HCC QME Exam – Terms, Dates, and Concepts | 2025/2026
Updated Study Guide & Exam Prep | 100% Pass Guarantee
A QME certification is valid for how may years? - correct answer2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME? -
correct answer(1) QME competency exam
(2) 12-hour course in 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 months prior to application)
What are 2 reasons for termination/suspension of a QME without a hearing? - correct
answer(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
What are the 6 reasons for discipline (suspension/termination) of QME that would
require a hearing? - correct 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.
What is the definition of an Injury in WC claims? - correct answer(1) Injury or disease
arising out of employment
(2) Injury caused by treatment of an injury
(3) Reaction to, or side effect from care
What is the definition of Specific Injury in WC claims? - correct answerInjury from of a
single incident or exposure
What is the definition of Cumulative Injury in WC claims? - correct answerRepetitive
trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC cases? -
correct answer(1) Cause a disability
(2) Need for medical treatment
What is the definition of occupational disease? - correct answerDisease/Injury that is
caused by work
,What are the 7 types of excluded injuries in WC Cases? - correct answer(1) Use of
alcohol or illegal drugs
(2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured employee is the initial physical aggressor
(5) Committing of a felony
(6) Off-duty recreational activities
(7) Psychiatric injuries claimed after notice of termination
What are the 4 basic conditions to establish a workers' compensation claim? - correct
answer(1) Injury
(2) Employment relationship
(3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
What 3 requirements constitutes an aggravation of a pre-existing, non-industrial
condition in WC cases? - correct answer(1) Causes a temporary or permanent increase
in disability
(2) Creates a new need for medical treatment
(3) Requires a change in the existing course of treatment
What 4 items are determined by the DOI? - correct answer(1) Compensation rate
(2) Employers who are liable for the claim.
(3) Statute of limitations for particular procedures
(4) Regulations that will apply to the worker's injury
What are 3 factors are needed to establish a causation determination? - correct
answer(1) Presence of pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
What are the 5 major types of causation? - correct answer(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation? - correct answerWork exposures are directly
responsible for the health outcomes
What is the definition of contributing causation? - correct answerSeveral work factors
led to the disease
What is the definition of Acceleration Causation? - correct answer- Disease/injury is
accelerated by of work.
, - (The date of the onset of the disease is much sooner than it would have been in the
absence of the exposure)
What is the definition of precipitation causation? - correct answer- Work exposure
causes the the illness.
(For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest.)
What is the definition of Aggravation Causation? - correct answerA medical condition
may be present already, but work exposure makes it worse
What is principle of "taking employees as you find them"? - correct answerThe employer
cannot avoid liability for an occupational injury by claiming that the injury would not have
happened if the worker had been in a different physical
or emotional condition before the accident.
What are the 3 criteria for compensation of psychiatric injuries in WC claims? - correct
answer(1) Diagnosed mental disorder
(2) Causes disability or need for medical treatment
(3) Employee can demonstrate that events of employment were predominant cause of
the injury
What is the definition of proximate cause? - correct answerConnection between injury
and employment
*Employment does not need to be the only cause of injury, just a contributing cause
What are the 5 requirements needed to constitute a psychiatric injury in WC claims? -
correct answer(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 continuously), unless the injury was caused by a
sudden and extraordinary employment 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 notification of termination or layoff
What are 5 criteria for compensation of psychiatric claims after notice of
termination/layoff? - correct answer(1) Injury was the result of sudden and extraordinary
events of employment
(2) Employer had notice of the injury before the notice of termination or layoff.
(3) Psychiatric Medical records existing before the notice of termination/layoff
(4) Sexual or racial harassment.
Updated Study Guide & Exam Prep | 100% Pass Guarantee
A QME certification is valid for how may years? - correct answer2 years (LC 139.2)
What are 3 requirements a physician must complete to become a certified QME? -
correct answer(1) QME competency exam
(2) 12-hour course in 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 months prior to application)
What are 2 reasons for termination/suspension of a QME without a hearing? - correct
answer(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
What are the 6 reasons for discipline (suspension/termination) of QME that would
require a hearing? - correct 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.
What is the definition of an Injury in WC claims? - correct answer(1) Injury or disease
arising out of employment
(2) Injury caused by treatment of an injury
(3) Reaction to, or side effect from care
What is the definition of Specific Injury in WC claims? - correct answerInjury from of a
single incident or exposure
What is the definition of Cumulative Injury in WC claims? - correct answerRepetitive
trauma over a period of time
What are the 2 requirements for a condition to be considered an injury in WC cases? -
correct answer(1) Cause a disability
(2) Need for medical treatment
What is the definition of occupational disease? - correct answerDisease/Injury that is
caused by work
,What are the 7 types of excluded injuries in WC Cases? - correct answer(1) Use of
alcohol or illegal drugs
(2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured employee is the initial physical aggressor
(5) Committing of a felony
(6) Off-duty recreational activities
(7) Psychiatric injuries claimed after notice of termination
What are the 4 basic conditions to establish a workers' compensation claim? - correct
answer(1) Injury
(2) Employment relationship
(3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
What 3 requirements constitutes an aggravation of a pre-existing, non-industrial
condition in WC cases? - correct answer(1) Causes a temporary or permanent increase
in disability
(2) Creates a new need for medical treatment
(3) Requires a change in the existing course of treatment
What 4 items are determined by the DOI? - correct answer(1) Compensation rate
(2) Employers who are liable for the claim.
(3) Statute of limitations for particular procedures
(4) Regulations that will apply to the worker's injury
What are 3 factors are needed to establish a causation determination? - correct
answer(1) Presence of pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
What are the 5 major types of causation? - correct answer(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
What is the definition of direct causation? - correct answerWork exposures are directly
responsible for the health outcomes
What is the definition of contributing causation? - correct answerSeveral work factors
led to the disease
What is the definition of Acceleration Causation? - correct answer- Disease/injury is
accelerated by of work.
, - (The date of the onset of the disease is much sooner than it would have been in the
absence of the exposure)
What is the definition of precipitation causation? - correct answer- Work exposure
causes the the illness.
(For example, an underlying tendency or asymptomatic problem was present, but the
work exposure causes it to clinically manifest.)
What is the definition of Aggravation Causation? - correct answerA medical condition
may be present already, but work exposure makes it worse
What is principle of "taking employees as you find them"? - correct answerThe employer
cannot avoid liability for an occupational injury by claiming that the injury would not have
happened if the worker had been in a different physical
or emotional condition before the accident.
What are the 3 criteria for compensation of psychiatric injuries in WC claims? - correct
answer(1) Diagnosed mental disorder
(2) Causes disability or need for medical treatment
(3) Employee can demonstrate that events of employment were predominant cause of
the injury
What is the definition of proximate cause? - correct answerConnection between injury
and employment
*Employment does not need to be the only cause of injury, just a contributing cause
What are the 5 requirements needed to constitute a psychiatric injury in WC claims? -
correct answer(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 continuously), unless the injury was caused by a
sudden and extraordinary employment 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 notification of termination or layoff
What are 5 criteria for compensation of psychiatric claims after notice of
termination/layoff? - correct answer(1) Injury was the result of sudden and extraordinary
events of employment
(2) Employer had notice of the injury before the notice of termination or layoff.
(3) Psychiatric Medical records existing before the notice of termination/layoff
(4) Sexual or racial harassment.
