QME EXAM QUESTIONS WITH ANSWERS

QME EXAM QUESTIONS WITH ANSWERS


Holds authority to appoint physicians as QME evaluators - ans-
nb nb nb nb nb nb nb nb nb




Administrative Director (AD) (LC 139.2) nb nb nb nb




Term of appointment as QME evaluator - ans-2 years (LC 139.2)
nb nb nb nb nb nb nb nb nb nb




3 requirements when seeking appointment as QME - ans-
nb nb nb nb nb nb nb nb




(1) Pass the QME competency exam;
nb nb nb nb nb




(2) Complete a 12-hour course in disability eval report writing;
nb nb nb nb nb nb nb nb nb




(3) Devote at least 1/3rd of total practice time to providing direct medical treatment (or have
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb n




served as a AME on 8+ occasions in past 12 mos prior to application)
b nb nb nb nb nb nb nb nb nb nb nb nb nb




2 reasons for termination/suspension of a QME w/o a hearing - ans-
nb nb nb nb nb nb nb nb nb nb nb




(1) Licensing board suspends/revokes/terminates license to practice
nb nb nb nb nb nb




(2) Failure to pay required fee (upon appointment and yearly thereafter)
nb nb nb nb nb nb nb nb nb nb




6 reasons for discipline (suspension/termination) of QMEs after a hearing - ans-
nb nb nb nb nb nb nb nb nb nb nb




(1) Violation of material statutory or administrative duty;
nb nb nb nb nb nb nb




(2) Failure to follow medical procedures or qualifications;
nb nb nb nb nb nb nb




(3) Failure to comply with the timeframe standards;
nb nb nb nb nb nb nb nb




(4) Failure to meet licensing/certification requirements;
nb nb nb nb nb




(5) Preparation of medical-
nb nb nb




legal evaluations that fail to meet the minimum standards for those reports as established b
nb nb nb nb nb nb nb nb nb nb nb nb nb nb




y the administrative director or the appeals board;
nb nb nb nb nb nb nb




(6) Making material misrepresentations or false statements in an application for appointme
nb nb nb nb nb nb nb nb nb nb nb




nt or reappointment as a qualified medical evaluator.
nb nb nb nb nb nb nb




3 types of substantive medical disputes resolved by QMEs - ans-
nb nb nb nb nb nb nb nb nb nb




(1) Compensability of the claim;
nb nb nb nb




(2) Permanent disability;
nb nb




(3) "Catch- nb




all" (temporary disability, work restrictions, new and further disabilities after permanent dis
nb nb nb nb nb nb nb nb nb nb nb




ability (detereoration of original injury), compensability of new body part added to claim)
nb nb nb nb nb nb nb nb nb nb nb nb




Definition of *injury* in compensability claims - ans- nb nb nb nb nb nb nb




(1) An injury or disease arising out of employment;
nb nb nb nb nb nb nb nb




(2) A *derivative* injury caused by treatment of an injury arising out of employment;
nb nb nb nb nb nb nb nb nb nb nb nb nb




(3) Any reaction to or side effect from preventative health care the employer provides to he
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb




alth care workers nb nb




*Specific injury* - ans-Occurs as the result of a single incident or exposure
nb nb nb nb nb nb nb nb nb nb nb nb

, *Cumulative injury* - ans- nb nb nb




Results from repetitive trauma (mental or physical) over a period of time
nb nb nb nb nb nb nb nb nb nb nb




2 requirements for a condition to be considered an injury - ans-(1) Cause disability; or
nb nb nb nb nb nb nb nb nb nb nb nb nb nb




(2) Result in a need for medical treatment
nb nb nb nb nb nb nb




Occupational disease - ans-Disease that in whole or part is caused by work nb nb nb nb nb nb nb nb nb nb nb nb




7 types of excluded injuries - ans-
nb nb nb nb nb nb




(1) Caused by employee's use of alcohol or illegal controlled substances;
nb nb nb nb nb nb nb nb nb nb




(2) Intentionally self-inflicted injuries;
nb nb nb




(3) Suicide;
nb




(4) Resulting from altercations, in which the injured employee is the *initial physical aggres
nb nb nb nb nb nb nb nb nb nb nb nb nb




sor*;
(5) Resulting from the employee's commission of a felony, for which the employee has bee
nb nb nb nb nb nb nb nb nb nb nb nb nb nb




n convicted (including "wobbly felonies," which are crimes that may be prosecuted as misd
nb nb nb nb nb nb nb nb nb nb nb nb nb




emeanors or felonies) nb nb




(6) Resulting from off-
nb nb nb




duty recreational activities, in which participation in the activities does not constitute part of
nb nb nb nb nb nb nb nb nb nb nb nb nb nb




the employee's work-
nb nb




related duties and the activity is not an expressed or implicit condition of employment;
nb nb nb nb nb nb nb nb nb nb nb nb nb




(7) Psychiatric injuries claimed after notice of termination/
nb nb nb nb nb nb nb




layoff unless certain conditions exist
nb nb nb nb




4 basic conditions to establish a workers' compensation claim - ans-
nb nb nb nb nb nb nb nb nb nb




(1) *Injury* (physiological or psychological harm);
nb nb nb nb nb




(2) Employment relationship;
nb nb




(3) Injury caused by the employment (This is also referred to as arising out of employment [
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb




AOE].);
(4) Occurred in the course of the employment (COE)
nb nb nb nb nb nb nb nb




Aggravation of a pre-existing, non-industrial condition - ans- nb nb nb nb nb nb nb




(1) Causes a temporary or permanent increase in disability;
nb nb nb nb nb nb nb nb




(2) Creates a new need for medical treatment; or
nb nb nb nb nb nb nb nb nb




(3) Requires a change in the existing course of treatment
nb nb nb nb nb nb nb nb nb




Symptoms that don't constitute a new injury - ans-*Flare-nb nb nb nb nb nb nb nb




ups* or *recurrence* of a previous industrial injury or illness; not been caused by the curren
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb




t employment
nb




Date of injury (DOI)-specific injury - ans-Date on which the incident or exposure occurred
nb nb nb nb nb nb nb nb nb nb nb nb nb




Date of injury (DOI)-cumulative injury - ans-
nb nb nb nb nb nb




Date when the employee first suffered disability from the exposure, and either knew, or sho
nb nb nb nb nb nb nb nb nb nb nb nb nb nb




uld have known, that the disability was caused by present or previous employment
nb nb nb nb nb nb nb nb nb nb nb nb