QME EXAM 100 QUESTIONS WITH

QME EXAM |100 QUESTIONS| WITH

ACTUAL SOLUTIONS!!

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)

• 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)

• 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)

• 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.

• 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 1 / 2

*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

• 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

• 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

• 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

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