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.
1
,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*;
2
, (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
Date of injury (DOI)-specific injury - ANSWER Date on which the incident or exposure
occurred
Date of injury (DOI)-cumulative injury - ANSWER 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
3
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.
1
,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*;
2
, (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
Date of injury (DOI)-specific injury - ANSWER Date on which the incident or exposure
occurred
Date of injury (DOI)-cumulative injury - ANSWER 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
3
