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HCC QME Exam: Terms, Dates, and Concepts
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HCC QME Exam: Terms, Dates, and Concepts HCC QME Exam: Terms, Dates, and Concepts HCC QME Exam: Terms, Dates, and Concepts
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HCC QME Exam: Terms, Dates, andConcepts
A QME certification is valid for how may years? - ANS 2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME? - ANS (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? - ANS (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? -
ANS (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? - ANS (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? - ANS Injury from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims? - ANS Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC cases? - ANS (1) Cause a
disability
(2) Need for medical treatment
What is the definition of occupational disease? - ANS Disease/Injury that is caused by work
What are the 7 types of excluded injuries in WC Cases? - ANS (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? - ANS (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?
- ANS (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? - ANS (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? - ANS (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? - ANS (1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation? - ANS Work exposures are directly responsible for the health
outcomes
What is the definition of contributing causation? - ANS Several work factors led to the disease
What is the definition of Acceleration Causation? - ANS - 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? - ANS - Work exposure causes the the illness.
(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? - ANS A medical condition may be present already, but
work exposure makes it worse
What is principle of "taking employees as you find them"? - ANS 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? - ANS (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? - ANS 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? - ANS (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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