QME exam
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1. Holds authority to ap- Administrative Director (AD) (LC 139.2)
point physicians as
QME evaluators
2. Term of appointment as 2 years (LC 139.2)
QME evaluator
3. 3 requirements when (1) Pass the QME competency exam;
seeking appointment as (2) Complete a 12-hour course in disability eval report writing;
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 mos prior
to application)
4. 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to practice
nation/suspension of a (2) Failure to pay required fee (upon appointment and yearly thereafter)
QME w/o a hearing
5. 6 reasons for disci- (1) Violation of material statutory or administrative duty;
pline (suspension/ter- (2) Failure to follow medical procedures or qualifications;
mination) of QMEs after (3) Failure to comply with the timeframe standards;
a hearing (4) Failure to meet licensing/certification requirements;
(5) Preparation of medical-legal evaluations that fail to meet the min-
imum standards for those reports as established by the administrative
director or the appeals board;
(6) Making material misrepresentations or false statements in an appli-
cation for appointment or reappointment as a qualified medical evalu-
ator.
6. 3 types of substan- (1) Compensability of the claim;
tive medical disputes (2) Permanent disability;
resolved by QMEs (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)
, QME exam
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7. Definition of *injury* in (1) An injury or disease arising out of employment;
compensability claims (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
8. *Specific injury* Occurs as the result of a single incident or exposure
9. *Cumulative injury* Results from repetitive trauma (mental or physical) over a period of time
10. 2 requirements for a (1) Cause disability; or
condition to be consid- (2) Result in a need for medical treatment
ered an injury
11. Occupational disease Disease that in whole or part is caused by work
12. 7 types of excluded in- (1) Caused by employee's use of alcohol or illegal controlled sub-
juries stances;
(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
, QME exam
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13. 4 basic conditions to es- (1) *Injury* (physiological or psychological harm);
tablish a workers' com- (2) Employment relationship;
pensation claim (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)
14. Aggravation of a pre-ex- (1) Causes a temporary or permanent increase in disability;
isting, non-industrial (2) Creates a new need for medical treatment; or
condition (3) Requires a change in the existing course of treatment
15. Symptoms that don't *Flare-ups* or *recurrence* of a previous industrial injury or illness; not
constitute a new injury been caused by the current employment
16. Date of injury (DOI)-spe- Date on which the incident or exposure occurred
cific injury
17. Date of injury (DOI)-cu- Date when the employee first suffered disability from the exposure, and
mulative injury either knew, or should have known, that the disability was caused by
present or previous employment
18. Items determined by (1) Statute of limitations for particular procedures within the workers'
the DOI 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.
19. Reasonable medical Standard by which QME uses combination of existing medical and
probability scientific knowledge and the occupational and medical history of the
individual worker to conclude whether the work exposure contributed
to the injury
20. Evidentiary standard Preponderance of the evidence (51%; more likely than not)
of causation/contribu-
Study online at https://quizlet.com/_hgq1mb
1. Holds authority to ap- Administrative Director (AD) (LC 139.2)
point physicians as
QME evaluators
2. Term of appointment as 2 years (LC 139.2)
QME evaluator
3. 3 requirements when (1) Pass the QME competency exam;
seeking appointment as (2) Complete a 12-hour course in disability eval report writing;
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 mos prior
to application)
4. 2 reasons for termi- (1) Licensing board suspends/revokes/terminates license to practice
nation/suspension of a (2) Failure to pay required fee (upon appointment and yearly thereafter)
QME w/o a hearing
5. 6 reasons for disci- (1) Violation of material statutory or administrative duty;
pline (suspension/ter- (2) Failure to follow medical procedures or qualifications;
mination) of QMEs after (3) Failure to comply with the timeframe standards;
a hearing (4) Failure to meet licensing/certification requirements;
(5) Preparation of medical-legal evaluations that fail to meet the min-
imum standards for those reports as established by the administrative
director or the appeals board;
(6) Making material misrepresentations or false statements in an appli-
cation for appointment or reappointment as a qualified medical evalu-
ator.
6. 3 types of substan- (1) Compensability of the claim;
tive medical disputes (2) Permanent disability;
resolved by QMEs (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)
, QME exam
Study online at https://quizlet.com/_hgq1mb
7. Definition of *injury* in (1) An injury or disease arising out of employment;
compensability claims (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
8. *Specific injury* Occurs as the result of a single incident or exposure
9. *Cumulative injury* Results from repetitive trauma (mental or physical) over a period of time
10. 2 requirements for a (1) Cause disability; or
condition to be consid- (2) Result in a need for medical treatment
ered an injury
11. Occupational disease Disease that in whole or part is caused by work
12. 7 types of excluded in- (1) Caused by employee's use of alcohol or illegal controlled sub-
juries stances;
(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
, QME exam
Study online at https://quizlet.com/_hgq1mb
13. 4 basic conditions to es- (1) *Injury* (physiological or psychological harm);
tablish a workers' com- (2) Employment relationship;
pensation claim (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)
14. Aggravation of a pre-ex- (1) Causes a temporary or permanent increase in disability;
isting, non-industrial (2) Creates a new need for medical treatment; or
condition (3) Requires a change in the existing course of treatment
15. Symptoms that don't *Flare-ups* or *recurrence* of a previous industrial injury or illness; not
constitute a new injury been caused by the current employment
16. Date of injury (DOI)-spe- Date on which the incident or exposure occurred
cific injury
17. Date of injury (DOI)-cu- Date when the employee first suffered disability from the exposure, and
mulative injury either knew, or should have known, that the disability was caused by
present or previous employment
18. Items determined by (1) Statute of limitations for particular procedures within the workers'
the DOI 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.
19. Reasonable medical Standard by which QME uses combination of existing medical and
probability scientific knowledge and the occupational and medical history of the
individual worker to conclude whether the work exposure contributed
to the injury
20. Evidentiary standard Preponderance of the evidence (51%; more likely than not)
of causation/contribu-
