ASCORERS STUVIA
HCC QME EXAM: TERMS, DATES, AND
CONCEPTS NEWLY UPDATED
QUESTIONS WITH CORRECT ANSWERS
A+ GRADED
_____________ officers assist in the resolution of misunderstandings,
disputes, and complaints and conduct monthly seminars at each of
the 24 local district offices. ...ANS: Information and Assistance
(I&A)
"Any person who knowingly presents a false claim for the payment
of a loss, is guilty of a crime and may be for up to ______ years or a
fine up to $______, or both" ...ANS: 5 years, $50,000
A _____ day extension will be given when asked by a QME waiting for
test results or reports ...ANS: 30 day extension
A _____ day extension will be given when asked by a QME with "Good
Cause" (natural disaster or medical emergency) ...ANS: 15 day
extension
A claims administrator must submit all records within_____________
days of the IMR request? ...ANS: 15 days
A Follow Up Medical Legal Report (ML 101) is done ____ months
after the first evaluation, and _____ days to deliver the
report? ...ANS: - 9 months from the prior evaluation
- delivered within 30 days
,ASCORERS STUVIA
A medical-legal cost is defined as a cost for what? ...ANS:
Specified services incurred to prove or disprove a contested case
A Non-AME (QME) must reschedule a CANCELLED appointment
within _____ days of the original scheduled appointment and within
_____ days of the initial request, unless parties agree in writing to
accept a date past that. ...ANS: 30 days, 60 days
A PQME or APQME (but not AME) must reschedule cancelled
appointments within ____ days? ...ANS: 30 days to reschedule
A QME certification is valid for how may years? ...ANS: 2 years
(LC 139.2)
A QME does not have to provide a copy of the psychiatric report to
an injured worker when? ...ANS: the report may cause harm to
the IW
A QME evaluation for compensability (AOE/COE), do not send the
QME report to the_____? ...ANS: Local DEU ??? Chat GPT says IW's
Employer
A QME of an unrepresented IW, a copy of the report must be sent to
which parties? ...ANS: 1. IW
2. Local DEU
3. Claims Administrator (insurance company)
A QME report is due _____ days after the completion of the face-to-
face evaluation ...ANS: 30 days
A Supplemental QME report (no face-to-face evaluation) is due _____
days after the QME received a request to do the report? ...ANS: 60
days
,ASCORERS STUVIA
A violation of LC139(a) conflict of interest referral is a misdemeanor
subject to civil penalties up to $_________ per offense. ...ANS:
$5,000
A worker is injured on June 24, 2008, his vocational rehab benefits
are? ...ANS: Replaced by a supplemental job displacement benefit.
After 01/01/2008, Temporary Disability benefits may last up to
_____ weeks within _____ years of DOI? ...ANS: 1. 104 weeks
2. 5 year
After the injured worker completes a DWC-1 Claim Form, the
employer has _____ days to provide the form to the claims
administrator, employee, dependent, or representative? ...ANS: 1
working day
An AME must reschedule a cancelled appointment within _____ days
of the original scheduled appointment, but can be extended to _____
days if both parties agree? ...ANS: 60, 90 (30 more days than
QME)
An employer has an MPN then what can be pre-designated? ...ANS:
1. MD
2. DO
3. Medical Group
NOT a Chiropractor
An injured worker being treated within an approved MPN who does
not agree with the treating doctors opinion and treatment plan can
seek opinions from how many other doctors within the employers
MPN? ...ANS: 2 other doctors within the MPN
, ASCORERS STUVIA
An injured worker who is being accommodated by their employer
with modified work duty should receive temporary disability
compensation only if what is true? ...ANS: Only if the modified
work pays less than 85% of the IW's salary that was being paid at
the time of injury
An IW has _____ days to request and Independent Medical Review
(IMR) after a Utilization Review (UR) denial? ...ANS: 30 days
An IW may not be kept waiting for more than _____ after the
scheduled appointment time? ...ANS: 1 hour
An RFA for treatment can legally be denied by the employer's
insurance carriers Utilization Review doctor if the treatment is not
consistent with which two things? ...ANS: 1. MTUS
2. ACOEM
Apportionment can only be based on what? ...ANS: Causation of
the Permanent Disability
At every visit the QME is expected to assess and clearly document
which 2 things that is addressed by the MTUS? ...ANS: 1.
Functional improvement
2. Work Status including restrictions
Before the 2003 reforms, Disability is defined as_____? ...ANS: IW's
ability to compete in the open labor market
California passed first workers compensation act in what
year? ...ANS: 1911
California passed its first workers' compensation act (voluntary) in
...ANS: 1911
HCC QME EXAM: TERMS, DATES, AND
CONCEPTS NEWLY UPDATED
QUESTIONS WITH CORRECT ANSWERS
A+ GRADED
_____________ officers assist in the resolution of misunderstandings,
disputes, and complaints and conduct monthly seminars at each of
the 24 local district offices. ...ANS: Information and Assistance
(I&A)
"Any person who knowingly presents a false claim for the payment
of a loss, is guilty of a crime and may be for up to ______ years or a
fine up to $______, or both" ...ANS: 5 years, $50,000
A _____ day extension will be given when asked by a QME waiting for
test results or reports ...ANS: 30 day extension
A _____ day extension will be given when asked by a QME with "Good
Cause" (natural disaster or medical emergency) ...ANS: 15 day
extension
A claims administrator must submit all records within_____________
days of the IMR request? ...ANS: 15 days
A Follow Up Medical Legal Report (ML 101) is done ____ months
after the first evaluation, and _____ days to deliver the
report? ...ANS: - 9 months from the prior evaluation
- delivered within 30 days
,ASCORERS STUVIA
A medical-legal cost is defined as a cost for what? ...ANS:
Specified services incurred to prove or disprove a contested case
A Non-AME (QME) must reschedule a CANCELLED appointment
within _____ days of the original scheduled appointment and within
_____ days of the initial request, unless parties agree in writing to
accept a date past that. ...ANS: 30 days, 60 days
A PQME or APQME (but not AME) must reschedule cancelled
appointments within ____ days? ...ANS: 30 days to reschedule
A QME certification is valid for how may years? ...ANS: 2 years
(LC 139.2)
A QME does not have to provide a copy of the psychiatric report to
an injured worker when? ...ANS: the report may cause harm to
the IW
A QME evaluation for compensability (AOE/COE), do not send the
QME report to the_____? ...ANS: Local DEU ??? Chat GPT says IW's
Employer
A QME of an unrepresented IW, a copy of the report must be sent to
which parties? ...ANS: 1. IW
2. Local DEU
3. Claims Administrator (insurance company)
A QME report is due _____ days after the completion of the face-to-
face evaluation ...ANS: 30 days
A Supplemental QME report (no face-to-face evaluation) is due _____
days after the QME received a request to do the report? ...ANS: 60
days
,ASCORERS STUVIA
A violation of LC139(a) conflict of interest referral is a misdemeanor
subject to civil penalties up to $_________ per offense. ...ANS:
$5,000
A worker is injured on June 24, 2008, his vocational rehab benefits
are? ...ANS: Replaced by a supplemental job displacement benefit.
After 01/01/2008, Temporary Disability benefits may last up to
_____ weeks within _____ years of DOI? ...ANS: 1. 104 weeks
2. 5 year
After the injured worker completes a DWC-1 Claim Form, the
employer has _____ days to provide the form to the claims
administrator, employee, dependent, or representative? ...ANS: 1
working day
An AME must reschedule a cancelled appointment within _____ days
of the original scheduled appointment, but can be extended to _____
days if both parties agree? ...ANS: 60, 90 (30 more days than
QME)
An employer has an MPN then what can be pre-designated? ...ANS:
1. MD
2. DO
3. Medical Group
NOT a Chiropractor
An injured worker being treated within an approved MPN who does
not agree with the treating doctors opinion and treatment plan can
seek opinions from how many other doctors within the employers
MPN? ...ANS: 2 other doctors within the MPN
, ASCORERS STUVIA
An injured worker who is being accommodated by their employer
with modified work duty should receive temporary disability
compensation only if what is true? ...ANS: Only if the modified
work pays less than 85% of the IW's salary that was being paid at
the time of injury
An IW has _____ days to request and Independent Medical Review
(IMR) after a Utilization Review (UR) denial? ...ANS: 30 days
An IW may not be kept waiting for more than _____ after the
scheduled appointment time? ...ANS: 1 hour
An RFA for treatment can legally be denied by the employer's
insurance carriers Utilization Review doctor if the treatment is not
consistent with which two things? ...ANS: 1. MTUS
2. ACOEM
Apportionment can only be based on what? ...ANS: Causation of
the Permanent Disability
At every visit the QME is expected to assess and clearly document
which 2 things that is addressed by the MTUS? ...ANS: 1.
Functional improvement
2. Work Status including restrictions
Before the 2003 reforms, Disability is defined as_____? ...ANS: IW's
ability to compete in the open labor market
California passed first workers compensation act in what
year? ...ANS: 1911
California passed its first workers' compensation act (voluntary) in
...ANS: 1911
