Module2_Flashcards_Part2 (1)

Question 1

Front

Answer 1

Back

Question 2

What is the consequence of failing the QME competency exam?

Answer 2

You cannot be certified as a QME until you pass the exam.

Question 3

When must a QME notify parties of their exam cancellation?

Answer 3

As soon as possible, generally within 5 business days.

Question 4

What is the role of the claims administrator in QME scheduling?

Answer 4

May schedule an exam if the injured worker is unrepresented and fails to act within 10 days.

Question 5

When can an Agreed Medical Evaluator (AME) be used instead of a QME?

Answer 5

When both parties (injured worker and insurer) agree on one doctor to evaluate the case.

Question 6

What is the difference between QME and AME?

Answer 6

QME is selected via panel process; AME is jointly agreed upon by both parties.

Question 7

What is the time frame for a QME to issue the initial report after the evaluation?

Answer 7

Within 30 days of the examination date unless an extension is approved.

Question 8

What is considered good cause for extending QME reporting time?

Answer 8

Awaiting test results, specialist input, or unavoidable delays beyond the physician’s control.

Question 9

What must a QME include in the medical-legal report?

Answer 9

Patient history, exam findings, diagnosis, impairment rating, apportionment, MMI, work restrictions.

Question 10

What must a QME state about causation?

Answer 10

Whether the industrial injury is a substantial cause (35–40% or more) of the disability or need for treatment.

Question 11

When can a QME disqualify themselves from a case?

Answer 11

Conflict of interest, lack of specialty expertise, or inability to meet reporting deadlines.

Question 12

What are common QME specialties besides orthopedics?

Answer 12

Psychiatry, neurology, chiropractic, pain medicine, internal medicine, occupational medicine.

Question 13

How does an injured worker challenge a QME report?

Answer 13

File an objection and request another QME panel or AME within legal time limits.

Question 14

What is the purpose of permanent disability ratings?

Answer 14

To quantify lasting functional impairment and guide compensation.

Question 15

What is whole person impairment (WPI)?

Answer 15

A percentage estimate of how much an injury affects a person’s overall functioning based on AMA Guides.

Question 16

What is the purpose of the 5th Edition AMA Guides in California?

Answer 16

They standardize impairment ratings for consistency and fairness in workers’ compensation cases.

Question 17

What is a supplemental QME report?

Answer 17

A follow-up report clarifying or adding information to the original QME report after a request by parties.

Question 18

When is a QME required to review medical records?

Answer 18

Before and during the evaluation if records are provided; may request additional relevant records.

Question 19

What happens if parties dispute which records the QME should review?

Answer 19

They can petition a judge to decide admissibility of disputed records.

Question 20

How are interpreter services handled in QME exams?

Answer 20

Interpreter must be certified/qualified; insurer usually pays for interpreter services.

Question 21

What is the rule about videotaping or recording QME exams?

Answer 21

Generally not allowed without prior agreement or court order.

Question 22

Who pays the QME for the evaluation?

Answer 22

The employer or insurer in most cases, as part of workers’ compensation system.

Question 23

What is the legal time limit to object to the QME specialty chosen by the panel?

Answer 23

10 days from receipt of the panel list (represented) or as soon as possible for unrepresented workers.

Question 24

What must the QME do if additional testing is needed?

Answer 24

Arrange or recommend tests and explain in the report why they are necessary for evaluation.

Question 25

How should a QME handle incomplete or missing records?

Answer 25

Note missing records, explain potential impact on the opinion, and may request additional records.

Question 26

What is the “substantial evidence” requirement for QME reports?

Answer 26

Report must be based on facts, medical reasoning, and reasonable medical probability.

Question 27

What is the penalty for false or misleading QME reports?

Answer 27

Possible decertification, fines, and referral to licensing boards.

Question 28

How long is the QME reappointment cycle after initial certification?

Answer 28

Two years, with required continuing education and compliance review.

Question 29

What is the process to renew QME status?

Answer 29

Submit proof of continuing education, pay renewal fee, and meet compliance standards.

Question 30

When may the DWC deny QME renewal?

Answer 30

Failure to complete CE, unpaid fees, disciplinary actions, or repeated inadequate reports.

Question 31

What must QMEs do to maintain impartiality?

Answer 31

Disclose conflicts of interest, avoid treating the injured worker, and remain neutral between parties.