QME EXAM WITH VERIFIED ANSWERS
1. Holds authority to ap-
point physicians as
QME evaluators
2. Term of appointment as
QME evaluator
3. 3 requirements when
seeking appointment
as QME
4. 2 reasons for termi-
nation/suspension of a
QME w/o a hearing
5. 6 reasons for disci-
pline (suspensi...
1. Holds authority to ap- Administrative Director (AD) (LC 139.2)
point physicians as
QME evaluators
2. Term of appointment as 2 years (LC 139.2)
QME evaluator
3. 3 requirements when (1) Pass the QME competency exam;
seeking appointment (2) Complete a 12-hour course in disability eval
as QME 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)
4. 2 reasons for termi- (1) Licensing board suspends/revokes/terminates
nation/suspension of a license to practice
QME w/o a hearing (2) Failure to pay required fee (upon appointment
and yearly thereafter)
5. 6 reasons for disci- (1) Violation of material statutory or administrative
pline (suspension/ter- duty;
mination) of QMEs after (2) Failure to follow medical procedures or qualifi-
a hearing cations;
(3) Failure to comply with the timeframe stan-
dards;
(4) Failure to meet licensing/certification require-
ments;
(5) Preparation of medical-legal evaluations that
fail to meet the minimum standards for those re-
ports 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.
6. 3 types of substan- (1) Compensability of the claim;
tive medical disputes (2) Permanent disability;
resolved by QMEs (3) "Catch-all" (temporary disability, work restric-
, QME EXAM WITH VERIFIED ANSWERS
tions, new and further disabilities after permanent
disability (detereoration of original injury), com-
pensability of new body part added to claim)
7. Definition of *injury* in (1) An injury or disease arising out of employment;
compensability claims (2) A *derivative* injury caused by treatment of an
injury arising out of employment;
(3) Any reaction to or side effect from preventative
health care the employer provides to health care
workers
8. *Specific injury* Occurs as the result of a single incident or expo-
sure
9. *Cumulative injury* Results from repetitive trauma (mental or physical)
over a period of time
10. 2 requirements for a (1) Cause disability; or
condition to be consid- (2) Result in a need for medical treatment
ered an injury
11. Occupational disease Disease that in whole or part is caused by work
12. 7 types of excluded in- (1) Caused by employee's use of alcohol or illegal
juries 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 con-
stitute 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 ter-
mination/layoff unless certain conditions exist
, QME EXAM WITH VERIFIED ANSWERS
13. 4 basic conditions to (1) *Injury* (physiological or psychological harm);
establish a workers' (2) Employment relationship;
compensation claim (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)
14. Aggravation of a (1) Causes a temporary or permanent increase in
pre-existing, non-in- disability;
dustrial condition (2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of
treatment
15. Symptoms that don't *Flare-ups* or *recurrence* of a previous industrial
constitute a new injury injury or illness; not been caused by the current
employment
16. Date of injury Date on which the incident or exposure occurred
(DOI)-specific injury
17. Date of injury (DOI)-cu- Date when the employee first suffered disability
mulative injury from the exposure, and either knew, or should have
known, that the disability was caused by present
or previous employment
18. Items determined by (1) Statute of limitations for particular procedures
the DOI within the workers' compensation system;
(2) Regulations that will apply to the worker's in-
jury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
19. Reasonable medical Standard by which QME uses combination of ex-
probability isting medical and scientific knowledge and the
occupational and medical history of the individual
worker to conclude whether the work exposure
contributed to the injury
20.20.
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