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Holds authority to appoint physicians as QME evaluators - CORRECT ANSWERS️️Administrative Director (AD) (LC 139.2) Term of appointment as QME evaluator - CORRECT ANSWERS️️2 years (LC 139.2) 3 requirements when seeking appointment as QME - CORRECT ANSWERS️️(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 mos prior to application) 2 reasons for termination/suspension of a QME w/o a hearing - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️(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* - CORRECT ANSWERS️️Occurs as the result of a single incident or exposure *Cumulative injury* - CORRECT ANSWERS️️Results from repetitive trauma (mental or physical) over a period of time 2 requirements for a condition to be considered an injury - CORRECT ANSWERS️️(1) Cause disability; or (2) Result in a need for medical treatment Occupational disease - CORRECT ANSWERS️️Disease that in whole or part is caused by work 7 types of excluded injuries - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️(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 - CORRECT ANSWERS️️*Flare-ups* or *recurrence* of a previous industrial injury or illness; not been caused by the current employment Date of injury (DOI)-specific injury - CORRECT ANSWERS️️Date on which the incident or exposure occurred Date of injury (DOI)-cumulative injury - CORRECT ANSWERS️️Date 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 - CORRECT ANSWERS️️(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.