Module2_Flashcards_Part1

Question 1

Front

Answer 1

Back

Question 2

What is a Qualified Medical Evaluation (QME)?

Answer 2

An impartial medical evaluation performed by a certified physician to assess an injured worker’s condition and resolve workers’ compensation disputes.

Question 3

Why are QMEs important in California workers’ compensation?

Answer 3

They provide objective medical opinions to settle disputes about injury extent, treatment, disability, and return-to-work status.

Question 4

When is a QME typically needed?

Answer 4

When there is a dispute about injury severity, treatment necessity, disability rating, or return-to-work capability.

Question 5

Who can request a QME?

Answer 5

Usually the injured worker or the insurance company; requests are filed with the Division of Workers’ Compensation.

Question 6

How are QMEs selected?

Answer 6

A panel of QMEs is provided; parties select a physician or follow legal processes if they cannot agree.

Question 7

What must a QME be to qualify?

Answer 7

A licensed California physician experienced in the relevant specialty, trained in impairment evaluation, and certified by the DWC.

Question 8

Who certifies QMEs in California?

Answer 8

The Division of Workers’ Compensation (DWC) under the Administrative Director.

Question 9

What training is required to become a QME?

Answer 9

Completion of an approved QME training program on workers’ comp law, medical-legal reporting, and AMA impairment guidelines.

Question 10

What exam must a physician pass to become a QME?

Answer 10

A written exam on workers’ compensation law, impairment rating, and medical-legal reporting.

Question 11

How long is a QME appointment term?

Answer 11

Two years; reappointment requires meeting ongoing requirements and continuing education.

Question 12

How many continuing education hours are required for QME reappointment after April 1, 2026?

Answer 12

At least 16 hours in impairment evaluation or workers’ comp medical dispute topics within the prior 24 months.

Question 13

What could prevent QME reappointment?

Answer 13

License suspension, too many rejected reports, noncompliance with regulations, or unpaid fees.

Question 14

Who schedules a QME exam if the employee is unrepresented and fails to act within 10 days?

Answer 14

The claims administrator may schedule the appointment per Labor Code §4062.1(c).

Question 15

How soon must a QME exam be scheduled after request?

Answer 15

Within 90 days of request; up to 120 days if the QME cannot meet the 90-day limit.

Question 16

What is the time frame to reschedule if a QME cancels an appointment?

Answer 16

Within 60 days of cancellation unless parties agree otherwise.

Question 17

What is the primary role of a QME report?

Answer 17

To provide a medical-legal evaluation resolving disputed issues in a workers’ compensation claim.

Question 18

What standard guides impairment ratings in QME reports?

Answer 18

The AMA Guides to the Evaluation of Permanent Impairment, 5th Edition (per California requirement).

Question 19

What is apportionment in QME reports?

Answer 19

Separating work-related impairment from non-industrial or pre-existing conditions.

Question 20

What is maximum medical improvement (MMI)?

Answer 20

The point at which a condition is stable and unlikely to change substantially with further treatment.

Question 21

Who can be a QME besides MDs/DOs?

Answer 21

Chiropractors, podiatrists, optometrists, psychologists if certified under QME rules.

Question 22

What must be included in a QME appointment notice?

Answer 22

Exam date/time, location, specialty, instructions for the worker, and rescheduling rights.

Question 23

When must QME supplemental reports be issued after a request?

Answer 23

Within 60 days unless an extension is agreed upon by parties.

Question 24

What is the penalty for late QME reporting without good cause?

Answer 24

Possible denial of payment for the report and disciplinary action by the DWC.

Question 25

What is the purpose of the DWC Medical Unit?

Answer 25

It oversees QME certification, panels, and compliance with reporting standards.

Question 26

How long must QME records be retained?

Answer 26

At least five years after the evaluation or as otherwise required by law.

Question 27

What is the purpose of a Panel QME list?

Answer 27

To give parties three randomly selected certified QMEs from which to choose an evaluator.

Question 28

What happens if the parties cannot agree on a QME from the panel?

Answer 28

A randomly assigned QME from the panel is selected by the DWC system.

Question 29

What is the legal time limit to object to a treating physician’s opinion before requesting a QME?

Answer 29

Within 30 days (represented) or 20 days (unrepresented) after receiving the report, per Labor Code timelines.

Question 30

What does “substantial medical evidence” mean in QME context?

Answer 30

Evidence based on reasonable medical probability with adequate history, exam, and rationale.

Question 31

Who reviews QME reports for adequacy?

Answer 31

The DWC Medical Unit and judges during workers’ compensation hearings.