QME EXAM WITH CORRECT QUESTIONS &
ANSWERS WITH THE LATEST UPDATE 2025
GRADE A+
6 reasons for discipline (suspension/termination) of QMEs after a hearing - -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.
Types of reports - -answer--Comprehensive (first)
Follow-up
Supplemental
Factual correction - -answer--Type of supplemental report confined to review of the medical
records in possession of the QME at the time of the evaluation
May be requested in cases involving determination of *permanent disability* for
*unrepresented* workers
Time limits for unavailability of QMEs - -answer--14-90 days
,Holds authority to appoint physicians as QME evaluators - -answer--Administrative Director (AD)
(LC 139.2)
Term of appointment as QME evaluator - -answer--2 years (LC 139.2)
3 requirements when seeking appointment as QME - -answer--(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 - -answer--(1) Licensing board
suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
3 types of substantive medical disputes resolved by QMEs - -answer--(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))
Definition of *injury* in compensability claims - -answer--(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
,What is a specific injury - -answer--Occurs as the result of a single incident or exposure
What is a cumulative injury - -answer--Results from repetitive trauma (mental or physical) over a
period of time
2 requirements for a condition to be considered an injury - -answer--(1) Cause disability
OR
(2) Result in a need for medical treatment
What is an occupational disease - -answer--Disease that in whole or part is caused by work
7 types of excluded injuries - -answer--(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 - -answer--(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 - -answer--(1) Causes a temporary or
permanent increase in disability
OR
(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 - -answer--Flare-ups or recurrence of a previous
industrial injury or illness; not been caused by the current employment
Date of injury (DOI)-specific injury - -answer--Date on which the incident or exposure occurred
Date of injury (DOI)-cumulative injury - -answer--Date 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 - -answer--(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
ANSWERS WITH THE LATEST UPDATE 2025
GRADE A+
6 reasons for discipline (suspension/termination) of QMEs after a hearing - -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.
Types of reports - -answer--Comprehensive (first)
Follow-up
Supplemental
Factual correction - -answer--Type of supplemental report confined to review of the medical
records in possession of the QME at the time of the evaluation
May be requested in cases involving determination of *permanent disability* for
*unrepresented* workers
Time limits for unavailability of QMEs - -answer--14-90 days
,Holds authority to appoint physicians as QME evaluators - -answer--Administrative Director (AD)
(LC 139.2)
Term of appointment as QME evaluator - -answer--2 years (LC 139.2)
3 requirements when seeking appointment as QME - -answer--(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 - -answer--(1) Licensing board
suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
3 types of substantive medical disputes resolved by QMEs - -answer--(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))
Definition of *injury* in compensability claims - -answer--(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
,What is a specific injury - -answer--Occurs as the result of a single incident or exposure
What is a cumulative injury - -answer--Results from repetitive trauma (mental or physical) over a
period of time
2 requirements for a condition to be considered an injury - -answer--(1) Cause disability
OR
(2) Result in a need for medical treatment
What is an occupational disease - -answer--Disease that in whole or part is caused by work
7 types of excluded injuries - -answer--(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 - -answer--(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 - -answer--(1) Causes a temporary or
permanent increase in disability
OR
(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 - -answer--Flare-ups or recurrence of a previous
industrial injury or illness; not been caused by the current employment
Date of injury (DOI)-specific injury - -answer--Date on which the incident or exposure occurred
Date of injury (DOI)-cumulative injury - -answer--Date 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 - -answer--(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
