QME EXAM QUESTIONS AND ANSWERS (GRADED A)QME EXAM QUESTIONS AND ANSWERS (GRADED A)QME EXAM QUESTIONS AND ANSWERS (GRADED A)QME EXAM QUESTIONS AND ANSWERS (GRADED A)Holds authority to appoint physicians as QME evaluators - ANSWER-Administrative Director (AD) (LC 139.2)
Term of appointment as QME ...
QME EXAM QUESTIONS AND ANSWERS
(GRADED A)
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;
(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 - ANSWER-(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 - ANSWER-*Flare-ups* or *recurrence* of a
previous industrial injury or illness; not been caused by the current employment
Date of injury (DOI)-specific injury - ANSWER-Date on which the incident or exposure
occurred
Date of injury (DOI)-cumulative injury - ANSWER-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
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