HCC QME Exam: Terms, Dates, and Concepts
1. A QME certification is valid 2 years (LC 139.2)
for how may years?
2. What are 3 requirements a (1) QME competency exam
physician must complete to (2) 12-hour course in report writing
become a certified QME? (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 months prior to application)
3. What are 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to
nation/suspension of a QME practice
without a hearing? (2) Failure to pay required fee (upon appointment and yearly
thereafter)
4. What are the 6 reasons for (1) Violation of material statutory or administrative duty;
discipline (suspension/termi- (2) Failure to follow medical procedures or qualifications;
nation) of QME that would re- (3) Failure to comply with the timeframe standards;
quire a hearing? (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.
5. What is the definition of an (1) Injury or disease arising out of employment
Injury in WC claims? (2) Injury caused by treatment of an injury
(3) Reaction to, or side ettect from care
6. What is the definition of Spe- Injury from of a single incident or exposure
cific Injury in WC claims?
7. Repetitive trauma over a period of time
, HCC QME Exam: Terms, Dates, and Concepts
What is the definition of Cu-
mulative Injury in WC claims?
8. What are the 2 requirements (1) Cause a disability
for a condition to be consid- (2) Need for medical treatment
ered an injury in WC cases?
9. What is the definition of oc- Disease/Injury that is caused by work
cupational disease?
10. What are the 7 types of ex- (1) Use of alcohol or illegal drugs
cluded injuries in WC Cases? (2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured employee is the initial
physical aggressor
(5) Committing of a felony
(6) Ott-duty recreational activities
(7) Psychiatric injuries claimed after notice of termination
11. What are the 4 basic condi- (1) Injury
tions to establish a workers' (2) Employment relationship
compensation claim? (3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
12. What 3 requirements con- (1) Causes a temporary or permanent increase in disability
stitutes an aggravation of (2) Creates a new need for medical treatment
a pre-existing, non-industrial (3) Requires a change in the existing course of treatment
condition in WC cases?
13. What 4 items are determined (1) Compensation rate
by the DOI? (2) Employers who are liable for the claim.
(3) Statute of limitations for particular procedures
(4) Regulations that will apply to the worker's injury
, HCC QME Exam: Terms, Dates, and Concepts
14. What are 3 factors are need- (1) Presence of pathological conditions and disability
ed to establish a causation (2) Relevant work exposures
determination? (3) Non-industrial exposures (other causes of disease)
15. What are the 5 major types of (1) Direct
causation? (2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
16. What is the definition of di- Work exposures are directly responsible for the health outcomes
rect causation?
17. What is the definition of con- Several work factors led to the disease
tributing causation?
18. What is the definition of Ac- - Disease/injury is accelerated by of work.
celeration Causation? - (The date of the onset of the disease is much sooner than it
would have been in the absence of the exposure)
19. What is the definition of pre- - Work exposure causes the the illness.
cipitation causation? (For example, an underlying tendency or asymptomatic prob-
lem was present, but the work exposure causes it to clinically
manifest.)
20. What is the definition of Ag- A medical condition may be present already, but work exposure
gravation Causation? makes it worse
21. What is principle of "tak- The employer cannot avoid liability for an occupational injury by
ing employees as you find claiming that the injury would not have happened if the worker
them"? had been in a ditterent physical
or emotional condition before the accident.
, HCC QME Exam: Terms, Dates, and Concepts
22. What are the 3 criteria for (1) Diagnosed mental disorder
compensation of psychiatric (2) Causes disability or need for medical treatment
injuries in WC claims? (3) Employee can demonstrate that events of employment were
predominant cause of the injury
23. What is the definition of Connection between injury and employment
proximate cause?
*Employment does not need to be the only cause of injury, just
a contributing cause
24. What are the 5 requirements (1) Actual events of employment were the predominant cause >
needed to constitute a psy- 50% among all combined causes of the psychiatric injury (except
chiatric injury in WC claims? if the injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act (contributed >= 35%
causation)
(3) worked for at least 6 months (not continuously), unless the
injury was caused by a sudden and extraordinary employment
condition
(4) Injury was not substantially caused by "lawful, nondiscrimi-
natory, 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
layott
25. What are 5 criteria for (1) Injury was the result of sudden and extraordinary events of
compensation of psychiatric employment
claims after notice of termi- (2) Employer had notice of the injury before the notice of termi-
nation/layoff? nation or layott.
(3) Psychiatric Medical records existing before the notice of
termination/layott
(4) Sexual or racial harassment.
1. A QME certification is valid 2 years (LC 139.2)
for how may years?
2. What are 3 requirements a (1) QME competency exam
physician must complete to (2) 12-hour course in report writing
become a certified QME? (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 months prior to application)
3. What are 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to
nation/suspension of a QME practice
without a hearing? (2) Failure to pay required fee (upon appointment and yearly
thereafter)
4. What are the 6 reasons for (1) Violation of material statutory or administrative duty;
discipline (suspension/termi- (2) Failure to follow medical procedures or qualifications;
nation) of QME that would re- (3) Failure to comply with the timeframe standards;
quire a hearing? (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.
5. What is the definition of an (1) Injury or disease arising out of employment
Injury in WC claims? (2) Injury caused by treatment of an injury
(3) Reaction to, or side ettect from care
6. What is the definition of Spe- Injury from of a single incident or exposure
cific Injury in WC claims?
7. Repetitive trauma over a period of time
, HCC QME Exam: Terms, Dates, and Concepts
What is the definition of Cu-
mulative Injury in WC claims?
8. What are the 2 requirements (1) Cause a disability
for a condition to be consid- (2) Need for medical treatment
ered an injury in WC cases?
9. What is the definition of oc- Disease/Injury that is caused by work
cupational disease?
10. What are the 7 types of ex- (1) Use of alcohol or illegal drugs
cluded injuries in WC Cases? (2) Self inflicted injuries
(3) Suicide
(4) Altercations, in which the injured employee is the initial
physical aggressor
(5) Committing of a felony
(6) Ott-duty recreational activities
(7) Psychiatric injuries claimed after notice of termination
11. What are the 4 basic condi- (1) Injury
tions to establish a workers' (2) Employment relationship
compensation claim? (3) Injury caused by the employment (AOE)
(4) Occurred in the course of the employment (COE)
12. What 3 requirements con- (1) Causes a temporary or permanent increase in disability
stitutes an aggravation of (2) Creates a new need for medical treatment
a pre-existing, non-industrial (3) Requires a change in the existing course of treatment
condition in WC cases?
13. What 4 items are determined (1) Compensation rate
by the DOI? (2) Employers who are liable for the claim.
(3) Statute of limitations for particular procedures
(4) Regulations that will apply to the worker's injury
, HCC QME Exam: Terms, Dates, and Concepts
14. What are 3 factors are need- (1) Presence of pathological conditions and disability
ed to establish a causation (2) Relevant work exposures
determination? (3) Non-industrial exposures (other causes of disease)
15. What are the 5 major types of (1) Direct
causation? (2) Contributing
(3) Acceleration
(4) Precipitation
(5) Aggravation
16. What is the definition of di- Work exposures are directly responsible for the health outcomes
rect causation?
17. What is the definition of con- Several work factors led to the disease
tributing causation?
18. What is the definition of Ac- - Disease/injury is accelerated by of work.
celeration Causation? - (The date of the onset of the disease is much sooner than it
would have been in the absence of the exposure)
19. What is the definition of pre- - Work exposure causes the the illness.
cipitation causation? (For example, an underlying tendency or asymptomatic prob-
lem was present, but the work exposure causes it to clinically
manifest.)
20. What is the definition of Ag- A medical condition may be present already, but work exposure
gravation Causation? makes it worse
21. What is principle of "tak- The employer cannot avoid liability for an occupational injury by
ing employees as you find claiming that the injury would not have happened if the worker
them"? had been in a ditterent physical
or emotional condition before the accident.
, HCC QME Exam: Terms, Dates, and Concepts
22. What are the 3 criteria for (1) Diagnosed mental disorder
compensation of psychiatric (2) Causes disability or need for medical treatment
injuries in WC claims? (3) Employee can demonstrate that events of employment were
predominant cause of the injury
23. What is the definition of Connection between injury and employment
proximate cause?
*Employment does not need to be the only cause of injury, just
a contributing cause
24. What are the 5 requirements (1) Actual events of employment were the predominant cause >
needed to constitute a psy- 50% among all combined causes of the psychiatric injury (except
chiatric injury in WC claims? if the injury is a derivative of an underlying physical injury)
(2) If the injury resulted from a violent act (contributed >= 35%
causation)
(3) worked for at least 6 months (not continuously), unless the
injury was caused by a sudden and extraordinary employment
condition
(4) Injury was not substantially caused by "lawful, nondiscrimi-
natory, 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
layott
25. What are 5 criteria for (1) Injury was the result of sudden and extraordinary events of
compensation of psychiatric employment
claims after notice of termi- (2) Employer had notice of the injury before the notice of termi-
nation/layoff? nation or layott.
(3) Psychiatric Medical records existing before the notice of
termination/layott
(4) Sexual or racial harassment.
