QME EXAM |100 QUESTIONS| WITH ACTUAL
SOLUTIONS!!
Holds authority to appoint physicians as QME evaluators
Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator
2 years (LC 139.2)
3 requirements when seeking appointment as QME
(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)
2 reasons for termination/suspension of a QME w/o a hearing
(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
6 reasons for discipline (suspension/termination) of QMEs after a hearing
(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.
,3 types of substantive medical disputes resolved by QMEs
(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
(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
Specific injury
Occurs as the result of a single incident or exposure
Cumulative injury
Results from repetitive trauma (mental or physical) over a period of time
2 requirements for a condition to be considered an injury
(1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease
Disease that in whole or part is caused by work
, 7 types of excluded injuries
(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
4 basic conditions to establish a workers' compensation claim
(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
(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
SOLUTIONS!!
Holds authority to appoint physicians as QME evaluators
Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator
2 years (LC 139.2)
3 requirements when seeking appointment as QME
(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)
2 reasons for termination/suspension of a QME w/o a hearing
(1) Licensing board suspends/revokes/terminates license to practice
(2) Failure to pay required fee (upon appointment and yearly thereafter)
6 reasons for discipline (suspension/termination) of QMEs after a hearing
(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.
,3 types of substantive medical disputes resolved by QMEs
(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
(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
Specific injury
Occurs as the result of a single incident or exposure
Cumulative injury
Results from repetitive trauma (mental or physical) over a period of time
2 requirements for a condition to be considered an injury
(1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease
Disease that in whole or part is caused by work
, 7 types of excluded injuries
(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
4 basic conditions to establish a workers' compensation claim
(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
(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
