• A10 days
• B20 days
• C30 days
• D60 days

Under Labor Code §4650, when is the first temporary disability (TD) payment due?

• AWithin 14 days of the date of injury
• BWithin 14 days of the employer's knowledge of injury and disability
• COn the first day of lost work
• DWithin 30 days of the doctor's first report

Under Labor Code §4656, what is the maximum aggregate duration of temporary disability for most injuries occurring on or after January 1, 2008?

• A52 weeks
• B104 weeks within 5 years from date of injury
• C240 weeks
• DUnlimited until MMI

What is the weekly TD rate?

• A50% of average weekly wage with no cap
• BTwo-thirds of average weekly wages, subject to statutory min/max under §4453
• C100% of average weekly wage
• DDetermined solely by the QME

Under Labor Code §4658, permanent disability is rated using which method?

• APre-SB 899 1997 rating schedule alone
• BAMA Guides 5th Edition as incorporated in the 2005 PDRS
• CAMA Guides 6th Edition
• DACOEM guidelines

A PD rating string in California typically uses which order of adjustments?

• AWPI → occupation → age → DFEC
• BWPI → DFEC adjustment → occupational variant → age adjustment
• CWPI → age → DFEC → occupation
• DOccupation → age → WPI → DFEC

What does Almaraz/Guzman permit?

• AA QME to rate impairment using any chapter of the AMA Guides 5th Edition to most accurate…
• BA QME to use AMA Guides 6th Edition
• CApplicants to bypass the QME process
• DCarriers to deny PD entirely

What does Ogilvie permit?

• ARebuttal of the scheduled DFEC adjustment using vocational evidence
• BRejection of the AMA Guides entirely
• CUnlimited TD
• DDirect civil action against the employer

Under Labor Code §4659, an injured worker with a permanent disability of 70% or greater is entitled to what additional benefit?

• ALifetime medical only
• BA life pension paid for life after PD weeks are exhausted
• CSupplemental TD
• DVocational training only

What is the Supplemental Job Displacement Benefit (SJDB) voucher under Labor Code §4658.7?

• AA $1,000 settlement bonus
• BA non-transferable retraining and skill-enhancement voucher for injuries on/after 1/1/2013
• CA QME fee waiver
• DA guarantee of reemployment

What is the SJDB voucher amount under §4658.7(d)?

• A$2,000
• B$4,000
• C$6,000
• D$10,000

Under Labor Code §4656, what is the maximum aggregate TD for catastrophic conditions like severe burns and HIV?

• A104 weeks
• B240 weeks within 5 years
• CUnlimited
• D52 weeks

Under Labor Code §4658(d), how is PD paid when the worker is not offered regular, modified, or alternative work within 60 days of MMI?

• APD is reduced by 15%
• BPD is increased by 15% (for pre-2013 injuries) — but §4658(d) was repealed for 2013+ inju…
• CNo effect on PD
• DPD is doubled

Death benefits under Labor Code §4702 are payable to whom?

• AOnly the surviving spouse
• BTotal and partial dependents of the deceased employee, with amounts varying by number of…
• COnly minor children
• DAnyone designated by the employee in writing

Under Labor Code §4060, when may a party request a panel QME on a represented case?

• AOnly after trial
• BOnly with WCAB approval
• CWhen the parties cannot agree on an AME on an issue of compensability or medical-legal ev…
• DNever; only AMEs are used

Under §4062.2, after a QME panel is issued in a represented case, how many days does each party have to strike one panel member?

• A5 days
• B10 days from assignment of the panel
• C20 days
• D30 days

What is the principal advantage of using an AME instead of a panel QME?

• AAMEs are free
• BAME opinions are generally given substantial evidentiary weight at the WCAB because both…
• CAMEs cannot be cross-examined
• DAME reports are not subject to deposition

In an unrepresented case, who selects the QME panel specialty under §4062.1?

• AThe employer alone
• BThe injured worker after the panel is issued
• CThe Medical Unit picks the specialty based on the treating physician's report
• DThe PTP unilaterally

How long does a QME generally have to issue the medical-legal report after the evaluation under 8 CCR §38?

• A10 days
• B20 days
• C30 days, extendable to 60 days for good cause
• D60 days, no extensions

When a panel dispute arises (e.g., wrong specialty, untimely panel request), what is the proper forum?

• ASuperior Court
• BThe DWC Medical Unit, with WCAB review available
• CThe Court of Appeal
• DFederal District Court

Under Labor Code §4061, after the PTP issues a P&S report rating PD, what must the claims administrator serve to the unrepresented worker?

• AA Stipulations with Request for Award
• BA notice of options including the right to obtain a panel QME evaluation
• CA C&R
• DA Settlement Statement

Under §4062, an objection to a medical determination of the PTP (other than a PD rating in an unrepresented case) must be made within how many days of receipt?

• A10 days for represented; 20 days for unrepresented
• B30 days for both represented and unrepresented
• C60 days
• DNo deadline

What is the typical purpose of a supplemental QME report?

• ATo address records received after the initial evaluation or to clarify ambiguities
• BTo increase the QME's fee
• CTo replace the QME
• DTo convert a QME into an AME

Under 8 CCR §35, may an attorney provide non-medical advocacy letters to a QME?

• AYes, without restriction
• BOnly with prior written notice and 20 days for the opposing party to object (Maxham analy…
• CNever
• DOnly with WCAB approval