QME EXAM NEWEST ACTUAL EXAM COMPLETE 350
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!!
6 reasons for discipline (suspension/termination) of QMEs after a hearing - CORRECT
ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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* - CORRECT ANSWERS-Occurs as the result of a single incident or exposure
*Cumulative injury* - CORRECT ANSWERS-Results from repetitive trauma (mental or physical)
over a period of time
,2 requirements for a condition to be considered an injury - CORRECT ANSWERS-(1) Cause
disability; or
(2) Result in a need for medical treatment
Occupational disease - CORRECT ANSWERS-Disease that in whole or part is caused by work
7 types of excluded injuries - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-*Flare-ups* or
*recurrence* of a previous industrial injury or illness; not been caused by the current employment
, Date of injury (DOI)-specific injury - CORRECT ANSWERS-Date on which the incident or
exposure occurred
Date of injury (DOI)-cumulative injury - CORRECT ANSWERS-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 - CORRECT ANSWERS-(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.
Reasonable medical probability - CORRECT ANSWERS-Standard by which QME uses
combination of existing medical and scientific knowledge and the occupational and medical history of
the individual worker to conclude whether the work exposure contributed to the injury
Evidentiary standard of causation/contribution in compensability disputes - CORRECT
ANSWERS-Preponderance of the evidence (51%; more likely than not)
3 factors to establish in making a causation determination - CORRECT ANSWERS-(1) Presence
of pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - CORRECT ANSWERS-(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!!
6 reasons for discipline (suspension/termination) of QMEs after a hearing - CORRECT
ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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* - CORRECT ANSWERS-Occurs as the result of a single incident or exposure
*Cumulative injury* - CORRECT ANSWERS-Results from repetitive trauma (mental or physical)
over a period of time
,2 requirements for a condition to be considered an injury - CORRECT ANSWERS-(1) Cause
disability; or
(2) Result in a need for medical treatment
Occupational disease - CORRECT ANSWERS-Disease that in whole or part is caused by work
7 types of excluded injuries - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-(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 - CORRECT ANSWERS-*Flare-ups* or
*recurrence* of a previous industrial injury or illness; not been caused by the current employment
, Date of injury (DOI)-specific injury - CORRECT ANSWERS-Date on which the incident or
exposure occurred
Date of injury (DOI)-cumulative injury - CORRECT ANSWERS-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 - CORRECT ANSWERS-(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.
Reasonable medical probability - CORRECT ANSWERS-Standard by which QME uses
combination of existing medical and scientific knowledge and the occupational and medical history of
the individual worker to conclude whether the work exposure contributed to the injury
Evidentiary standard of causation/contribution in compensability disputes - CORRECT
ANSWERS-Preponderance of the evidence (51%; more likely than not)
3 factors to establish in making a causation determination - CORRECT ANSWERS-(1) Presence
of pathological conditions and disability
(2) Relevant work exposures
(3) Non-industrial exposures (other causes of disease)
5 major types of causation - CORRECT ANSWERS-(1) Direct
(2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
