QME Latest exam
*Cumulative injury* - ANSWER-Results from repetitive trauma (mental or physical) over a period of
time
*Specific injury* - ANSWER-Occurs as the result of a single incident or exposure
2 reasons for termination/suspension of a QME w/o a hearing - ANSWER-(1) Licensing board
suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
2 requirements for a condition to be considered an injury - ANSWER-(1) Cause disability; or
(2) Result in a need for medical treatment
3 factors to establish in making a causation determination - ANSWER-(1) Presence of pathological
conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
3 requirements when seeking appointment as QME - ANSWER-(1) Pass the QME competency exam;
(2) Complete a 12-hour course in disability eval report writing;
(3) Devote at least 1/3rd of total practice time to providing direct medical treatment (or have served
as a AME on 8+ occasions in past 12 mos prior to application)
3 types of substantive medical disputes resolved by QMEs - ANSWER-(1) Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and further disabilities after permanent
disability (detereoration of original injury), compensability of new body part added to claim)
4 basic conditions to establish a workers' compensation claim - ANSWER-(1) *Injury* (physiological
or psychological harm);
(2) Employment relationship;
(3) Injury caused by the employment (This is also referred to as arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
5 major types of causation - ANSWER-(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
6 reasons for discipline (suspension/termination) of QMEs after a hearing - ANSWER-(1) Violation of
material statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
, QME Latest exam
(3) Failure to comply with the timeframe standards;
(4) Failure to meet licensing/certification requirements;
(5) Preparation of medical-legal evaluations that fail to meet the minimum standards for those
reports as 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.
7 types of excluded injuries - ANSWER-(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 (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
Acceleration - ANSWER-Disease process is accelerated by virtue of work exposure. The date of the
onset of the disease is much sooner than it would have been in the absence of the exposure.
Admissible reports before a WCJ to resolve the issue of compensability - ANSWER-(1) Properly
acquired QME
(2) Primary treating physician
Aggravation - ANSWER-A medical condition may be present already, but work exposure makes it
worse
Aggravation of a pre-existing, non-industrial condition - ANSWER-(1) Causes a temporary or
permanent increase in disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
Apportionment - ANSWER-Estimate of approximate percentage of permanent disability caused by a
work-related injury (& approximate percentage caused by other factors)
Only applies to permanent disability
Cause for termination of temporary disability - ANSWER-Finding of permanent and stationary (P&S)
OR maximum medical improvement (MMI) by the primary treating physician
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