Holds authority to appoint Administrative Director (AD) (LC 139.2)
physicians as QME
evaluators
Term of appointment as 2 years (LC 139.2)
QME evaluator
(1) Pass the QME competency exam;
(2) Complete a 12-hour course in disability eval report
3 requirements when
writing;
seeking appointment as
(3) Devote at least 1/3rd of total practice time to
QME
providing direct medical treatment (or have served as a
AME on 8+ occasions in past 12 mos prior to application)
(1) Licensing board suspends/revokes/terminates license
2 reasons for
to practice
termination/suspension of a
(2) Failure to pay required fee (upon appointment and
QME w/o a hearing
yearly thereafter)
(1) Violation of material statutory or administrative duty;
(2) Failure to follow medical procedures or
qualifications;
(3) Failure to comply with the timeframe standards;
(4) Failure to meet licensing/certification requirements;
6 reasons for discipline
(5) Preparation of medical-legal evaluations that fail to
(suspension/termination) of
meet the minimum standards for those reports as
QMEs after a hearing
established by the administrative director or the appeals
board;
(6) Making material misrepresentations or false
statements in an application for appointment or
reappointment as a qualified medical evaluator.
, (1) Compensability of the claim;
(2) Permanent disability;
3 types of substantive
(3) "Catch-all" (temporary disability, work restrictions,
medical disputes resolved
new and further disabilities after permanent disability
by QMEs
(detereoration of original injury), compensability of new
body part added to claim)
(1) An injury or disease arising out of employment;
(2) A derivative injury caused by treatment of an injury
Definition of injury in arising out of employment;
compensability claims (3) Any reaction to or side effect from preventative
health care the employer provides to health care
workers
Specific injury Occurs as the result of a single incident or exposure
Results from repetitive trauma (mental or physical) over a
Cumulative injury
period of time
2 requirements for a (1) Cause disability; or
condition to be considered (2) Result in a need for medical treatment
an injury
Occupational disease Disease that in whole or part is caused by work
, (1) Caused by employee's use of alcohol or illegal
controlled substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured
employee is the initial physical aggressor;
(5) Resulting from the employee's commission of a
felony, for which the employee has been convicted
7 types of excluded injuries (including "wobbly felonies," which are crimes that may
be prosecuted as misdemeanors or felonies)
(6) Resulting from off-duty recreational activities, in
which participation in the activities does not constitute
part of the employee's work-related duties and the
activity is not an expressed or implicit condition of
employment;
(7) Psychiatric injuries claimed after notice of
termination/layoff unless certain conditions exist
(1) Injury (physiological or psychological harm);
4 basic conditions to (2) Employment relationship;
establish a workers' (3) Injury caused by the employment (This is also
compensation claim referred to as arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
(1) Causes a temporary or permanent increase in
Aggravation of a pre-
disability;
existing, non-industrial
(2) Creates a new need for medical treatment; or
condition
(3) Requires a change in the existing course of treatment
Symptoms that don't Flare-ups or recurrence of a previous industrial injury or
constitute a new injury illness; not been caused by the current employment
Date of injury (DOI)-specific Date on which the incident or exposure occurred
injury
Date when the employee first suffered disability from the
Date of injury (DOI)- exposure, and either knew, or should have known, that
cumulative injury the disability was caused by present or previous
employment
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