HCC QME Exam Questions with 100%
Correct Answers | Verified | Updated
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
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
(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
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