HCC QME Exam 2026/2027 | Key Terms, Dates &
Core Concepts | 100% Verified Study Guide
A QME certification is valid for how may years?
2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME?
(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?
(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?
(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?
(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?
Injury from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims?
Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC
cases?
(1) Cause a disability
(2) Need for medical treatment
What is the definition of occupational disease?
Disease/Injury that is caused by work
,What are the 7 types of excluded injuries in WC Cases?
(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?
(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?
(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?
, (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?
(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?
(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation?
Work exposures are directly responsible for the health outcomes
What is the definition of contributing causation?
Several work factors led to the disease
Core Concepts | 100% Verified Study Guide
A QME certification is valid for how may years?
2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME?
(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?
(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?
(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?
(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?
Injury from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims?
Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC
cases?
(1) Cause a disability
(2) Need for medical treatment
What is the definition of occupational disease?
Disease/Injury that is caused by work
,What are the 7 types of excluded injuries in WC Cases?
(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?
(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?
(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?
, (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?
(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?
(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation?
Work exposures are directly responsible for the health outcomes
What is the definition of contributing causation?
Several work factors led to the disease
