- | P a g e
pg. 1
QME EXAM PREP/ QME FINAL EXAM AND
PRACTICE EXAM NEWEST 2025 TEST BANK|
COMPLETE 450 ACTUAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
- factors to establish in making a causation determination - ANSWER -
(1) Presence of pathological conditions and disability (2) Relevant work exposures (3) Non-industrial exposures (other causes of disease)
- major types of causation - ANSWER - (1) Direct
(2) Contributing (3) Acceleration (4) Precipitation (5) Aggravation
Direct causation - ANSWER - Work exposures are directly responsible for the health outcomes
Contributing causation - ANSWER - Several factors led to the disease; work exposure is one of these factors
- / 4
- | P a g e
pg. 2 Conflict of Interest (COI) - ANSWER - An evaluator may not request or accept any compensation or other thing of value from any source that does or could create a conflict with his or her duties as an evaluator
Persons/entities with whom a QME may have a disqualifying COI - ANSWER - (1) Injured worker (or their attorney) (2) Employer (or their attorney) (3) Claims administrator (or their attorney) (4) Primary/secondary treating physician, if treatment by physician is being disputed (5) UR physician reviewer or expert reviewer or UR organization if decision is being disputed (6) Surgical center if surgery is being disputed (7) Purveyor of medical goods/svcs if goods/svcs are being disputed
Disqualifying COIs - ANSWER - (1) Familial relationship, including cohabitation (2) Significant financial interest (3) Professional affiliation in same medical group/business affiliation (4) Any other relationship/interest not addressed which would cause a person aware of the facts to reasonably entertain a doubt that an evaluator would be able to act with integrity and impartiality
Time frame for an evaluator to disclose COI - ANSWER - Within 5 business days of becoming aware of the conflict, in writing
- / 4
- | P a g e
pg. 3 Options of represented workers after disclosure of COI by evaluator - ANSWER - (1) Waive the COI (2) Replace the evaluator's name on the panel (if COI discovered before any names have been stricken) (3) Request a new panel (if COI discovered after appt made)
Decider of disputes about whether a COI may affect the integrity and impartiality of the evaluation or supplemental reports - ANSWER - WCALJ assigned to the case
Required exam disclosures - ANSWER - (1) Injured worker may ask the evaluator and evaluator shall promptly answer questions about any matter concerning the evaluation process; (2) Injured worker may discontinue the evaluation based on *good cause*; (3) Disclosure of probationary status, if required as a condition of probation.
Good cause for discontinuing the evaluation by an injured worker - ANSWER - (1) Discriminatory conduct, based on race, sex, national origin, religion or sexual preference; (2) Abuse, hostile or rude behavior, including behavior demonstrating a bias against injured workers; (3) Requests that the worker submit to an unnecessary exam or procedure.
- / 4
- | P a g e
pg. 4 Good cause for discontinuing a comprehensive medical-legal evaluation by a QME - ANSWER - (1) Injured worker/representative uses abusive language towards the evaluator/evaluator's staff; (2) Injured worker/representative deliberately attempts to disrupt the operation of the evaluator's office in any way; (3) Injured worker is intoxicated or under the influence of any medication which impairs the injured worker's ability to participate in the evaluation/process.
Face-to-face time - ANSWER - Only time evaluator is present with an injured worker, taking a history, performing a physical exam or discussing the worker's medical condition with the worker
Minimum face-to-face time requirements for uncomplicated evaluations
- ANSWER - 20 minutes for neuromusculoskeletal evaluations
60 minutes for psychiatric evaluations 30 minutes for all other evaluations
Required contents of report - ANSWER - (1) Date of examination; (2) Street address at which examination was performed; (3) All contested medical issues arising from all injuries reported on one or more claim forms prior to the appointment that are within the evaluator's scope of practice and areas of clinical competence; (4) Disputed issues beyond the evaluator's expertise;
- / 4