QME Test with Correct Answers
Disciplinary action against APQME or QME is done by __ - ✅✅ Administrative Director
Non AME must reschedule a cancelled appointment within __ days of the original
scheduled appointment and within __ days of the initial request, unless parties agree in
writing to accept a date past that - ✅✅ 30 days, 60 days
AME must reschedule a cancelled appointment within __ days of the original scheduled
appointment, but can be extended to __ days if both parties agree - ✅✅ 60, 90 (30
more days)
Letter outlining issues for the evaluator to address and all records for the evaluator must
be served to the opposing party no less than __ days in advance of the evaluation -
✅✅ 20 days
Employees have __ days to dispute for a certain record to be included in the evaluation,
which is notified by the __. The objected records/info is not sent to an evaluator, unless
ordered by __ - ✅✅ 10 days, claims administrator, WCALJ (W/C Admin Law Judge)
Unrepresented employee can scheduled QME less than 20 days of initial request, but
the information that will be sent to the evaluator must be given to the employee at least
20 days before: true/false - ✅✅ true
If QME is deposed, the appointment must be within __ days of the notice and held near
original exam (or within __ miles) - ✅✅ 120 days, 20 miles
Form __ is used to serve the QME reports to the applicant attorney and the claims
administrator, while form __ is used for unrepresented workers. - ✅✅ Form 122 (120 =
release psych report to non-IW; 121 = protect psych report from IW); Form 111 for
unrepresented workers
QME Form 111 and 120? - ✅✅ 111 = "QME Findings Summary Form", 120 =
Voluntary Directive for Alternative Service (for patient to designate someone to read the
report)
If IW refuses/fails to designate a physician on Form 120, sensitive psych QME report
will be sent to __ or __ - ✅✅ AA for represented, PTP for unrepresented
QME Form 112, which is for __, must be filed at least __ days BEFORE the 30 day due
date, can be extended for max of __ days. Good cause can extend for __ days. - ✅✅
extension request; 5 days before; max 30 more days; 15 more days for good cause
QME Form 113 = - ✅✅ denial of request for QME report EXTENSION
, QME reports must be saved for at least __ - ✅✅ 5 years
More than 1 QME office cost additional __ annual fee, which must be a street address
with space usual for a medical practice - ✅✅ $100
QME SFI Form 124, which is __, is required with each annual fee - ✅✅ "Specified
Financial Interest" form
QME fee is due within __ days of receipt for notice and if not paid within __, need to
take the QME exam again - ✅✅ 30 days, 2 years
QME certificate should arrive within __ days of eligibility and must be displayed at all
times - ✅✅ 45 days
QME scheduling "Appointment Notification Form" to all parties sent out in __ days -
✅✅ 5
QME reports is due (served) __ days after face to face? (even if need additional
records) - ✅✅ 30
Supplement report (no face to face) is due __ days after the request - ✅✅ 60
If pain even slightly affects ADLs, can give ratings of __% - ✅✅ 1-3% add on
What is QME Form 120? - ✅✅ Voluntary by patient to not release mental health info
directly to patient, but another to discuss with patient
What is QME Form 121? - ✅✅ Protect from patient
AOE vs COE? - ✅✅ AaOE = arose from activities of employment, COrE = course of
regular site of employment
HIV patients need __ file - ✅✅ fictitious name file
QME has to retain reports for __ years - ✅✅ 5
Minimum face to face time for neuromuscular __, psych __, and all else __ minutes -
✅✅ 20 for NM, 60 for psych, 30 for all else
Apportionment can only be based on __ - ✅✅ permanent disability
Difference between: light duty and modified duty, both of which are "reasonable
accommodations" - ✅✅ light duty = totally different job; modified duty = same job
modified
Total disability benefits for most workers last __ weeks for DOI from 1/1/2005 - ✅✅ 104
Disciplinary action against APQME or QME is done by __ - ✅✅ Administrative Director
Non AME must reschedule a cancelled appointment within __ days of the original
scheduled appointment and within __ days of the initial request, unless parties agree in
writing to accept a date past that - ✅✅ 30 days, 60 days
AME must reschedule a cancelled appointment within __ days of the original scheduled
appointment, but can be extended to __ days if both parties agree - ✅✅ 60, 90 (30
more days)
Letter outlining issues for the evaluator to address and all records for the evaluator must
be served to the opposing party no less than __ days in advance of the evaluation -
✅✅ 20 days
Employees have __ days to dispute for a certain record to be included in the evaluation,
which is notified by the __. The objected records/info is not sent to an evaluator, unless
ordered by __ - ✅✅ 10 days, claims administrator, WCALJ (W/C Admin Law Judge)
Unrepresented employee can scheduled QME less than 20 days of initial request, but
the information that will be sent to the evaluator must be given to the employee at least
20 days before: true/false - ✅✅ true
If QME is deposed, the appointment must be within __ days of the notice and held near
original exam (or within __ miles) - ✅✅ 120 days, 20 miles
Form __ is used to serve the QME reports to the applicant attorney and the claims
administrator, while form __ is used for unrepresented workers. - ✅✅ Form 122 (120 =
release psych report to non-IW; 121 = protect psych report from IW); Form 111 for
unrepresented workers
QME Form 111 and 120? - ✅✅ 111 = "QME Findings Summary Form", 120 =
Voluntary Directive for Alternative Service (for patient to designate someone to read the
report)
If IW refuses/fails to designate a physician on Form 120, sensitive psych QME report
will be sent to __ or __ - ✅✅ AA for represented, PTP for unrepresented
QME Form 112, which is for __, must be filed at least __ days BEFORE the 30 day due
date, can be extended for max of __ days. Good cause can extend for __ days. - ✅✅
extension request; 5 days before; max 30 more days; 15 more days for good cause
QME Form 113 = - ✅✅ denial of request for QME report EXTENSION
, QME reports must be saved for at least __ - ✅✅ 5 years
More than 1 QME office cost additional __ annual fee, which must be a street address
with space usual for a medical practice - ✅✅ $100
QME SFI Form 124, which is __, is required with each annual fee - ✅✅ "Specified
Financial Interest" form
QME fee is due within __ days of receipt for notice and if not paid within __, need to
take the QME exam again - ✅✅ 30 days, 2 years
QME certificate should arrive within __ days of eligibility and must be displayed at all
times - ✅✅ 45 days
QME scheduling "Appointment Notification Form" to all parties sent out in __ days -
✅✅ 5
QME reports is due (served) __ days after face to face? (even if need additional
records) - ✅✅ 30
Supplement report (no face to face) is due __ days after the request - ✅✅ 60
If pain even slightly affects ADLs, can give ratings of __% - ✅✅ 1-3% add on
What is QME Form 120? - ✅✅ Voluntary by patient to not release mental health info
directly to patient, but another to discuss with patient
What is QME Form 121? - ✅✅ Protect from patient
AOE vs COE? - ✅✅ AaOE = arose from activities of employment, COrE = course of
regular site of employment
HIV patients need __ file - ✅✅ fictitious name file
QME has to retain reports for __ years - ✅✅ 5
Minimum face to face time for neuromuscular __, psych __, and all else __ minutes -
✅✅ 20 for NM, 60 for psych, 30 for all else
Apportionment can only be based on __ - ✅✅ permanent disability
Difference between: light duty and modified duty, both of which are "reasonable
accommodations" - ✅✅ light duty = totally different job; modified duty = same job
modified
Total disability benefits for most workers last __ weeks for DOI from 1/1/2005 - ✅✅ 104
