Holds authority to appoint
Occupational disease 2
physicians as QME evaluators
3 Precipitation 4 Specific injury
Don't know?
Terms in this set (100)
, (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)
2 requirements for a (1) Cause disability; or
condition to be considered (2) Result in a need for medical treatment
an injury
3 factors to establish in (1) Presence of pathological conditions and disability
making a causation (2) Relevant work exposures
determination (3) Non-industrial exposures (other causes of disease)
(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) 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) 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) Direct
(2) Contributing
5 major types of causation (3) Acceleration
(4) Precipitation
(5) Aggravation
, (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) 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
Disease process is accelerated by virtue of work
exposure. The date of the onset of the disease is much
Acceleration
sooner than it would have been in the absence of the
exposure.
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