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HCC QME Exam 2024 with correct answers
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HCC QME Exam 2024 with correct answers
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HCC QME Exam 2024 with correctanswers
A QME certification is valid for how may years? - ANSWER: ➡ 2 years (LC 139.2)
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What are 3 requirements a physician must complete to become a certified QME? - ANSWER:
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➡ (1) QME competency exam
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(2) 12-hour course in report writing
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(3) Devote at least 1/3rd of total practice time to providing direct medical treatment (or
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have served as a AME on 8+ occasions in past 12 months prior to application)
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What are 2 reasons for termination/suspension of a QME without a hearing? - ANSWER: ➡
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(1) Licensing board suspends/revokes/terminates license to practice
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(2) Failure to pay required fee (upon appointment and yearly thereafter)
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What are the 6 reasons for discipline (suspension/termination) of QME that would require a
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hearing? - ANSWER: ➡ (1) Violation of material statutory or administrative duty;
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(2) Failure to follow medical procedures or qualifications;
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(3) Failure to comply with the timeframe standards;
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(4) Failure to meet licensing/certification requirements;
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(5) Preparation of medical-legal evaluations that fail to meet the minimum standards for
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those reports as established by the administrative director or the appeals board;
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(6) Making material misrepresentations or false statements in an application for
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appointment or reappointment as a qualified medical evaluator.
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What is the definition of an Injury in WC claims? - ANSWER: ➡ (1) Injury or disease arising
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out of employment
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(2) Injury caused by treatment of an injury
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,(3) Reaction to, or side effect from care
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What is the definition of Specific Injury in WC claims? - ANSWER: ➡ Injury from of a single
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incident or exposure
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What is the definition of Cumulative Injury in WC claims? - ANSWER: ➡ Repetitive trauma
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over a period of time
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What are the 2 requirements for a condition to be considered an injury in WC cases? -
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ANSWER: ➡ (1) Cause a disability
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(2) Need for medical treatment
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What is the definition of occupational disease? - ANSWER: ➡ Disease/Injury that is caused
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by work
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What are the 7 types of excluded injuries in WC Cases? - ANSWER: ➡ (1) Use of alcohol or
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illegal drugs
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(2) Self inflicted injuries
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(3) Suicide
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(4) Altercations, in which the injured employee is the initial physical aggressor
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(5) Committing of a felony
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(6) Off-duty recreational activities
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(7) Psychiatric injuries claimed after notice of termination
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What are the 4 basic conditions to establish a workers' compensation claim? - ANSWER: ➡
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(1) Injury
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(2) Employment relationship
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(3) Injury caused by the employment (AOE)
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(4) Occurred in the course of the employment (COE)
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,What 3 requirements constitutes an aggravation of a pre-existing, non-industrial condition
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in WC cases? - ANSWER: ➡ (1) Causes a temporary or permanent increase in disability
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(2) Creates a new need for medical treatment
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(3) Requires a change in the existing course of treatment
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What 4 items are determined by the DOI? - ANSWER: ➡ (1) Compensation rate
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(2) Employers who are liable for the claim.
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(3) Statute of limitations for particular procedures
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(4) Regulations that will apply to the worker's injury
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What are 3 factors are needed to establish a causation determination? - ANSWER: ➡ (1)
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Presence of pathological conditions and disability
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(2) Relevant work exposures
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(3) Non-industrial exposures (other causes of disease)
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What are the 5 major types of causation? - ANSWER: ➡ (1) Direct
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(2) Contributing
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(3) Acceleration
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(4) Precipitation
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(5) Aggravation
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What is the definition of direct causation? - ANSWER: ➡ Work exposures are directly
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responsible for the health outcomes
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What is the definition of contributing causation? - ANSWER: ➡ Several work factors led to
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the disease
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, What is the definition of Acceleration Causation? - ANSWER: ➡ - Disease/injury is
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accelerated by of work.
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- (The date of the onset of the disease is much sooner than it would have been in the absence
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of the exposure)
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What is the definition of precipitation causation? - ANSWER: ➡ - Work exposure causes the
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the illness.
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(For example, an underlying tendency or asymptomatic problem was present, but the work
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exposure causes it to clinically manifest.)
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What is the definition of Aggravation Causation? - ANSWER: ➡ A medical condition may be
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present already, but work exposure makes it worse
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What is principle of "taking employees as you find them"? - ANSWER: ➡ The employer
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cannot avoid liability for an occupational injury by claiming that the injury would not have
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happened if the worker had been in a different physical
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or emotional condition before the accident.
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What are the 3 criteria for compensation of psychiatric injuries in WC claims? - ANSWER: ➡
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(1) Diagnosed mental disorder
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(2) Causes disability or need for medical treatment
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(3) Employee can demonstrate that events of employment were predominant cause of the
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injury
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What is the definition of proximate cause? - ANSWER: ➡ Connection between injury and
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employment
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*Employment does not need to be the only cause of injury, just a contributing cause
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What are the 5 requirements needed to constitute a psychiatric injury in WC claims? -
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ANSWER: ➡ (1) Actual events of employment were the predominant cause > 50% among
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