QME EXAM – EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) | 2027 Q&A | INSTANT DOWNLOAD
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1. Holds authority to appoint physicians as QME evaluators - Correct Answer
Administrative Director (AD) (LC 139.2)
2. Term of appointment as QME evaluator - Correct Answer 2 years (LC 139.2)
3. 3 requirements when seeking appointment as QME - Correct 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)
4. 2 reasons for termination/suspension of a QME w/o a hearing - Correct Answer
(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
5. 6 reasons for discipline (suspension/termination) of QMEs after a hearing -
Correct 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.
6. 3 types of substantive medical disputes resolved by QMEs - Correct 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)
7. Definition of injury in compensability claims - Correct 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
8. Specific injury - Correct Answer Occurs as the result of a single incident or
exposure
9. Cumulative injury - Correct Answer Results from repetitive trauma (mental or
physical) over a period of time
10. 2 requirements for a condition to be considered an injury - Correct Answer (1)
Cause disability; or
(2) Result in a need for medical treatment
, 11. Occupational disease - Correct Answer Disease that in whole or part is caused
by work
12. 7 types of excluded injuries - Correct 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
13. 4 basic conditions to establish a workers' compensation claim - Correct 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)
14. Aggravation of a pre-existing, non-industrial condition - Correct 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
15. Symptoms that don't constitute a new injury - Correct Answer Flare-ups or
recurrence of a previous industrial injury or illness; not been caused by the
current employment
16. Date of injury (DOI)-specific injury - Correct Answer Date on which the incident or
exposure occurred
17. Date of injury (DOI)-cumulative injury - Correct 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
18. Items determined by the DOI - Correct Answer (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.
19. Reasonable medical probability - Correct Answer 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
20. Evidentiary standard of causation/contribution in compensability disputes -
Correct Answer Preponderance of the evidence (51%; more likely than not)
(VERIFIED ANSWERS) | 2027 Q&A | INSTANT DOWNLOAD
1. Holds authority to appoint physicians as QME evaluators - Correct Answer
Administrative Director (AD) (LC 139.2)
2. Term of appointment as QME evaluator - Correct Answer 2 years (LC 139.2)
3. 3 requirements when seeking appointment as QME - Correct 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)
4. 2 reasons for termination/suspension of a QME w/o a hearing - Correct Answer
(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
5. 6 reasons for discipline (suspension/termination) of QMEs after a hearing -
Correct 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.
6. 3 types of substantive medical disputes resolved by QMEs - Correct 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)
7. Definition of injury in compensability claims - Correct 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
8. Specific injury - Correct Answer Occurs as the result of a single incident or
exposure
9. Cumulative injury - Correct Answer Results from repetitive trauma (mental or
physical) over a period of time
10. 2 requirements for a condition to be considered an injury - Correct Answer (1)
Cause disability; or
(2) Result in a need for medical treatment
, 11. Occupational disease - Correct Answer Disease that in whole or part is caused
by work
12. 7 types of excluded injuries - Correct 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
13. 4 basic conditions to establish a workers' compensation claim - Correct 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)
14. Aggravation of a pre-existing, non-industrial condition - Correct 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
15. Symptoms that don't constitute a new injury - Correct Answer Flare-ups or
recurrence of a previous industrial injury or illness; not been caused by the
current employment
16. Date of injury (DOI)-specific injury - Correct Answer Date on which the incident or
exposure occurred
17. Date of injury (DOI)-cumulative injury - Correct 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
18. Items determined by the DOI - Correct Answer (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.
19. Reasonable medical probability - Correct Answer 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
20. Evidentiary standard of causation/contribution in compensability disputes -
Correct Answer Preponderance of the evidence (51%; more likely than not)
