HCC QME Exam: Terms, Dates, and Concepts
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A QME certification is valid for how may
2 years (LC 139.2)
years?
(1) QME competency exam
(2) 12-hour course in report writing
What are 3 requirements a physician (3) Devote at least 1/3rd of total prac-
must complete to become a certified tice time to providing direct medical treat-
QME? ment (or have served as a AME on 8+
occasions in past 12 months prior to ap-
plication)
(1) Licensing board suspends/re-
What are 2 reasons for termination/sus- vokes/terminates license to practice
pension of a QME without a hearing? (2) Failure to pay required fee (upon ap-
pointment and yearly thereafter)
(1) Violation of material statutory or ad-
ministrative duty;
(2) Failure to follow medical procedures
or qualifications;
(3) Failure to comply with the timeframe
standards;
(4) Failure to meet licensing/certification
What are the 6 reasons for discipline requirements;
(suspension/termination) of QME that (5) Preparation of medical-legal evalua-
would require a hearing? tions that fail to meet the minimum stan-
dards 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 qual-
ified medical evaluator.
(1) Injury or disease arising out of em-
ployment
What is the definition of an Injury in WC
(2) Injury caused by treatment of an in-
claims?
jury
(3) Reaction to, or side effect from care
What is the definition of Specific Injury in Injury from of a single incident or expo-
WC claims? sure
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
What is the definition of Cumulative In-
Repetitive trauma over a period of time
jury in WC claims?
What are the 2 requirements for a con-
(1) Cause a disability
dition to be considered an injury in WC
(2) Need for medical treatment
cases?
What is the definition of occupational dis-
Disease/Injury that is caused by work
ease?
(1) Use of alcohol or illegal drugs
(2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured em-
What are the 7 types of excluded injuries
ployee is the initial physical aggressor
in WC Cases?
(5) Committing of a felony
(6) Off-duty recreational activities
(7) Psychiatric injuries claimed after no-
tice of termination
(1) Injury
(2) Employment relationship
What are the 4 basic conditions to estab- (3) Injury caused by the employment
lish a workers' compensation claim? (AOE)
(4) Occurred in the course of the employ-
ment (COE)
(1) Causes a temporary or permanent
increase in disability
What 3 requirements constitutes an ag-
(2) Creates a new need for medical treat-
gravation of a pre-existing, non-industrial
ment
condition in WC cases?
(3) Requires a change in the existing
course of treatment
(1) Compensation rate
(2) Employers who are liable for the
claim.
What 4 items are determined by the
(3) Statute of limitations for particular
DOI?
procedures
(4) Regulations that will apply to the
worker's injury
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
(1) Presence of pathological conditions
and disability
What are 3 factors are needed to estab-
(2) Relevant work exposures
lish a causation determination?
(3) Non-industrial exposures (other
causes of disease)
(1) Direct
(2) Contributing
What are the 5 major types of causation? (3) Acceleration
(4) Precipitation
(5) Aggravation
Work exposures are directly responsible
What is the definition of direct causation?
for the health outcomes
What is the definition of contributing cau-
Several work factors led to the disease
sation?
- Disease/injury is accelerated by of
work.
What is the definition of Acceleration
- (The date of the onset of the disease is
Causation?
much sooner than it would have been in
the absence of the exposure)
- Work exposure causes the the illness.
(For example, an underlying tendency or
What is the definition of precipitation
asymptomatic problem was present, but
causation?
the work exposure causes it to clinically
manifest.)
What is the definition of Aggravation A medical condition may be present al-
Causation? ready, but work exposure makes it worse
The employer cannot avoid liability for an
occupational injury by claiming that the
What is principle of "taking employees as injury would not have happened if the
you find them"? worker had been in a different physical
or emotional condition before the acci-
dent.
(1) Diagnosed mental disorder
What are the 3 criteria for compensation (2) Causes disability or need for medical
of psychiatric injuries in WC claims? treatment
(3) Employee can demonstrate that
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
events of employment were predominant
cause of the injury
Connection between injury and employ-
ment
What is the definition of proximate
cause? *Employment does not need to be the
only cause of injury, just a contributing
cause
(1) Actual events of employment were
the predominant cause > 50% among
all combined causes of the psychiatric
injury (except if the injury is a derivative
of an underlying physical injury)
(2) If the injury resulted from a violent act
(contributed >= 35% causation)
(3) worked for at least 6 months (not con-
What are the 5 requirements needed
tinuously), unless the injury was caused
to constitute a psychiatric injury in WC
by a sudden and extraordinary employ-
claims?
ment condition
(4) Injury was not substantially caused
by "lawful, nondiscriminatory, good faith
personnel actions" - 35% to more.
(e.g., being passed over for promotion or
being transferred to another department)
(5) Claim can not be filed after notifica-
tion of termination or layoff
(1) Injury was the result of sudden and
extraordinary events of employment
(2) Employer had notice of the injury be-
fore the notice of termination or layoff.
What are 5 criteria for compensation of
(3) Psychiatric Medical records existing
psychiatric claims after notice of termi-
before the notice of termination/layoff
nation/layoff?
(4) Sexual or racial harassment.
(5) There is evidence that the DOI is after
the date of notice of termination, but be-
fore the effective date of the termination.
Who determines IW Impairment ratings? A QME/PTP/AME
Study online at https://quizlet.com/_fepaik
A QME certification is valid for how may
2 years (LC 139.2)
years?
(1) QME competency exam
(2) 12-hour course in report writing
What are 3 requirements a physician (3) Devote at least 1/3rd of total prac-
must complete to become a certified tice time to providing direct medical treat-
QME? ment (or have served as a AME on 8+
occasions in past 12 months prior to ap-
plication)
(1) Licensing board suspends/re-
What are 2 reasons for termination/sus- vokes/terminates license to practice
pension of a QME without a hearing? (2) Failure to pay required fee (upon ap-
pointment and yearly thereafter)
(1) Violation of material statutory or ad-
ministrative duty;
(2) Failure to follow medical procedures
or qualifications;
(3) Failure to comply with the timeframe
standards;
(4) Failure to meet licensing/certification
What are the 6 reasons for discipline requirements;
(suspension/termination) of QME that (5) Preparation of medical-legal evalua-
would require a hearing? tions that fail to meet the minimum stan-
dards 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 qual-
ified medical evaluator.
(1) Injury or disease arising out of em-
ployment
What is the definition of an Injury in WC
(2) Injury caused by treatment of an in-
claims?
jury
(3) Reaction to, or side effect from care
What is the definition of Specific Injury in Injury from of a single incident or expo-
WC claims? sure
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
What is the definition of Cumulative In-
Repetitive trauma over a period of time
jury in WC claims?
What are the 2 requirements for a con-
(1) Cause a disability
dition to be considered an injury in WC
(2) Need for medical treatment
cases?
What is the definition of occupational dis-
Disease/Injury that is caused by work
ease?
(1) Use of alcohol or illegal drugs
(2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured em-
What are the 7 types of excluded injuries
ployee is the initial physical aggressor
in WC Cases?
(5) Committing of a felony
(6) Off-duty recreational activities
(7) Psychiatric injuries claimed after no-
tice of termination
(1) Injury
(2) Employment relationship
What are the 4 basic conditions to estab- (3) Injury caused by the employment
lish a workers' compensation claim? (AOE)
(4) Occurred in the course of the employ-
ment (COE)
(1) Causes a temporary or permanent
increase in disability
What 3 requirements constitutes an ag-
(2) Creates a new need for medical treat-
gravation of a pre-existing, non-industrial
ment
condition in WC cases?
(3) Requires a change in the existing
course of treatment
(1) Compensation rate
(2) Employers who are liable for the
claim.
What 4 items are determined by the
(3) Statute of limitations for particular
DOI?
procedures
(4) Regulations that will apply to the
worker's injury
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
(1) Presence of pathological conditions
and disability
What are 3 factors are needed to estab-
(2) Relevant work exposures
lish a causation determination?
(3) Non-industrial exposures (other
causes of disease)
(1) Direct
(2) Contributing
What are the 5 major types of causation? (3) Acceleration
(4) Precipitation
(5) Aggravation
Work exposures are directly responsible
What is the definition of direct causation?
for the health outcomes
What is the definition of contributing cau-
Several work factors led to the disease
sation?
- Disease/injury is accelerated by of
work.
What is the definition of Acceleration
- (The date of the onset of the disease is
Causation?
much sooner than it would have been in
the absence of the exposure)
- Work exposure causes the the illness.
(For example, an underlying tendency or
What is the definition of precipitation
asymptomatic problem was present, but
causation?
the work exposure causes it to clinically
manifest.)
What is the definition of Aggravation A medical condition may be present al-
Causation? ready, but work exposure makes it worse
The employer cannot avoid liability for an
occupational injury by claiming that the
What is principle of "taking employees as injury would not have happened if the
you find them"? worker had been in a different physical
or emotional condition before the acci-
dent.
(1) Diagnosed mental disorder
What are the 3 criteria for compensation (2) Causes disability or need for medical
of psychiatric injuries in WC claims? treatment
(3) Employee can demonstrate that
, HCC QME Exam: Terms, Dates, and Concepts
Study online at https://quizlet.com/_fepaik
events of employment were predominant
cause of the injury
Connection between injury and employ-
ment
What is the definition of proximate
cause? *Employment does not need to be the
only cause of injury, just a contributing
cause
(1) Actual events of employment were
the predominant cause > 50% among
all combined causes of the psychiatric
injury (except if the injury is a derivative
of an underlying physical injury)
(2) If the injury resulted from a violent act
(contributed >= 35% causation)
(3) worked for at least 6 months (not con-
What are the 5 requirements needed
tinuously), unless the injury was caused
to constitute a psychiatric injury in WC
by a sudden and extraordinary employ-
claims?
ment condition
(4) Injury was not substantially caused
by "lawful, nondiscriminatory, good faith
personnel actions" - 35% to more.
(e.g., being passed over for promotion or
being transferred to another department)
(5) Claim can not be filed after notifica-
tion of termination or layoff
(1) Injury was the result of sudden and
extraordinary events of employment
(2) Employer had notice of the injury be-
fore the notice of termination or layoff.
What are 5 criteria for compensation of
(3) Psychiatric Medical records existing
psychiatric claims after notice of termi-
before the notice of termination/layoff
nation/layoff?
(4) Sexual or racial harassment.
(5) There is evidence that the DOI is after
the date of notice of termination, but be-
fore the effective date of the termination.
Who determines IW Impairment ratings? A QME/PTP/AME
