QME Study Guide Questions with 100%
Verified Answers
Time limit for unrepresented injured worker to submit request for a QME panel
after receiving form from employer - ✅✅ 10 days
Time frame after which unrepresented worker has the right to obtain an evaluation
from any QME within a reasonable geographic area - ✅✅ After 20 days, if
request for QME panel is not issued
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 - ✅✅ Within 10 days after the
panel is issued
Rights of the claim administrator in selecting the QME and arranging the
appointment - ✅✅ 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 - ✅✅ 10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the
injured worker - ✅✅ Within 60 days of a request for an appointment (up to 90
days)
Time frame to submit the QME Appointment Notification Form - ✅✅ Within 5
business days of making the appointment
Parties receiving service of the QME Appointment Notification Form - ✅✅
Employee (+ representative) AND Employer/claims administrator (+
representative)
Trigger to send medical records and other information to the QME - ✅✅ Receipt
of the QME Appointment Notification Form
, Causes for issuance of a replacement panel - ✅✅ (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)
What is a supplemental report? - ✅✅ Review of medical records by QME.
Who holds authority to appoint physicians as QME evaluators? - ✅✅
Administrative Director (AD)
What is the term of appointment as QME evaluator? - ✅✅ 2 years
What are the 3 requirements when seeking appointment as QME? - ✅✅ (1) Pass
the QME competency exam; (2) Complete a 12-hour course in disability eval
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 the 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 QMEs after 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 are the 3 types of substantive medical disputes resolved by QMEs? - ✅✅
(1) Compensability of the claim; (2) Permanent disability; (3) 'Catch-all'
(temporary disability, work restrictions, new and further disabilities after
permanent disability (deterioration of original injury), compensability of new body
part added to claim)
Verified Answers
Time limit for unrepresented injured worker to submit request for a QME panel
after receiving form from employer - ✅✅ 10 days
Time frame after which unrepresented worker has the right to obtain an evaluation
from any QME within a reasonable geographic area - ✅✅ After 20 days, if
request for QME panel is not issued
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 - ✅✅ Within 10 days after the
panel is issued
Rights of the claim administrator in selecting the QME and arranging the
appointment - ✅✅ 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 - ✅✅ 10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the
injured worker - ✅✅ Within 60 days of a request for an appointment (up to 90
days)
Time frame to submit the QME Appointment Notification Form - ✅✅ Within 5
business days of making the appointment
Parties receiving service of the QME Appointment Notification Form - ✅✅
Employee (+ representative) AND Employer/claims administrator (+
representative)
Trigger to send medical records and other information to the QME - ✅✅ Receipt
of the QME Appointment Notification Form
, Causes for issuance of a replacement panel - ✅✅ (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)
What is a supplemental report? - ✅✅ Review of medical records by QME.
Who holds authority to appoint physicians as QME evaluators? - ✅✅
Administrative Director (AD)
What is the term of appointment as QME evaluator? - ✅✅ 2 years
What are the 3 requirements when seeking appointment as QME? - ✅✅ (1) Pass
the QME competency exam; (2) Complete a 12-hour course in disability eval
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 the 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 QMEs after 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 are the 3 types of substantive medical disputes resolved by QMEs? - ✅✅
(1) Compensability of the claim; (2) Permanent disability; (3) 'Catch-all'
(temporary disability, work restrictions, new and further disabilities after
permanent disability (deterioration of original injury), compensability of new body
part added to claim)
