QME exam
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1. Holds authority to Administrative Director (AD) (LC 139.2)
ap- point
physicians as QME
evaluators
2. Term of appointment as 2 years (LC 139.2)
QME evaluator
3. 3 requirements when (1) Pass the QME competency exam;
seeking appointment as (2) Complete a 12-hour course in disability eval report
writing;
QME (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)
4. 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to
nation/suspension practice
of a QME w/o a (2) Failure to pay required fee (upon appointment and yearly
hearing thereafter)
5. 6 reasons for disci-
pline (1) Violation of material statutory or administrative duty;
(suspension/ter- (2) Failure to follow medical procedures or qualifications;
mination) of QMEs after (3) Failure to comply with the timeframe standards;
a hearing substan- tive medical disputes
resolved by QMEs
6. 3 types of
1/
34
, QME exam
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(4) Failure to meet
licensing/certification
requirements;
(5) Preparation of medical-
legal evaluations that fail to
meet the min- imum standards
for those reports as established
by the administrative director or
the appeals board;
(6) Making material
misrepresentations or false
statements in an appli- cation for
appointment or reappointment as
a qualified medical evalu- ator.
(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)
2/
34
, QME exam
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7. Definition of (1) An injury or disease arising out of employment;
*injury* in (2) A *derivative* injury caused by treatment of an injury
compensability arising out of employment;
claims (3) Any reaction to or side ettect from preventative health
care the employer provides to health care workers
8. *Specific injury* Occurs as the result of a single incident or exposure
9. *Cumulative injury* Results from repetitive trauma (mental or physical) over a
period of time
10. 2 requirements for (1) Cause disability; or
a condition to be (2) Result in a need for medical treatment
consid- ered an
injury
11. Occupational disease Disease that in whole or part is caused by work
12. 7 types of excluded (1) Caused by employee's use of alcohol or illegal
in- juries controlled sub- stances;
(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 ott-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
3/
34
, QME exam
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expressed or implicit condition of
employment;
(7) Psychiatric injuries claimed
after notice of termination/layott
unless certain conditions exist
4/
34
Study online at
https://quizlet.com/_527tt4
1. Holds authority to Administrative Director (AD) (LC 139.2)
ap- point
physicians as QME
evaluators
2. Term of appointment as 2 years (LC 139.2)
QME evaluator
3. 3 requirements when (1) Pass the QME competency exam;
seeking appointment as (2) Complete a 12-hour course in disability eval report
writing;
QME (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)
4. 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to
nation/suspension practice
of a QME w/o a (2) Failure to pay required fee (upon appointment and yearly
hearing thereafter)
5. 6 reasons for disci-
pline (1) Violation of material statutory or administrative duty;
(suspension/ter- (2) Failure to follow medical procedures or qualifications;
mination) of QMEs after (3) Failure to comply with the timeframe standards;
a hearing substan- tive medical disputes
resolved by QMEs
6. 3 types of
1/
34
, QME exam
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(4) Failure to meet
licensing/certification
requirements;
(5) Preparation of medical-
legal evaluations that fail to
meet the min- imum standards
for those reports as established
by the administrative director or
the appeals board;
(6) Making material
misrepresentations or false
statements in an appli- cation for
appointment or reappointment as
a qualified medical evalu- ator.
(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)
2/
34
, QME exam
Study online at
https://quizlet.com/_527tt4
7. Definition of (1) An injury or disease arising out of employment;
*injury* in (2) A *derivative* injury caused by treatment of an injury
compensability arising out of employment;
claims (3) Any reaction to or side ettect from preventative health
care the employer provides to health care workers
8. *Specific injury* Occurs as the result of a single incident or exposure
9. *Cumulative injury* Results from repetitive trauma (mental or physical) over a
period of time
10. 2 requirements for (1) Cause disability; or
a condition to be (2) Result in a need for medical treatment
consid- ered an
injury
11. Occupational disease Disease that in whole or part is caused by work
12. 7 types of excluded (1) Caused by employee's use of alcohol or illegal
in- juries controlled sub- stances;
(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 ott-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
3/
34
, QME exam
Study online at
https://quizlet.com/_527tt4
expressed or implicit condition of
employment;
(7) Psychiatric injuries claimed
after notice of termination/layott
unless certain conditions exist
4/
34
