QME Exam Already RATED A+
Questions and Answers About Qualified Medical Evaluators (QME) and Workers' Compensation Claims
Q1: Who has the authority to appoint physicians as Qualified Medical Evaluators?
A1: The Administrative Director (AD) is responsible for appointing physicians as QMEs, a...
QME Exam Already RATED A+
Questions and Answers About Qualified Medical Evaluators (QME) and Workers' Compensation Claims
Q1: Who has the authority to appoint physicians as Qualified Medical Evaluators?
A1: The Administrative Director (AD) is responsible for appointing physicians as QMEs, as specified in
Labor Code 139.2.
---
Q2: What is the duration of a QME evaluator's appointment?
A2: A QME evaluator's appointment lasts for a period of 2 years, according to Labor Code 139.2.
---
Q3: What are the prerequisites for an individual seeking appointment as a QME?
A3: To be eligible for QME appointment, candidates must:
1. Pass the QME competency examination.
2. Complete a 12-hour course focused on writing disability evaluation reports.
3. Spend at least one-third of their total practice time providing direct medical treatment or serve as an
AME on eight or more occasions within the 12 months preceding the application.
---
Q4: Under what circumstances can a QME be terminated or suspended without a hearing?
A4: A QME may face termination or suspension without a hearing for the following reasons:
1. The licensing board has suspended, revoked, or terminated their license to practice.
2. The QME fails to pay the required fees, both upon appointment and annually thereafter.
---
,Q5: What are some grounds for disciplining a QME following a hearing?
A5: After a hearing, a QME may be disciplined (suspended or terminated) for several reasons, including:
1. Violation of significant statutory or administrative duties.
2. Failure to adhere to medical procedures or qualifications.
3. Non-compliance with established timeframe standards.
4. Inability to meet licensing or certification requirements.
5. Creating inadequate medical-legal evaluations that do not meet minimum standards set by the
administrative director or appeals board.
6. Making substantial misrepresentations or false statements in the application for appointment or
reappointment.
---
Q6: What substantive medical disputes are typically resolved by QMEs?
A6: QMEs commonly address the following types of substantive medical disputes:
1. The compensability of a claim.
2. Assessment of permanent disability.
3. A broad category covering issues like temporary disability, work restrictions, further disabilities arising
from an original injury, or the addition of new body parts to a claim.
---
Q7: How is an injury defined in the context of compensability claims?
A7: An injury, for compensability purposes, can be defined as:
1. An injury or disease arising out of employment.
2. A derivative injury resulting from treatment for an injury related to employment.
3. Any reactions to or side effects from preventative healthcare provided by the employer to healthcare
workers.
, ---
Q8: What distinguishes a specific injury from a cumulative injury?
A8: A specific injury occurs due to a singular incident or exposure, while a cumulative injury develops
from repetitive trauma, whether mental or physical, over an extended period.
---
Q9: What are the criteria for a condition to qualify as an injury?
A9: To be considered an injury, the condition must:
1. Cause some form of disability.
2. Result in a requirement for medical treatment.
---
Q10: What is classified as an occupational disease?
A10: An occupational disease is any disease that is, in whole or in part, caused by work-related activities.
---
Q11: Name some types of injuries that are excluded from workers' compensation coverage.
A11: Injuries that may be excluded include:
1. Those caused by the employee's use of alcohol or illegal drugs.
2. Intentionally self-inflicted injuries.
3. Suicidal actions.
4. Injuries stemming from altercations in which the employee was the initial aggressor.
5. Injuries resulting from the employee's commission of a felony, for which they have been convicted.
6. Off-duty recreational activities that do not relate to the employee's work duties.
7. Psychiatric injuries claimed after notice of termination or layoff, unless specific conditions apply.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller bestscores1. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.73. You're not tied to anything after your purchase.
