QME Exam Already RATED A+
Questions and Answers About Qualified Medical Evaluators (QME) and Workers' Compensation Claims
Q1: Who has the authority to appoint physicians as Qualified Medical Evaluators?
A1: The Administrative Director (AD) is responsible for appointing physicians as QMEs, a...
QME Exam Already RATED A+
Questions and Answers About Qualified Medical Evaluators (QME) and Workers' Compensation Claims
Q1: Who has the authority to appoint physicians as Qualified Medical Evaluators?
A1: The Administrative Director (AD) is responsible for appointing physicians as QMEs, as specified in
Labor Code 139.2.
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Q2: What is the duration of a QME evaluator's appointment?
A2: A QME evaluator's appointment lasts for a period of 2 years, according to Labor Code 139.2.
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Q3: What are the prerequisites for an individual seeking appointment as a QME?
A3: To be eligible for QME appointment, candidates must:
1. Pass the QME competency examination.
2. Complete a 12-hour course focused on writing disability evaluation reports.
3. Spend at least one-third of their total practice time providing direct medical treatment or serve as an
AME on eight or more occasions within the 12 months preceding the application.
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Q4: Under what circumstances can a QME be terminated or suspended without a hearing?
A4: A QME may face termination or suspension without a hearing for the following reasons:
1. The licensing board has suspended, revoked, or terminated their license to practice.
2. The QME fails to pay the required fees, both upon appointment and annually thereafter.
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,Q5: What are some grounds for disciplining a QME following a hearing?
A5: After a hearing, a QME may be disciplined (suspended or terminated) for several reasons, including:
1. Violation of significant statutory or administrative duties.
2. Failure to adhere to medical procedures or qualifications.
3. Non-compliance with established timeframe standards.
4. Inability to meet licensing or certification requirements.
5. Creating inadequate medical-legal evaluations that do not meet minimum standards set by the
administrative director or appeals board.
6. Making substantial misrepresentations or false statements in the application for appointment or
reappointment.
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Q6: What substantive medical disputes are typically resolved by QMEs?
A6: QMEs commonly address the following types of substantive medical disputes:
1. The compensability of a claim.
2. Assessment of permanent disability.
3. A broad category covering issues like temporary disability, work restrictions, further disabilities arising
from an original injury, or the addition of new body parts to a claim.
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Q7: How is an injury defined in the context of compensability claims?
A7: An injury, for compensability purposes, can be defined as:
1. An injury or disease arising out of employment.
2. A derivative injury resulting from treatment for an injury related to employment.
3. Any reactions to or side effects from preventative healthcare provided by the employer to healthcare
workers.
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Q8: What distinguishes a specific injury from a cumulative injury?
A8: A specific injury occurs due to a singular incident or exposure, while a cumulative injury develops
from repetitive trauma, whether mental or physical, over an extended period.
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Q9: What are the criteria for a condition to qualify as an injury?
A9: To be considered an injury, the condition must:
1. Cause some form of disability.
2. Result in a requirement for medical treatment.
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Q10: What is classified as an occupational disease?
A10: An occupational disease is any disease that is, in whole or in part, caused by work-related activities.
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Q11: Name some types of injuries that are excluded from workers' compensation coverage.
A11: Injuries that may be excluded include:
1. Those caused by the employee's use of alcohol or illegal drugs.
2. Intentionally self-inflicted injuries.
3. Suicidal actions.
4. Injuries stemming from altercations in which the employee was the initial aggressor.
5. Injuries resulting from the employee's commission of a felony, for which they have been convicted.
6. Off-duty recreational activities that do not relate to the employee's work duties.
7. Psychiatric injuries claimed after notice of termination or layoff, unless specific conditions apply.
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