California QME Exam 2025 updated -
Based on ICAC Course Material
questions well answered
Holds authority to appoint physicians as QME evaluators -{answer}-
Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator -{answer}-2 years (LC 139.2)
3 requirements when seeking appointment as QME -{answer}-(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 -{answer}-
(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 -{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.
, 3 types of substantive medical disputes resolved by QMEs -{answer}-(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 -{answer}-(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* -{answer}-Occurs as the result of a single incident or
exposure
*Cumulative injury* -{answer}-Results from repetitive trauma (mental or
physical) over a period of time
2 requirements for a condition to be considered an injury -{answer}-(1)
Cause disability; or
(2) Result in a need for medical treatment
Occupational disease -{answer}-Disease that in whole or part is caused
by work
7 types of excluded injuries -{answer}-(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
Based on ICAC Course Material
questions well answered
Holds authority to appoint physicians as QME evaluators -{answer}-
Administrative Director (AD) (LC 139.2)
Term of appointment as QME evaluator -{answer}-2 years (LC 139.2)
3 requirements when seeking appointment as QME -{answer}-(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 -{answer}-
(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 -{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.
, 3 types of substantive medical disputes resolved by QMEs -{answer}-(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 -{answer}-(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* -{answer}-Occurs as the result of a single incident or
exposure
*Cumulative injury* -{answer}-Results from repetitive trauma (mental or
physical) over a period of time
2 requirements for a condition to be considered an injury -{answer}-(1)
Cause disability; or
(2) Result in a need for medical treatment
Occupational disease -{answer}-Disease that in whole or part is caused
by work
7 types of excluded injuries -{answer}-(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
