HCC QME Exam Terms, Dates, and Concepts
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exam with correct answers
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A |QME |certification |is |valid |for |how |may |years? |- |correct |answer | |2 |years |(LC |139.2)
What |are |3 |requirements |a |physician |must |complete |to |become |a |certified |QME? |- |correct |answer | |
(1) |QME |competency |exam
(2) |12-hour |course |in |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 |months |prior |to |application)
What |are |2 |reasons |for |termination/suspension |of |a |QME |without |a |hearing? |- |correct |answer | |(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 |QME |that |would |require |a |hearing?
|- |correct |answer | |(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.
What |is |the |definition |of |an |Injury |in |WC |claims? |- |correct |answer | |(1) |Injury |or |disease |arising |out |of |
employment
(2) |Injury |caused |by |treatment |of |an |injury |
(3) |Reaction |to, |or |side |effect |from |care
,What |is |the |definition |of |Specific |Injury |in |WC |claims? |- |correct |answer | |Injury |from |of |a |single |
incident |or |exposure
What |is |the |definition |of |Cumulative |Injury |in |WC |claims? |- |correct |answer | |Repetitive |trauma |over |a |
period |of |time
What |are |the |2 |requirements |for |a |condition |to |be |considered |an |injury |in |WC |cases? |- |correct |
answer | |(1) |Cause |a |disability
(2) |Need |for |medical |treatment
What |is |the |definition |of |occupational |disease? |- |correct |answer | |Disease/Injury |that |is |caused |by |
work
What |are |the |7 |types |of |excluded |injuries |in |WC |Cases? |- |correct |answer | |(1) |Use |of |alcohol |or |illegal |
drugs
(2) |Self |inflicted |injuries
(3) |Suicide
(4) |Altercations, |in |which |the |injured |employee |is |the |initial |physical |aggressor
(5) |Committing |of |a |felony
(6) |Off-duty |recreational |activities
(7) |Psychiatric |injuries |claimed |after |notice |of |termination
What |are |the |4 |basic |conditions |to |establish |a |workers' |compensation |claim? |- |correct |answer | |(1) |
Injury
(2) |Employment |relationship
(3) |Injury |caused |by |the |employment |(AOE)
(4) |Occurred |in |the |course |of |the |employment |(COE)
What |3 |requirements |constitutes |an |aggravation |of |a |pre-existing, |non-industrial |condition |in |WC |
cases? |- |correct |answer | |(1) |Causes |a |temporary |or |permanent |increase |in |disability
,(2) |Creates |a |new |need |for |medical |treatment |
(3) |Requires |a |change |in |the |existing |course |of |treatment
What |4 |items |are |determined |by |the |DOI? |- |correct |answer | |(1) |Compensation |rate
(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
What |are |3 |factors |are |needed |to |establish |a |causation |determination? |- |correct |answer | |(1) |Presence
|of |pathological |conditions |and |disability
(2) |Relevant |work |exposures
(3) |Non-industrial |exposures |(other |causes |of |disease)
What |are |the |5 |major |types |of |causation? |- |correct |answer | |(1) |Direct
(2) |Contributing
(3) |Acceleration
(4) |Precipitation
(5) |Aggravation
What |is |the |definition |of |direct |causation? |- |correct |answer | |Work |exposures |are |directly |responsible |
for |the |health |outcomes
What |is |the |definition |of |contributing |causation? |- |correct |answer | |Several |work |factors |led |to |the |
disease
What |is |the |definition |of |Acceleration |Causation? |- |correct |answer | |- |Disease/injury |is |accelerated |by |
of |work. |
- |(The |date |of |the |onset |of |the |disease |is |much |sooner |than |it |would |have |been |in |the |absence |of |the
|exposure)
, What |is |the |definition |of |precipitation |causation? |- |correct |answer | |- |Work |exposure |causes |the |the |
illness. |
(For |example, |an |underlying |tendency |or |asymptomatic |problem |was |present, |but |the |work |exposure |
causes |it |to |clinically |manifest.)
What |is |the |definition |of |Aggravation |Causation? |- |correct |answer | |A |medical |condition |may |be |
present |already, |but |work |exposure |makes |it |worse
What |is |principle |of |"taking |employees |as |you |find |them"? |- |correct |answer | |The |employer |cannot |
avoid |liability |for |an |occupational |injury |by |claiming |that |the |injury |would |not |have |happened |if |the |
worker |had |been |in |a |different |physical
or |emotional |condition |before |the |accident.
What |are |the |3 |criteria |for |compensation |of |psychiatric |injuries |in |WC |claims? |- |correct |answer | |(1) |
Diagnosed |mental |disorder
(2) |Causes |disability |or |need |for |medical |treatment
(3) |Employee |can |demonstrate |that |events |of |employment |were |predominant |cause |of |the |injury
What |is |the |definition |of |proximate |cause? |- |correct |answer | |Connection |between |injury |and |
employment
*Employment |does |not |need |to |be |the |only |cause |of |injury, |just |a |contributing |cause
What |are |the |5 |requirements |needed |to |constitute |a |psychiatric |injury |in |WC |claims? |- |correct |answer
| |(1) |Actual |events |of |employment |were |the |predominant |cause |> |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% |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, |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
| | | | | | |
exam with correct answers
| | |
A |QME |certification |is |valid |for |how |may |years? |- |correct |answer | |2 |years |(LC |139.2)
What |are |3 |requirements |a |physician |must |complete |to |become |a |certified |QME? |- |correct |answer | |
(1) |QME |competency |exam
(2) |12-hour |course |in |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 |months |prior |to |application)
What |are |2 |reasons |for |termination/suspension |of |a |QME |without |a |hearing? |- |correct |answer | |(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 |QME |that |would |require |a |hearing?
|- |correct |answer | |(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.
What |is |the |definition |of |an |Injury |in |WC |claims? |- |correct |answer | |(1) |Injury |or |disease |arising |out |of |
employment
(2) |Injury |caused |by |treatment |of |an |injury |
(3) |Reaction |to, |or |side |effect |from |care
,What |is |the |definition |of |Specific |Injury |in |WC |claims? |- |correct |answer | |Injury |from |of |a |single |
incident |or |exposure
What |is |the |definition |of |Cumulative |Injury |in |WC |claims? |- |correct |answer | |Repetitive |trauma |over |a |
period |of |time
What |are |the |2 |requirements |for |a |condition |to |be |considered |an |injury |in |WC |cases? |- |correct |
answer | |(1) |Cause |a |disability
(2) |Need |for |medical |treatment
What |is |the |definition |of |occupational |disease? |- |correct |answer | |Disease/Injury |that |is |caused |by |
work
What |are |the |7 |types |of |excluded |injuries |in |WC |Cases? |- |correct |answer | |(1) |Use |of |alcohol |or |illegal |
drugs
(2) |Self |inflicted |injuries
(3) |Suicide
(4) |Altercations, |in |which |the |injured |employee |is |the |initial |physical |aggressor
(5) |Committing |of |a |felony
(6) |Off-duty |recreational |activities
(7) |Psychiatric |injuries |claimed |after |notice |of |termination
What |are |the |4 |basic |conditions |to |establish |a |workers' |compensation |claim? |- |correct |answer | |(1) |
Injury
(2) |Employment |relationship
(3) |Injury |caused |by |the |employment |(AOE)
(4) |Occurred |in |the |course |of |the |employment |(COE)
What |3 |requirements |constitutes |an |aggravation |of |a |pre-existing, |non-industrial |condition |in |WC |
cases? |- |correct |answer | |(1) |Causes |a |temporary |or |permanent |increase |in |disability
,(2) |Creates |a |new |need |for |medical |treatment |
(3) |Requires |a |change |in |the |existing |course |of |treatment
What |4 |items |are |determined |by |the |DOI? |- |correct |answer | |(1) |Compensation |rate
(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
What |are |3 |factors |are |needed |to |establish |a |causation |determination? |- |correct |answer | |(1) |Presence
|of |pathological |conditions |and |disability
(2) |Relevant |work |exposures
(3) |Non-industrial |exposures |(other |causes |of |disease)
What |are |the |5 |major |types |of |causation? |- |correct |answer | |(1) |Direct
(2) |Contributing
(3) |Acceleration
(4) |Precipitation
(5) |Aggravation
What |is |the |definition |of |direct |causation? |- |correct |answer | |Work |exposures |are |directly |responsible |
for |the |health |outcomes
What |is |the |definition |of |contributing |causation? |- |correct |answer | |Several |work |factors |led |to |the |
disease
What |is |the |definition |of |Acceleration |Causation? |- |correct |answer | |- |Disease/injury |is |accelerated |by |
of |work. |
- |(The |date |of |the |onset |of |the |disease |is |much |sooner |than |it |would |have |been |in |the |absence |of |the
|exposure)
, What |is |the |definition |of |precipitation |causation? |- |correct |answer | |- |Work |exposure |causes |the |the |
illness. |
(For |example, |an |underlying |tendency |or |asymptomatic |problem |was |present, |but |the |work |exposure |
causes |it |to |clinically |manifest.)
What |is |the |definition |of |Aggravation |Causation? |- |correct |answer | |A |medical |condition |may |be |
present |already, |but |work |exposure |makes |it |worse
What |is |principle |of |"taking |employees |as |you |find |them"? |- |correct |answer | |The |employer |cannot |
avoid |liability |for |an |occupational |injury |by |claiming |that |the |injury |would |not |have |happened |if |the |
worker |had |been |in |a |different |physical
or |emotional |condition |before |the |accident.
What |are |the |3 |criteria |for |compensation |of |psychiatric |injuries |in |WC |claims? |- |correct |answer | |(1) |
Diagnosed |mental |disorder
(2) |Causes |disability |or |need |for |medical |treatment
(3) |Employee |can |demonstrate |that |events |of |employment |were |predominant |cause |of |the |injury
What |is |the |definition |of |proximate |cause? |- |correct |answer | |Connection |between |injury |and |
employment
*Employment |does |not |need |to |be |the |only |cause |of |injury, |just |a |contributing |cause
What |are |the |5 |requirements |needed |to |constitute |a |psychiatric |injury |in |WC |claims? |- |correct |answer
| |(1) |Actual |events |of |employment |were |the |predominant |cause |> |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% |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, |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
