QME WITH RATIONALIZED ANSWERS YEAR
2024/2025
Holds authority to appoint physicians as QME evaluators -
verified answers-Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator - verified answers-2
years (LC 139.2)
3 requirements when seeking appointment as QME - verified
answers-(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 -
verified answers-(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 - verified answers-(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.
3 types of substantive medical disputes resolved by QMEs -
verified answers-(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 - verified
answers-(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 to health care workers
*Specific injury* - verified answers-Occurs as the result of a
single incident or exposure
*Cumulative injury* - verified answers-Results from repetitive
trauma (mental or physical) over a period of time
2 requirements for a condition to be considered an injury -
verified answers-(1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease - verified answers-Disease that in whole
or part is caused by work
7 types of excluded injuries - verified answers-(1) Caused by
employee's use of alcohol or illegal controlled substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured employee is
the *initial physical aggressor*;
(5) Resulting from the employee's commission of a felony, for
which the employee has been convicted (including "wobbly
felonies," which are crimes that may be prosecuted as
misdemeanors or felonies)
(6) Resulting from off-duty recreational activities, in which
participation in the activities does not constitute part of the
, employee's work-related duties and the activity is not an
expressed or implicit condition of employment;
(7) Psychiatric injuries claimed after notice of termination/layoff
unless certain conditions exist
4 basic conditions to establish a workers' compensation claim -
verified answers-(1) *Injury* (physiological or psychological
harm);
(2) Employment relationship;
(3) Injury caused by the employment (This is also referred to as
arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
Aggravation of a pre-existing, non-industrial condition - verified
answers-(1) Causes a temporary or permanent increase in
disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
Symptoms that don't constitute a new injury - verified answers-
*Flare-ups* or *recurrence* of a previous industrial injury or
illness; not been caused by the current employment
Date of injury (DOI)-specific injury - verified answers-Date on
which the incident or exposure occurred
Date of injury (DOI)-cumulative injury - verified answers-Date
when the employee first suffered disability from the exposure,
and either knew, or should have known, that the disability was
caused by present or previous employment
Items determined by the DOI - verified answers-(1) Statute of
limitations for particular procedures within the workers'
compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
2024/2025
Holds authority to appoint physicians as QME evaluators -
verified answers-Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator - verified answers-2
years (LC 139.2)
3 requirements when seeking appointment as QME - verified
answers-(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 -
verified answers-(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 - verified answers-(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.
3 types of substantive medical disputes resolved by QMEs -
verified answers-(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 - verified
answers-(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 to health care workers
*Specific injury* - verified answers-Occurs as the result of a
single incident or exposure
*Cumulative injury* - verified answers-Results from repetitive
trauma (mental or physical) over a period of time
2 requirements for a condition to be considered an injury -
verified answers-(1) Cause disability; or
(2) Result in a need for medical treatment
Occupational disease - verified answers-Disease that in whole
or part is caused by work
7 types of excluded injuries - verified answers-(1) Caused by
employee's use of alcohol or illegal controlled substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured employee is
the *initial physical aggressor*;
(5) Resulting from the employee's commission of a felony, for
which the employee has been convicted (including "wobbly
felonies," which are crimes that may be prosecuted as
misdemeanors or felonies)
(6) Resulting from off-duty recreational activities, in which
participation in the activities does not constitute part of the
, employee's work-related duties and the activity is not an
expressed or implicit condition of employment;
(7) Psychiatric injuries claimed after notice of termination/layoff
unless certain conditions exist
4 basic conditions to establish a workers' compensation claim -
verified answers-(1) *Injury* (physiological or psychological
harm);
(2) Employment relationship;
(3) Injury caused by the employment (This is also referred to as
arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
Aggravation of a pre-existing, non-industrial condition - verified
answers-(1) Causes a temporary or permanent increase in
disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
Symptoms that don't constitute a new injury - verified answers-
*Flare-ups* or *recurrence* of a previous industrial injury or
illness; not been caused by the current employment
Date of injury (DOI)-specific injury - verified answers-Date on
which the incident or exposure occurred
Date of injury (DOI)-cumulative injury - verified answers-Date
when the employee first suffered disability from the exposure,
and either knew, or should have known, that the disability was
caused by present or previous employment
Items determined by the DOI - verified answers-(1) Statute of
limitations for particular procedures within the workers'
compensation system;
(2) Regulations that will apply to the worker's injury;
(3) Compensation rate for the worker's injury;
(4) Employers who are liable for the claim.
