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
4 basic conditions to establish a workers' compensation claim - answer✔(1) *Injury*
(physiological or psychological harm);
(2) Employment relationship;
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