QME EXAM COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+
/. 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)
/.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.
/.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 (detereoration 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
/.*Specific injury* - Answer-✅Occurs as the result of a single incident or exposure
/.*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
/.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;
(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
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+
/. 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)
/.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.
/.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 (detereoration 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
/.*Specific injury* - Answer-✅Occurs as the result of a single incident or exposure
/.*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
/.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;
(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
