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;
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,(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;
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, (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;
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