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HCC QME Exam: Terms, Dates, and
Concepts Questions and Correct Answers
A QME certification is valid for how may years? Ans: 2 years (LC
139.2)
What are 3 requirements a physician must complete to become a
certified QME? Ans: (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? Ans: (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? Ans: (1) Violation of material
statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
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(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? Ans: (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? Ans: Injury
from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims? Ans:
Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an
injury in WC cases? Ans: (1) Cause a disability
(2) Need for medical treatment
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What is the definition of occupational disease? Ans:
Disease/Injury that is caused by work
What are the 7 types of excluded injuries in WC Cases? Ans: (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? Ans: (1) Injury
(2) Employment relationship
(3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
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What 3 requirements constitutes an aggravation of a pre-existing,
non-industrial condition in WC cases? Ans: (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? Ans: (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? Ans: (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? Ans: (1) Direct
(2) Contributing
© 2025 All rights reserved
HCC QME Exam: Terms, Dates, and
Concepts Questions and Correct Answers
A QME certification is valid for how may years? Ans: 2 years (LC
139.2)
What are 3 requirements a physician must complete to become a
certified QME? Ans: (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? Ans: (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? Ans: (1) Violation of material
statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
© 2025 All rights reserved
, 2 | Page
(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? Ans: (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? Ans: Injury
from of a single incident or exposure
What is the definition of Cumulative Injury in WC claims? Ans:
Repetitive trauma over a period of time
What are the 2 requirements for a condition to be considered an
injury in WC cases? Ans: (1) Cause a disability
(2) Need for medical treatment
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, 3 | Page
What is the definition of occupational disease? Ans:
Disease/Injury that is caused by work
What are the 7 types of excluded injuries in WC Cases? Ans: (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? Ans: (1) Injury
(2) Employment relationship
(3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
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, 4 | Page
What 3 requirements constitutes an aggravation of a pre-existing,
non-industrial condition in WC cases? Ans: (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? Ans: (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? Ans: (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? Ans: (1) Direct
(2) Contributing
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