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HCC QME Exam: Terms, Dates, and Concepts Latest test
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HCC QME Exam: Terms, Dates, andConcepts
A QME certification is valid for how may years? - correct answer 2 years (LC
139.2)
What are 3 requirements a physician must complete to become a certified QME?
- correct answer (1) QME competency exam
(2) 12-hour course in 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 months prior to
application)
What are 2 reasons for termination/suspension of a QME without a hearing? -
correct answer (1) Licensing board suspends/revokes/terminates license to
practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
What are the 6 reasons for discipline (suspension/termination) of QME that
would require a hearing? - correct answer (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;
(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.
What is the definition of an Injury in WC claims? - correct answer (1) Injury or
disease arising out of employment
(2) Injury caused by treatment of an injury
(3) Reaction to, or side effect from care
,HCC QME Exam: Terms, Dates, and
Concepts
What is the definition of Specific Injury in WC claims? - correct answer Injury
from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims? - correct answer
Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC
cases? - correct answer (1) Cause a disability
(2) Need for medical treatment
What is the definition of occupational disease? - correct answer Disease/Injury
that is caused by work
What are the 7 types of excluded injuries in WC Cases? - correct answer (1) Use
of alcohol or illegal drugs
(2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured employee is the initial physical aggressor
(5) Committing of a felony
(6) Off-duty recreational activities
(7) Psychiatric injuries claimed after notice of termination
What are the 4 basic conditions to establish a workers' compensation claim? -
correct answer (1) Injury
(2) Employment relationship
(3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
What 3 requirements constitutes an aggravation of a pre-existing, non-industrial
condition in WC cases? - correct answer (1) Causes a temporary or permanent
increase in disability
(2) Creates a new need for medical treatment
,HCC QME Exam: Terms, Dates, and
Concepts
(3) Requires a change in the existing course of treatment
What 4 items are determined by the DOI? - correct answer (1) Compensation
rate
(2) Employers who are liable for the claim.
(3) Statute of limitations for particular procedures
(4) Regulations that will apply to the worker's injury
What are 3 factors are needed to establish a causation determination? - correct
answer (1) Presence of pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
What are the 5 major types of causation? - correct answer (1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation? - correct answer Work exposures are
directly responsible for the health outcomes
What is the definition of contributing causation? - correct answer Several work
factors led to the disease
What is the definition of Acceleration Causation? - correct answer -
Disease/injury is accelerated by of work.
- (The date of the onset of the disease is much sooner than it would have been in
the absence of the exposure)
What is the definition of precipitation causation? - correct answer - Work
exposure causes the the illness.
, HCC QME Exam: Terms, Dates, and
Concepts
(For example, an underlying tendency or asymptomatic problem was present, but
the work exposure causes it to clinically manifest.)
What is the definition of Aggravation Causation? - correct answer A medical
condition may be present already, but work exposure makes it worse
What is principle of "taking employees as you find them"? - correct answer The
employer cannot avoid liability for an occupational injury by claiming that the
injury would not have happened if the worker had been in a different physical
or emotional condition before the accident.
What are the 3 criteria for compensation of psychiatric injuries in WC claims? -
correct answer (1) Diagnosed mental disorder
(2) Causes disability or need for medical treatment
(3) Employee can demonstrate that events of employment were predominant
cause of the injury
What is the definition of proximate cause? - correct answer Connection between
injury and employment
*Employment does not need to be the only cause of injury, just a contributing
cause
What are the 5 requirements needed to constitute a psychiatric injury in WC
claims? - correct answer (1) Actual events of employment were the predominant
cause > 50% among all combined causes of the psychiatric injury (except if the
injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act (contributed >= 35% causation)
(3) worked for at least 6 months (not continuously), unless the injury was caused
by a sudden and extraordinary employment condition
(4) Injury was not substantially caused by "lawful, nondiscriminatory, good faith
personnel actions" - 35% to more.
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