QME Competency Exam Prep Guide
Questions with complete solutions
What are the 3 types of substantive medical disputes resolved by QMEs? ✔️✔️Correct Ans-(1)
Compensability of the claim; (2) Permanent disability; (3) 'Catch-all' (temporary disability, work
restrictions, new and further disabilities after permanent disability (deterioration of original injury),
compensability of new body part added to claim)
What is the definition of 'injury' in compensability claims? ✔️✔️Correct Ans-(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
Time frame in which either party in unrepresented cases may object to a medication determination
by the treating physician ✔️✔️Correct Ans-30 days, in writing
Time limit for unrepresented injured worker to submit request for a QME panel after receiving form
from employer ✔️✔️Correct Ans-10 days
Time frame after which unrepresented worker has the right to obtain an evaluation from any QME
within a reasonable geographic area ✔️✔️Correct Ans-After 20 days, if request for QME panel is not
issued
Time frame in which an injured worker is required to select a physician from the QME panel, make
an appointment for the exam and inform the claims administrator of the selection and appointment
✔️✔️Correct Ans-Within 10 days after the panel is issued
Rights of the claim administrator in selecting the QME and arranging the appointment ✔️✔️Correct
Ans-If injured worker does not inform the claims administrator of the selection or date of
appointment
Time frame in represented cases during which each party may strike one name from the QME panel
✔️✔️Correct Ans-10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the injured worker
✔️✔️Correct Ans-Within 60 days of a request for an appointment (up to 90 days)
, Time frame to submit the QME Appointment Notification Form ✔️✔️Correct Ans-Within 5 business
days of making the appointment
Parties receiving service of the QME Appointment Notification Form ✔️✔️Correct Ans-Employee (+
representative) AND Employer/claims administrator (+ representative)
Trigger to send medical records and other information to the QME ✔️✔️Correct Ans-Receipt of the
QME Appointment Notification Form
Who holds authority to appoint physicians as QME evaluators? ✔️✔️Correct Ans-Administrative
Director (AD) (LC 139.2)
What is the term of appointment as QME evaluator? ✔️✔️Correct Ans-2 years (LC 139.2)
What are the 3 requirements when seeking appointment as QME? ✔️✔️Correct Ans-(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)
What are the 2 reasons for termination/suspension of a QME without a hearing? ✔️✔️Correct Ans-(1)
Licensing board suspends/revokes/terminates license to practice; (2) Failure to pay required fee
(upon appointment and yearly thereafter)
What are the 6 reasons for discipline (suspension/termination) of QMEs after a hearing? ✔️✔️Correct
Ans-(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.
Causes for issuance of a replacement panel ✔️✔️Correct Ans-(1) Failure to serve the QME
Appointment Notification Form; (2) Disclosure of COI by an evaluator after an appointment has been
made; (3) Necessity for subsequent examination by a QME in a different specialty (due to limitations
in scope of practice or clinical competency)
Questions with complete solutions
What are the 3 types of substantive medical disputes resolved by QMEs? ✔️✔️Correct Ans-(1)
Compensability of the claim; (2) Permanent disability; (3) 'Catch-all' (temporary disability, work
restrictions, new and further disabilities after permanent disability (deterioration of original injury),
compensability of new body part added to claim)
What is the definition of 'injury' in compensability claims? ✔️✔️Correct Ans-(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
Time frame in which either party in unrepresented cases may object to a medication determination
by the treating physician ✔️✔️Correct Ans-30 days, in writing
Time limit for unrepresented injured worker to submit request for a QME panel after receiving form
from employer ✔️✔️Correct Ans-10 days
Time frame after which unrepresented worker has the right to obtain an evaluation from any QME
within a reasonable geographic area ✔️✔️Correct Ans-After 20 days, if request for QME panel is not
issued
Time frame in which an injured worker is required to select a physician from the QME panel, make
an appointment for the exam and inform the claims administrator of the selection and appointment
✔️✔️Correct Ans-Within 10 days after the panel is issued
Rights of the claim administrator in selecting the QME and arranging the appointment ✔️✔️Correct
Ans-If injured worker does not inform the claims administrator of the selection or date of
appointment
Time frame in represented cases during which each party may strike one name from the QME panel
✔️✔️Correct Ans-10 days after the assignment of the panel
Time frame in which selected QME must schedule an appointment to see the injured worker
✔️✔️Correct Ans-Within 60 days of a request for an appointment (up to 90 days)
, Time frame to submit the QME Appointment Notification Form ✔️✔️Correct Ans-Within 5 business
days of making the appointment
Parties receiving service of the QME Appointment Notification Form ✔️✔️Correct Ans-Employee (+
representative) AND Employer/claims administrator (+ representative)
Trigger to send medical records and other information to the QME ✔️✔️Correct Ans-Receipt of the
QME Appointment Notification Form
Who holds authority to appoint physicians as QME evaluators? ✔️✔️Correct Ans-Administrative
Director (AD) (LC 139.2)
What is the term of appointment as QME evaluator? ✔️✔️Correct Ans-2 years (LC 139.2)
What are the 3 requirements when seeking appointment as QME? ✔️✔️Correct Ans-(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)
What are the 2 reasons for termination/suspension of a QME without a hearing? ✔️✔️Correct Ans-(1)
Licensing board suspends/revokes/terminates license to practice; (2) Failure to pay required fee
(upon appointment and yearly thereafter)
What are the 6 reasons for discipline (suspension/termination) of QMEs after a hearing? ✔️✔️Correct
Ans-(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.
Causes for issuance of a replacement panel ✔️✔️Correct Ans-(1) Failure to serve the QME
Appointment Notification Form; (2) Disclosure of COI by an evaluator after an appointment has been
made; (3) Necessity for subsequent examination by a QME in a different specialty (due to limitations
in scope of practice or clinical competency)
