QME EXAM QUESTIONS WITH 100%
SOLVED ANSWERS
Time frame in which an injured worker is required to select a physician from the QME
panel, make an appointment for the exam and inform the claims administrator of the
selection and appointment - Answer- Within 10 days after the panel is issued
Rights of the claim administrator in selecting the QME and arranging the appointment -
Answer- If injured worker does not inform the claims administrator of the selection or
date of appointment
Time frame in represented cases during which each party may strike one name from the
QME panel - Answer- 10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the injured
worker - Answer- Within 60 days of a request for an appointment (up to 90 days)
Time frame to submit the QME Appointment Notification Form - Answer- Within 5
business days of making the appointment
Parties receiving service of the QME Appointment Notification Form - Answer-
Employee (+ representative)
Employer/claims administrator (+ representative)
Trigger to send medical records and other information to the QME - Answer- Receipt of
the QME Appointment Notification Form
Causes for issuance of a replacement panel - Answer- (1) Failure to serve the QME
Appointment Notification Form;
(2) Disclosure of COI by an evaluator after an appointment has been made;
(3) Necessity for subsequent examination by a QME in a different specialty (due to
limitations in scope of practice or clinical competency)
(4) QME doesn't practice in the requested specialty
(5) QME cannot schedule an appointment within 60 days of the initial request of the
appointment
(6) Injured worker changes address since initial request for a panel but before initial
appointment
(7) Two or more members of a QME panel are from the same group practice
(8) QME is unavailabile
(9) QME who previously reported on the case is unavailable
, (10) QME is currently, or has been, the treating physician of the worker for the injury
currently under dispute
(11) Claims administrator/employer agrees that a new panel be issued based upon the
geographic area of the worker's employment
(12) Untimely filing of report by QME
(13) QME doesn't cancel an appointment in a timely manner
(14) QME panel was issued more than 24 months prior to the request for the
replacement panel and none of the QMEs have examined the worker
(15) Qualifed and competent QME refuses to provide an evaluation or written statement
explaining why he/she is not qualified or competent to address one or more issues in
dispute in the case
(16) Administrative Director orders an additional QME evaluation
Responsibility for arranging for and paying an interpreter for the QME exam - Answer-
Employer
Information which may be provided to the QME by any party - Answer- (1) All records
prepared/maintained by treating physician(s)
(2) Other medical records, relevant to the determination of the medical issue in dispute
(3) Letter outlining medical determination of the primary treating physician or the
compensability issue requested to address in the evaluation
(4) If concerning a dispute over a UR decision, a copy of the treating physician's report
and the claim administrator's decision to approve, delay, deny or modify the disputed
treatment
(5) Non-medical records relevant to determination of medical issue(s) in dispute
Time frame for service of info on an opposing party that a party proposes to provide to
the selected QME - Answer- 20 days before the info is provided to the evaluator
Time frame to object to sending of non-medical records to the selected QME - Answer-
Within 10 days
Info which should never be sent to the selected QME - Answer- (1) Any medical/legal
report rejected by a party as untimely
(2) Evaluation/consulting report written by a physician other than the treatment
physician that addresses permanent impairment, permanent disability, or apportionment
(unless ruled admissible by a WCALJ)
(3) Any medical report/record or other info stricken or found inadequate/inadmissable by
a WCALJ
Ex-parte contact - Answer- Any communication--written or oral--by one party (or their
representative) with the evaluator *outside of the presence of the opposing party*
Conflict of Interest (COI) - Answer- An evaluator may not request or accept any
compensation or other thing of value from any source that does or could create a
conflict with his or her duties as an evaluator
SOLVED ANSWERS
Time frame in which an injured worker is required to select a physician from the QME
panel, make an appointment for the exam and inform the claims administrator of the
selection and appointment - Answer- Within 10 days after the panel is issued
Rights of the claim administrator in selecting the QME and arranging the appointment -
Answer- If injured worker does not inform the claims administrator of the selection or
date of appointment
Time frame in represented cases during which each party may strike one name from the
QME panel - Answer- 10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the injured
worker - Answer- Within 60 days of a request for an appointment (up to 90 days)
Time frame to submit the QME Appointment Notification Form - Answer- Within 5
business days of making the appointment
Parties receiving service of the QME Appointment Notification Form - Answer-
Employee (+ representative)
Employer/claims administrator (+ representative)
Trigger to send medical records and other information to the QME - Answer- Receipt of
the QME Appointment Notification Form
Causes for issuance of a replacement panel - Answer- (1) Failure to serve the QME
Appointment Notification Form;
(2) Disclosure of COI by an evaluator after an appointment has been made;
(3) Necessity for subsequent examination by a QME in a different specialty (due to
limitations in scope of practice or clinical competency)
(4) QME doesn't practice in the requested specialty
(5) QME cannot schedule an appointment within 60 days of the initial request of the
appointment
(6) Injured worker changes address since initial request for a panel but before initial
appointment
(7) Two or more members of a QME panel are from the same group practice
(8) QME is unavailabile
(9) QME who previously reported on the case is unavailable
, (10) QME is currently, or has been, the treating physician of the worker for the injury
currently under dispute
(11) Claims administrator/employer agrees that a new panel be issued based upon the
geographic area of the worker's employment
(12) Untimely filing of report by QME
(13) QME doesn't cancel an appointment in a timely manner
(14) QME panel was issued more than 24 months prior to the request for the
replacement panel and none of the QMEs have examined the worker
(15) Qualifed and competent QME refuses to provide an evaluation or written statement
explaining why he/she is not qualified or competent to address one or more issues in
dispute in the case
(16) Administrative Director orders an additional QME evaluation
Responsibility for arranging for and paying an interpreter for the QME exam - Answer-
Employer
Information which may be provided to the QME by any party - Answer- (1) All records
prepared/maintained by treating physician(s)
(2) Other medical records, relevant to the determination of the medical issue in dispute
(3) Letter outlining medical determination of the primary treating physician or the
compensability issue requested to address in the evaluation
(4) If concerning a dispute over a UR decision, a copy of the treating physician's report
and the claim administrator's decision to approve, delay, deny or modify the disputed
treatment
(5) Non-medical records relevant to determination of medical issue(s) in dispute
Time frame for service of info on an opposing party that a party proposes to provide to
the selected QME - Answer- 20 days before the info is provided to the evaluator
Time frame to object to sending of non-medical records to the selected QME - Answer-
Within 10 days
Info which should never be sent to the selected QME - Answer- (1) Any medical/legal
report rejected by a party as untimely
(2) Evaluation/consulting report written by a physician other than the treatment
physician that addresses permanent impairment, permanent disability, or apportionment
(unless ruled admissible by a WCALJ)
(3) Any medical report/record or other info stricken or found inadequate/inadmissable by
a WCALJ
Ex-parte contact - Answer- Any communication--written or oral--by one party (or their
representative) with the evaluator *outside of the presence of the opposing party*
Conflict of Interest (COI) - Answer- An evaluator may not request or accept any
compensation or other thing of value from any source that does or could create a
conflict with his or her duties as an evaluator
