10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
HCC QME Exam 2025/2026 | Key Terms, Dates & Core Concepts |
100% Verified Study Guide
A QME certification is valid 2 years (LC 139.2)
for how may years?
(1) QME competency exam
What are 3 requirements a (2) 12-hour course in report writing
physician must complete to (3) Devote at least 1/3rd of total practice time to
become a certified QME? providing direct medical treatment (or have served as
a AME on 8+ occasions in past 12 months prior to
application)
What are 2 reasons for (1) Licensing board suspends/revokes/terminates license to
termination/suspension of a practice
(2) Failure to pay required fee (upon appointment and yearly
QME without a hearing?
thereafter)
(1) Violation of material statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
(3) Failure to comply with the timeframe standards;
What are the 6 reasons for
(4) Failure to meet licensing/certification requirements;
discipline (5) Preparation of medical-legal evaluations that fail to
(suspension/termination) of meet the minimum standards for those reports as
QME that would require a established by the administrative director or the
hearing? appeals board;
(6) Making material misrepresentations or false
statements in an application for appointment or
reappointment as a qualified medical evaluator.
(1) Injury or disease arising out of employment
What is the definition of an
(2) Injury caused by treatment of an injury
Injury in WC claims?
(3) Reaction to, or side effect from care
What is the definition of Injury from of a single incident or exposure
Specific Injury in WC claims?
What is the definition of Repetitive trauma over a period of time
Cumulative Injury in WC
claims?
1/48
,10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
What are the 2 requirements (1) Cause a disability
for a condition to be (2) Need for medical treatment
considered an injury in WC
cases?
A QME report is due 30 days
days after the
completion of the face-to-
face evaluation
A Supplemental QME report 60 days
(no face-to- face evaluation)
is due days after the
QME received a request to
do the report?
In cases made permanent 1. Subjective factors of disability
and stationary before 2. Objective factors
January 1, 2005 the 3. Work restrictions
permanent
disability rating is based
upon which three things?
Apportionment can only be Causation of the Permanent Disability
based on what?
What is not a routine Ability to work
Activity of Daily Living per
the AMA guide to the
evaluation of
permanent impairment 5th
Ed?
How long are Temporary 104 weeks
Disability Benefits and
payments made from 2005
and on?
2/48
,10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
(1) Direct
(2) Contributing
What are the 5 major types of (3) Acceleration
causation? (4) Precipitation
(5) Aggravation
What is the definition of direct Work exposures are directly responsible for the health outcomes
causation?
What is the definition of Several work factors led to the disease
contributing causation?
- Disease/injury is accelerated by of work.
What is the definition of
- (The date of the onset of the disease is much sooner
Acceleration Causation?
than it would have been in the absence of the
exposure)
- Work exposure causes the the illness.
What is the definition of
(For example, an underlying tendency or asymptomatic
precipitation causation?
problem was present, but the work exposure causes it
to clinically manifest.)
What is the definition of A medical condition may be present already, but work exposure
Aggravation Causation? makes it worse
The employer cannot avoid liability for an occupational
What is principle of "taking
injury by claiming that the injury would not have
employees as you find
happened if the worker had been in a different
them"?
physical
or emotional condition before the accident.
(1) Diagnosed mental disorder
What are the 3 criteria for (2) Causes disability or need for medical treatment
compensation of psychiatric (3) Employee can demonstrate that events of
injuries in WC claims? employment were predominant cause of the injury
Connection between injury and employment
What is the definition of
proximate cause? *Employment does not need to be the only cause of injury, just a
contributing cause
3/48
, 10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
Actual events of employment were the predominant cause >
(1)
50% among all
combined causes of the psychiatric injury (except if the
injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act (contributed >= 35%
What are the 5 requirements causation)
needed to constitute a (3) worked for at least 6 months (not continuously), unless
psychiatric injury in WC the injury was caused by a sudden and extraordinary
claims? employment condition
(4) Injury was not substantially caused by "lawful,
nondiscriminatory, good faith personnel actions" -
35% to more.
(e.g., being passed over for promotion or being transferred to
another department)
(5) Claim can not be filed after notification of termination or layoff
(1) Injury was the result of sudden and extraordinary events of
employment
What are 5 criteria for (2) Employer had notice of the injury before the notice of
compensation of termination or layoff.
psychiatric claims after (3) Psychiatric Medical records existing before the notice of
termination/layoff
notice of
(4) Sexual or racial harassment.
termination/layoff?
(5) There is evidence that the DOI is after the date of
notice of termination, but before the effective date of
the termination.
Who determines IW A QME/PTP/AME
Impairment ratings?
Who has the responsibility of The Disability Evaluation Unit (not physicians)
assigning the permanent
disability rating?
What can cause a The termination of Temporary Disability by treating physician
Permanent Disability
dispute?
What is the cause for The finding of P&S / MMI by the primary treating physician.
termination of Temporary
Disability benefits?
Estimate of approximate percentage of permanent
disability caused by a work- related injury and
What is Apportionment?
approximate percentage caused by non work-related
injuries.
4/48
HCC QME Exam 2025/2026 | Key Terms, Dates & Core Concepts |
100% Verified Study Guide
A QME certification is valid 2 years (LC 139.2)
for how may years?
(1) QME competency exam
What are 3 requirements a (2) 12-hour course in report writing
physician must complete to (3) Devote at least 1/3rd of total practice time to
become a certified QME? providing direct medical treatment (or have served as
a AME on 8+ occasions in past 12 months prior to
application)
What are 2 reasons for (1) Licensing board suspends/revokes/terminates license to
termination/suspension of a practice
(2) Failure to pay required fee (upon appointment and yearly
QME without a hearing?
thereafter)
(1) Violation of material statutory or administrative duty;
(2) Failure to follow medical procedures or qualifications;
(3) Failure to comply with the timeframe standards;
What are the 6 reasons for
(4) Failure to meet licensing/certification requirements;
discipline (5) Preparation of medical-legal evaluations that fail to
(suspension/termination) of meet the minimum standards for those reports as
QME that would require a established by the administrative director or the
hearing? appeals board;
(6) Making material misrepresentations or false
statements in an application for appointment or
reappointment as a qualified medical evaluator.
(1) Injury or disease arising out of employment
What is the definition of an
(2) Injury caused by treatment of an injury
Injury in WC claims?
(3) Reaction to, or side effect from care
What is the definition of Injury from of a single incident or exposure
Specific Injury in WC claims?
What is the definition of Repetitive trauma over a period of time
Cumulative Injury in WC
claims?
1/48
,10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
What are the 2 requirements (1) Cause a disability
for a condition to be (2) Need for medical treatment
considered an injury in WC
cases?
A QME report is due 30 days
days after the
completion of the face-to-
face evaluation
A Supplemental QME report 60 days
(no face-to- face evaluation)
is due days after the
QME received a request to
do the report?
In cases made permanent 1. Subjective factors of disability
and stationary before 2. Objective factors
January 1, 2005 the 3. Work restrictions
permanent
disability rating is based
upon which three things?
Apportionment can only be Causation of the Permanent Disability
based on what?
What is not a routine Ability to work
Activity of Daily Living per
the AMA guide to the
evaluation of
permanent impairment 5th
Ed?
How long are Temporary 104 weeks
Disability Benefits and
payments made from 2005
and on?
2/48
,10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
(1) Direct
(2) Contributing
What are the 5 major types of (3) Acceleration
causation? (4) Precipitation
(5) Aggravation
What is the definition of direct Work exposures are directly responsible for the health outcomes
causation?
What is the definition of Several work factors led to the disease
contributing causation?
- Disease/injury is accelerated by of work.
What is the definition of
- (The date of the onset of the disease is much sooner
Acceleration Causation?
than it would have been in the absence of the
exposure)
- Work exposure causes the the illness.
What is the definition of
(For example, an underlying tendency or asymptomatic
precipitation causation?
problem was present, but the work exposure causes it
to clinically manifest.)
What is the definition of A medical condition may be present already, but work exposure
Aggravation Causation? makes it worse
The employer cannot avoid liability for an occupational
What is principle of "taking
injury by claiming that the injury would not have
employees as you find
happened if the worker had been in a different
them"?
physical
or emotional condition before the accident.
(1) Diagnosed mental disorder
What are the 3 criteria for (2) Causes disability or need for medical treatment
compensation of psychiatric (3) Employee can demonstrate that events of
injuries in WC claims? employment were predominant cause of the injury
Connection between injury and employment
What is the definition of
proximate cause? *Employment does not need to be the only cause of injury, just a
contributing cause
3/48
, 10/11/25, 11:31 AM HCC QME Exam: Terms, Dates, and Concepts
Actual events of employment were the predominant cause >
(1)
50% among all
combined causes of the psychiatric injury (except if the
injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act (contributed >= 35%
What are the 5 requirements causation)
needed to constitute a (3) worked for at least 6 months (not continuously), unless
psychiatric injury in WC the injury was caused by a sudden and extraordinary
claims? employment condition
(4) Injury was not substantially caused by "lawful,
nondiscriminatory, good faith personnel actions" -
35% to more.
(e.g., being passed over for promotion or being transferred to
another department)
(5) Claim can not be filed after notification of termination or layoff
(1) Injury was the result of sudden and extraordinary events of
employment
What are 5 criteria for (2) Employer had notice of the injury before the notice of
compensation of termination or layoff.
psychiatric claims after (3) Psychiatric Medical records existing before the notice of
termination/layoff
notice of
(4) Sexual or racial harassment.
termination/layoff?
(5) There is evidence that the DOI is after the date of
notice of termination, but before the effective date of
the termination.
Who determines IW A QME/PTP/AME
Impairment ratings?
Who has the responsibility of The Disability Evaluation Unit (not physicians)
assigning the permanent
disability rating?
What can cause a The termination of Temporary Disability by treating physician
Permanent Disability
dispute?
What is the cause for The finding of P&S / MMI by the primary treating physician.
termination of Temporary
Disability benefits?
Estimate of approximate percentage of permanent
disability caused by a work- related injury and
What is Apportionment?
approximate percentage caused by non work-related
injuries.
4/48
