QME exam with correct answers 2024

QME exam with correct answers 2024

Holds authority to appoint physicians as QME evaluators - ANSWER: ➡ Administrative
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Director (AD) (LC 139.2)
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Term of appointment as QME evaluator - ANSWER: ➡ 2 years (LC 139.2)
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3 requirements when seeking appointment as QME - ANSWER: ➡ (1) Pass the QME
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competency exam;
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(2) Complete a 12-hour course in disability eval 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 mos prior to application)
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2 reasons for termination/suspension of a QME w/o a hearing - ANSWER: ➡ (1) Licensing
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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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6 reasons for discipline (suspension/termination) of QMEs after a hearing - ANSWER: ➡ (1)
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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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3 types of substantive medical disputes resolved by QMEs - ANSWER: ➡ (1) Compensability
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of the claim;
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,(2) Permanent disability;
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(3) "Catch-all" (temporary disability, work restrictions, new and further disabilities after
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permanent disability (detereoration of original injury), compensability of new body part
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added to claim)
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Definition of *injury* in compensability claims - ANSWER: ➡ (1) An injury or disease arising
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out of employment;
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(2) A *derivative* injury caused by treatment of an injury arising out of employment;
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(3) Any reaction to or side effect from preventative health care the employer provides to
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health care workers
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*Specific injury* - ANSWER: ➡ Occurs as the result of a single incident or exposure
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*Cumulative injury* - ANSWER: ➡ Results from repetitive trauma (mental or physical) over
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a period of time
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2 requirements for a condition to be considered an injury - ANSWER: ➡ (1) Cause disability;
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or
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(2) Result in a need for medical treatment
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Occupational disease - ANSWER: ➡ Disease that in whole or part is caused by work
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7 types of excluded injuries - ANSWER: ➡ (1) Caused by employee's use of alcohol or illegal
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controlled substances;
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(2) Intentionally self-inflicted injuries;
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(3) Suicide;
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(4) Resulting from altercations, in which the injured employee is the *initial physical
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aggressor*;
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(5) Resulting from the employee's commission of a felony, for which the employee has been
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convicted (including "wobbly felonies," which are crimes that may be prosecuted as
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misdemeanors or felonies)
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, (6) Resulting from off-duty recreational activities, in which participation in the activities
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does not constitute part of the employee's work-related duties and the activity is not an
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expressed or implicit condition of employment;
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(7) Psychiatric injuries claimed after notice of termination/layoff unless certain conditions
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exist
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4 basic conditions to establish a workers' compensation claim - ANSWER: ➡ (1) *Injury*
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(physiological or psychological harm);
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(2) Employment relationship;
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(3) Injury caused by the employment (This is also referred to as arising out of employment
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[AOE].);
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(4) Occurred in the course of the employment (COE)
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Aggravation of a pre-existing, non-industrial condition - ANSWER: ➡ (1) Causes a
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temporary or permanent increase in disability;
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(2) Creates a new need for medical treatment; or
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(3) Requires a change in the existing course of treatment
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Symptoms that don't constitute a new injury - ANSWER: ➡ *Flare-ups* or *recurrence* of a
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previous industrial injury or illness; not been caused by the current employment
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Date of injury (DOI)-specific injury - ANSWER: ➡ Date on which the incident or exposure
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occurred
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Date of injury (DOI)-cumulative injury - ANSWER: ➡ Date when the employee first suffered
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disability from the exposure, and either knew, or should have known, that the disability was
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caused by present or previous employment
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Items determined by the DOI - ANSWER: ➡ (1) Statute of limitations for particular
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procedures within the workers' compensation system;
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(2) Regulations that will apply to the worker's injury;
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