HCC QME Exam 2025/2026 | Key
Terms, Dates & Core Concepts |
100% Verified Study Guide
☑️
A QME certification is valid for how may years? - Correct Answer 2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME? - Correct
☑️
Answer (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? - Correct
☑️
Answer (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? - Correct 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.
, ☑️
What is the definition of an Injury in WC claims? - Correct Answer (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? - Correct Answer ☑️Injury from of a
single incident or exposure
☑️
What is the definition of Cumulative Injury in WC claims? - Correct Answer Repetitive
trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC cases? - Correct
☑️
Answer (1) Cause a disability
(2) Need for medical treatment
☑️
What is the definition of occupational disease? - Correct Answer Disease/Injury that is
caused by work
What are the 7 types of excluded injuries in WC Cases? - Correct Answer ☑️(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? - Correct
☑️
Answer (1) Injury
Terms, Dates & Core Concepts |
100% Verified Study Guide
☑️
A QME certification is valid for how may years? - Correct Answer 2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME? - Correct
☑️
Answer (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? - Correct
☑️
Answer (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? - Correct 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.
, ☑️
What is the definition of an Injury in WC claims? - Correct Answer (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? - Correct Answer ☑️Injury from of a
single incident or exposure
☑️
What is the definition of Cumulative Injury in WC claims? - Correct Answer Repetitive
trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC cases? - Correct
☑️
Answer (1) Cause a disability
(2) Need for medical treatment
☑️
What is the definition of occupational disease? - Correct Answer Disease/Injury that is
caused by work
What are the 7 types of excluded injuries in WC Cases? - Correct Answer ☑️(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? - Correct
☑️
Answer (1) Injury
