CDMS Medical Aspects of Disability and Case Management 2 — Questions and Answers
Question 1: What is the primary purpose of an independent medical examination (IME) in a disability claim?
- To provide ongoing treatment to the injured worker
- To obtain an objective medical opinion on causation, diagnosis, or functional capacity from a neutral physician (Correct answer)
- To replace the treating physician's medical records
- To determine the worker's eligibility for Social Security Disability Insurance
Correct answer: To obtain an objective medical opinion on causation, diagnosis, or functional capacity from a neutral physician
An IME provides an independent, objective medical evaluation to address specific clinical questions in a disputed or complex disability claim.
Question 2: In disability case management, what does 'medical necessity' mean?
- Any treatment the physician recommends regardless of evidence base
- Treatment that is appropriate, necessary, and consistent with accepted clinical standards for the condition (Correct answer)
- The minimum level of care required to avoid malpractice liability
- Treatment approved by the workers' compensation insurer in advance
Correct answer: Treatment that is appropriate, necessary, and consistent with accepted clinical standards for the condition
Medical necessity means that treatment is clinically appropriate, required for the condition, and consistent with evidence-based standards of care.
Question 3: Which medication class is associated with the highest risk of dependency and diversion in workers' compensation populations?
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Opioid analgesics (Correct answer)
- Muscle relaxants
- Anticonvulsants
Correct answer: Opioid analgesics
Opioid analgesics carry the highest risk of dependency, misuse, and diversion, making their management a critical issue in occupational disability cases.
Question 4: What is the purpose of utilization review (UR) in disability case management?
- To audit the accuracy of workers' compensation indemnity payments
- To evaluate the medical appropriateness and necessity of proposed or ongoing treatment (Correct answer)
- To determine an employee's legal entitlement to FMLA leave
- To assess employer compliance with OSHA safety standards
Correct answer: To evaluate the medical appropriateness and necessity of proposed or ongoing treatment
Utilization review assesses whether proposed medical treatment meets established clinical criteria for appropriateness and necessity.
Question 5: Which occupational health tool stratifies injured workers into low, medium, and high risk for developing chronic disability?
- Functional capacity evaluation (FCE)
- STarT Back Screening Tool or similar psychosocial screening instruments (Correct answer)
- The Oswestry Disability Index
- A job demands analysis
Correct answer: STarT Back Screening Tool or similar psychosocial screening instruments
Psychosocial screening tools like the STarT Back identify workers at elevated risk for chronic disability so early targeted interventions can be applied.
Question 6: What does 'chronic pain' generally mean in disability management contexts?
- Pain lasting longer than 12 weeks beyond normal tissue healing time (Correct answer)
- Any pain that requires opioid medication for management
- Pain rated 7 or higher on the numeric rating scale
- Pain that results from a permanent anatomical abnormality
Correct answer: Pain lasting longer than 12 weeks beyond normal tissue healing time
Chronic pain is generally defined as pain persisting beyond the expected healing period, typically three to six months or 12 weeks.
CDMS Medical Aspects of Disability and Case Management 2
What is the primary purpose of an independent medical examination (IME) in a disability claim?