QME EXAM NEWEST ACTUAL EXAM COMPLETE 350
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
reasons for termination/suspension of a QME w/o a hearing - ANSWER//(1) Licensing
board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
6 reasons for discipline (suspension/termination) of QMEs after a hearing -
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.
3 types of substantive medical disputes resolved by QMEs - ANSWER//(1)
Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and further disabilities after
permanent disability (detereoration of original injury), compensability of new body part
added to claim)
Definition of *injury* in compensability claims - ANSWER//(1) An injury or disease
arising out of employment;
(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
*Specific injury* - ANSWER//Occurs as the result of a single incident or exposure
,*Cumulative injury* - ANSWER//Results from repetitive trauma (mental or physical) over
a period of time
2 requirements for a condition to be considered an injury - ANSWER//(1) Cause
disability; or
(2) Result in a need for medical treatment
Occupational disease - ANSWER//Disease that in whole or part is caused by work
7 types of excluded injuries - ANSWER//(1) Caused by employee's use of alcohol or
illegal 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 constitute 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 termination/layoff unless certain conditions
exist
4 basic conditions to establish a workers' compensation claim - ANSWER//(1) *Injury*
(physiological or psychological harm);
(2) Employment relationship;
(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)
Aggravation of a pre-existing, non-industrial condition - ANSWER//(1) Causes a
temporary or permanent increase in disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
Symptoms that don't constitute a new injury - ANSWER//*Flare-ups* or *recurrence* of
a previous industrial injury or illness; not been caused by the current employment
Date of injury (DOI)-specific injury - ANSWER//Date on which the incident or exposure
occurred
Date of injury (DOI)-cumulative injury - ANSWER//Date when the employee first
suffered disability from the exposure, and either knew, or should have known, that the
disability was caused by present or previous employment
, Items determined by the DOI - ANSWER//(1) Statute of limitations for particular
procedures within the workers' compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
Reasonable medical probability - ANSWER//Standard by which QME uses combination
of existing medical and scientific knowledge and the occupational and medical history of
the individual worker to conclude whether the work exposure contributed to the injury
Evidentiary standard of causation/contribution in compensability disputes -
ANSWER//Preponderance of the evidence (51%; more likely than not)
3 factors to establish in making a causation determination - ANSWER//(1) Presence of
pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - ANSWER//(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
Direct causation - ANSWER//Work exposures are directly responsible for the health
outcomes
Contributing causation - ANSWER//Several factors led to the disease; work exposure is
one of these factors
Acceleration - ANSWER//Disease process is accelerated by virtue of work exposure.
The date of the onset of the disease is much sooner than it would have been in the
absence of the exposure.
Precipitation - ANSWER//Work exposure *precipitates* the manifestation of the illness.
For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest.
Aggravation - ANSWER//A medical condition may be present already, but work
exposure makes it worse
Principle of "taking employees as you find them" - ANSWER//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.
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
reasons for termination/suspension of a QME w/o a hearing - ANSWER//(1) Licensing
board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
6 reasons for discipline (suspension/termination) of QMEs after a hearing -
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.
3 types of substantive medical disputes resolved by QMEs - ANSWER//(1)
Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and further disabilities after
permanent disability (detereoration of original injury), compensability of new body part
added to claim)
Definition of *injury* in compensability claims - ANSWER//(1) An injury or disease
arising out of employment;
(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
*Specific injury* - ANSWER//Occurs as the result of a single incident or exposure
,*Cumulative injury* - ANSWER//Results from repetitive trauma (mental or physical) over
a period of time
2 requirements for a condition to be considered an injury - ANSWER//(1) Cause
disability; or
(2) Result in a need for medical treatment
Occupational disease - ANSWER//Disease that in whole or part is caused by work
7 types of excluded injuries - ANSWER//(1) Caused by employee's use of alcohol or
illegal 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 constitute 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 termination/layoff unless certain conditions
exist
4 basic conditions to establish a workers' compensation claim - ANSWER//(1) *Injury*
(physiological or psychological harm);
(2) Employment relationship;
(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)
Aggravation of a pre-existing, non-industrial condition - ANSWER//(1) Causes a
temporary or permanent increase in disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
Symptoms that don't constitute a new injury - ANSWER//*Flare-ups* or *recurrence* of
a previous industrial injury or illness; not been caused by the current employment
Date of injury (DOI)-specific injury - ANSWER//Date on which the incident or exposure
occurred
Date of injury (DOI)-cumulative injury - ANSWER//Date when the employee first
suffered disability from the exposure, and either knew, or should have known, that the
disability was caused by present or previous employment
, Items determined by the DOI - ANSWER//(1) Statute of limitations for particular
procedures within the workers' compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
Reasonable medical probability - ANSWER//Standard by which QME uses combination
of existing medical and scientific knowledge and the occupational and medical history of
the individual worker to conclude whether the work exposure contributed to the injury
Evidentiary standard of causation/contribution in compensability disputes -
ANSWER//Preponderance of the evidence (51%; more likely than not)
3 factors to establish in making a causation determination - ANSWER//(1) Presence of
pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - ANSWER//(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
Direct causation - ANSWER//Work exposures are directly responsible for the health
outcomes
Contributing causation - ANSWER//Several factors led to the disease; work exposure is
one of these factors
Acceleration - ANSWER//Disease process is accelerated by virtue of work exposure.
The date of the onset of the disease is much sooner than it would have been in the
absence of the exposure.
Precipitation - ANSWER//Work exposure *precipitates* the manifestation of the illness.
For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest.
Aggravation - ANSWER//A medical condition may be present already, but work
exposure makes it worse
Principle of "taking employees as you find them" - ANSWER//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.
