Q.M.E - ANSWER Qualified Medical Evaluator
A.M.E - ANSWER Agreed Medical Evaluator
Who appoints a physician to become a QME? - ANSWER The Administrative Director.
What is the term length for a QME? - ANSWER 2 years.
Per the DWC, the term "physician" includes what types of practitioners? - ANSWER
California licensed: MDs, DOs, psychologists, acupuncturists, optometrists, dentists,
podiatrists, and chiropractors.
Even though the DWC considers psychologists, acupuncturists, optometrists, dentists,
podiatrists, and chiropractors "physicians," can these practitioners advertise, represent, or
hold themselves out as physicians? - ANSWER No
Per the Labor Code, is a QME allowed to advertise that they are a QME in a legal journal? -
ANSWER Yes. There are restrictions regarding the contents but simply saying that "Dr. XYZ
is available to perform QME evaluations," is legal.
Who can become a QME? - ANSWER Only physicians as defined by the Labor Code can be
a QME (M.D., D.O., Psychologist, Acupuncturist, Dentist, Podiatrist, Chiropractor, or
Optometrist).
What are the 4 requirements to become a QME? - ANSWER - Pass the QME competency
examination.
1
,- Complete a 12-hour writing course.
- Submit a form regarding Disclosure of Specified Financial Interests.
- Devote at least one-third of total practice time to providing direct medical treatment.
True or false: QME's must disclose all financial interests, which are defined as having 5%
interest or more in any medical operation that provides treatment or medical evaluation,
goods or services for use in the California Worker's Compensation system. - ANSWER
True
What are two alternative requirements to become a QME if a physician does not have a
sufficient amount of direct medical treatment time/clinic? - ANSWER - The physician
must have served as an AME (Agreed Medical Evaluator) on eight or more occasions in the
12 months prior to the end of their 2-year term.
- The physician must demonstrate that they are disabled, retired, or teaching.
A minimum of ⅓ of a QME's time must involve direct medical treatment; what are two
exceptions? - ANSWER - The QME served as an AME 8 or more times in the past year.
- The QME is disabled, retired, or is a teaching physician.
Name the 3 distinct ways a physician can list a specialty. - ANSWER - Board certification in
that specialty.
- Completed postgraduate specialty training (certificate of completion).
- Grandfathered in: held an appointment as a QME in that specialty on June 30, 2000.
Besides meeting the original 3 requirements to become a QME, after 2-years, what are the 4
additional requirements for QME reappointment? - ANSWER - Compliance with all
applicable regulations and evaluation guidelines.
- Completion of at least 12 hours of continuing education.
- No more than 5 rejected reports by a Workers' Compensation Judge.
- No termination, suspension, or probation by any licensing board.
2
,What are the 2 ways a QME can be terminated or suspended? - ANSWER - The QME's
license to practice has been suspended or revoked or terminated by their licensing board.
- The QME failed to pay the required fee for reappointment.
How many locations can a QME list for QME work? - ANSWER 10
Can a QME provide medical treatment to an injured worker? - ANSWER No
During an evaluation, can the QME solicit the injured worker to become their patient in the
QME's private practice? - ANSWER No
In what two circumstances can a QME provide medical treatment to an injured worker? -
ANSWER - The injured worker requests it. (For instance, a QME sees an injured worker.
The injured worker then freely chooses the QME as their primary treating provider (PTP).
The QME must then excuse themself from future QME evaluations with that injured worker).
- Under emergency situations.
Define: M.T.U.S. - ANSWER Medical Treatment Utilization Schedule
What is the Medical Treatment Utilization Schedule (MTUS)? - ANSWER The treatments
adopted by the DWC's Administrative Director.
If a QME must render emergency treatment, then does it need to follow the Medical
Treatment Utilization Schedule (MTUS) or American College of Occupational and
Environmental Medicine (ACOEM) guidelines? - ANSWER No. The QME can administer
any necessary emergency treatment.
A QME generates a medical-legal report. In general, for what is this reported used? -
ANSWER To prove or disprove an aspect of a contested claim. Disputes can be about
3
, compensability, permanent or temporary disability, apportionment, permanent and
stationary status, etc.
Who relies upon a QME's medical-legal report? - ANSWER Insurance companies,
insurance adjusters, attorneys, worker's compensation judges, other QMEs, other AMEs, and
clinicians treating the injured worker.
What is a QME's primary responsibility? - ANSWER To resolve disputes without bias
towards either party (the defense attorney/ instance company or the applicant's attorney/
injured worker).
Is a QME considered an expert or expert witness? - ANSWER Yes. The QME's opinions in
the medical-legal report are used as "expert testimony" during depositions, employment
lawsuits, third party lawsuits, disability determinations, and treatment determinations.
Medical-legal testimony by a QME can occur in which settings? - ANSWER The QME will
serve as an expert witness and provide medical-legal testimony at a deposition or a WCAB
hearing (Workers' Compensation Appeals Board).
What statement must a QME include in the report in order for the medical legal report to be
used as evidence during a dispute (Labor Code section 5703)? - ANSWER Somewhere in
the report, the QME must state, "There has not been a violation of Section 139.3 and that
the contents of this report are true and correct to the best of my knowledge. This statement
is made under penalty of perjury."
Can a QME request or accept any compensation from any source for medical legal expenses
(such as for rebates, refunds, dividends, discounts, kickbacks, etc. in money or otherwise) if
such compensation is in addition to the fees authorized by Labor Code section 5307? -
ANSWER No. Labor Code section 5307 bars the QME from receiving compensation from a
party or any source that is in addition to payment for the report.
Can a QME legally refer an injured worker for clinical laboratory, diagnostic nuclear
medicine, radiation oncology, physical therapy, physical rehabilitation, psychometric testing,
4
A.M.E - ANSWER Agreed Medical Evaluator
Who appoints a physician to become a QME? - ANSWER The Administrative Director.
What is the term length for a QME? - ANSWER 2 years.
Per the DWC, the term "physician" includes what types of practitioners? - ANSWER
California licensed: MDs, DOs, psychologists, acupuncturists, optometrists, dentists,
podiatrists, and chiropractors.
Even though the DWC considers psychologists, acupuncturists, optometrists, dentists,
podiatrists, and chiropractors "physicians," can these practitioners advertise, represent, or
hold themselves out as physicians? - ANSWER No
Per the Labor Code, is a QME allowed to advertise that they are a QME in a legal journal? -
ANSWER Yes. There are restrictions regarding the contents but simply saying that "Dr. XYZ
is available to perform QME evaluations," is legal.
Who can become a QME? - ANSWER Only physicians as defined by the Labor Code can be
a QME (M.D., D.O., Psychologist, Acupuncturist, Dentist, Podiatrist, Chiropractor, or
Optometrist).
What are the 4 requirements to become a QME? - ANSWER - Pass the QME competency
examination.
1
,- Complete a 12-hour writing course.
- Submit a form regarding Disclosure of Specified Financial Interests.
- Devote at least one-third of total practice time to providing direct medical treatment.
True or false: QME's must disclose all financial interests, which are defined as having 5%
interest or more in any medical operation that provides treatment or medical evaluation,
goods or services for use in the California Worker's Compensation system. - ANSWER
True
What are two alternative requirements to become a QME if a physician does not have a
sufficient amount of direct medical treatment time/clinic? - ANSWER - The physician
must have served as an AME (Agreed Medical Evaluator) on eight or more occasions in the
12 months prior to the end of their 2-year term.
- The physician must demonstrate that they are disabled, retired, or teaching.
A minimum of ⅓ of a QME's time must involve direct medical treatment; what are two
exceptions? - ANSWER - The QME served as an AME 8 or more times in the past year.
- The QME is disabled, retired, or is a teaching physician.
Name the 3 distinct ways a physician can list a specialty. - ANSWER - Board certification in
that specialty.
- Completed postgraduate specialty training (certificate of completion).
- Grandfathered in: held an appointment as a QME in that specialty on June 30, 2000.
Besides meeting the original 3 requirements to become a QME, after 2-years, what are the 4
additional requirements for QME reappointment? - ANSWER - Compliance with all
applicable regulations and evaluation guidelines.
- Completion of at least 12 hours of continuing education.
- No more than 5 rejected reports by a Workers' Compensation Judge.
- No termination, suspension, or probation by any licensing board.
2
,What are the 2 ways a QME can be terminated or suspended? - ANSWER - The QME's
license to practice has been suspended or revoked or terminated by their licensing board.
- The QME failed to pay the required fee for reappointment.
How many locations can a QME list for QME work? - ANSWER 10
Can a QME provide medical treatment to an injured worker? - ANSWER No
During an evaluation, can the QME solicit the injured worker to become their patient in the
QME's private practice? - ANSWER No
In what two circumstances can a QME provide medical treatment to an injured worker? -
ANSWER - The injured worker requests it. (For instance, a QME sees an injured worker.
The injured worker then freely chooses the QME as their primary treating provider (PTP).
The QME must then excuse themself from future QME evaluations with that injured worker).
- Under emergency situations.
Define: M.T.U.S. - ANSWER Medical Treatment Utilization Schedule
What is the Medical Treatment Utilization Schedule (MTUS)? - ANSWER The treatments
adopted by the DWC's Administrative Director.
If a QME must render emergency treatment, then does it need to follow the Medical
Treatment Utilization Schedule (MTUS) or American College of Occupational and
Environmental Medicine (ACOEM) guidelines? - ANSWER No. The QME can administer
any necessary emergency treatment.
A QME generates a medical-legal report. In general, for what is this reported used? -
ANSWER To prove or disprove an aspect of a contested claim. Disputes can be about
3
, compensability, permanent or temporary disability, apportionment, permanent and
stationary status, etc.
Who relies upon a QME's medical-legal report? - ANSWER Insurance companies,
insurance adjusters, attorneys, worker's compensation judges, other QMEs, other AMEs, and
clinicians treating the injured worker.
What is a QME's primary responsibility? - ANSWER To resolve disputes without bias
towards either party (the defense attorney/ instance company or the applicant's attorney/
injured worker).
Is a QME considered an expert or expert witness? - ANSWER Yes. The QME's opinions in
the medical-legal report are used as "expert testimony" during depositions, employment
lawsuits, third party lawsuits, disability determinations, and treatment determinations.
Medical-legal testimony by a QME can occur in which settings? - ANSWER The QME will
serve as an expert witness and provide medical-legal testimony at a deposition or a WCAB
hearing (Workers' Compensation Appeals Board).
What statement must a QME include in the report in order for the medical legal report to be
used as evidence during a dispute (Labor Code section 5703)? - ANSWER Somewhere in
the report, the QME must state, "There has not been a violation of Section 139.3 and that
the contents of this report are true and correct to the best of my knowledge. This statement
is made under penalty of perjury."
Can a QME request or accept any compensation from any source for medical legal expenses
(such as for rebates, refunds, dividends, discounts, kickbacks, etc. in money or otherwise) if
such compensation is in addition to the fees authorized by Labor Code section 5307? -
ANSWER No. Labor Code section 5307 bars the QME from receiving compensation from a
party or any source that is in addition to payment for the report.
Can a QME legally refer an injured worker for clinical laboratory, diagnostic nuclear
medicine, radiation oncology, physical therapy, physical rehabilitation, psychometric testing,
4
