QME Exam 2026 2027 335 Application Questions with Detailed
Rationales California Qualified Medical Evaluator
Updated Questions and Verified Answers | 335 Questions | 100% VERIFIED
Introduction
The California Qualified Medical Evaluator (QME) examination evaluates the knowledge and
professional judgment required for competent medical-legal evaluation in the state
workers' compensation system. This comprehensive assessment spans eight core domains:
California Workers' Compensation System and Labor Code; Medical-Legal Evaluation and
QME Panel Process; Causation, Apportionment, and Aggravation; Impairment Rating and
the AMA Guides; QME Ethics, Regulations, and Billing; Med-Legal Report Writing and
Documentation; Legal Testimony and Deposition Preparation; and Nursing and Clinical
Roles in Workers' Compensation. Each question that follows targets a distinct sub-topic
within this blueprint. Mastery of these domains supports state certification and strengthens
medical-legal operational execution and clinical decision-making in workers' compensation.
1. Workers' compensation in California is fundamentally which type of system?
A. A tort-based system
B. A no-fault system
C. A criminal system
D. A contract system
Correct Answer: B. A no-fault system
Rationale: Workers' compensation provides benefits without regard to fault in
exchange for the exclusive remedy bar against civil suits. It is not a tort, criminal, or
contract system.
2. The 'exclusive remedy' doctrine means that an injured worker:
A. May sue the employer for any injury
B. May only sue the state
C. Has no benefits available
D. Generally cannot sue the employer in civil court and must seek benefits through
workers' compensation
Correct Answer: D. Generally cannot sue the employer in civil court and must seek
benefits through workers' compensation
Rationale: The exclusive remedy doctrine channels workplace injury claims into
workers' compensation and bars most civil suits against the employer. It does not
eliminate benefits.
3. Under Labor Code 3208, an 'injury' includes:
A. Only catastrophic injuries
B. Any injury or disease arising out of and in the course of employment
C. Only single-accident injuries
, D. Only injuries occurring off duty
Correct Answer: B. Any injury or disease arising out of and in the course of
employment
Rationale: Labor Code 3208 broadly defines injury to include injury or disease arising
out of and in the course of employment, including cumulative trauma.
4. 'Arising out of employment' (AOE) refers to:
A. The geographic location of the injury only
B. A causal connection between the employment and the injury
C. The time of day only
D. The worker's seniority
Correct Answer: B. A causal connection between the employment and the injury
Rationale: AOE concerns the causal relationship between the work and the injury.
Location, time, and seniority do not alone establish AOE.
5. 'In the course of employment' (COE) refers to:
A. Whether the injury was foreseeable
B. The worker's job title
C. The time, place, and circumstances under which the injury occurs
D. The employer's profitability
Correct Answer: C. The time, place, and circumstances under which the injury
occurs
Rationale: COE examines when, where, and under what circumstances the injury
occurred. It is distinct from foreseeability, title, or profitability.
6. A 'specific injury' is:
A. An injury developing gradually over time
B. A psychological injury only
C. An injury with no known cause
D. An injury resulting from a single identifiable event
Correct Answer: D. An injury resulting from a single identifiable event
Rationale: A specific injury arises from one identifiable incident. Gradual development
describes cumulative trauma.
7. A cumulative trauma (CT) injury is:
A. A single sudden accident
B. An injury caused by repetitive mentally or physically traumatic activities over time
C. An injury occurring during a car crash only
D. A congenital condition present at birth
Correct Answer: B. An injury caused by repetitive mentally or physically
traumatic activities over time
Rationale: Cumulative trauma results from repeated activities over time rather than a
single event. A single accident is a specific injury.
,8. Under Labor Code 5412, the date of injury for a cumulative trauma is:
A. The date the employee first suffered disability and knew or should have known it was
work-related
B. The date of hire
C. The date of the last treatment
D. The date of retirement
Correct Answer: A. The date the employee first suffered disability and knew or
should have known it was work-related
Rationale: Labor Code 5412 sets the CT date of injury as when the employee first had
disability and knew or should have known the injury was work-related.
9. Under Labor Code 5402, if a claim is not denied within 90 days of the claim form
being filed, the injury is:
A. Presumed compensable, subject to rebuttal
B. Automatically denied
C. Dismissed
D. Converted to a civil lawsuit
Correct Answer: A. Presumed compensable, subject to rebuttal
Rationale: Labor Code 5402 creates a rebuttable presumption of compensability when
the claim is not denied within 90 days of filing.
10. The waiting period for temporary disability benefits means that:
A. TD begins immediately for every injury
B. No TD is paid for the first 3 days unless the disability exceeds 14 days or the worker
is hospitalized
C. TD is never paid
D. TD is paid only after 30 days
Correct Answer: B. No TD is paid for the first 3 days unless the disability exceeds
14 days or the worker is hospitalized
Rationale: Under Labor Code 4650, no TD is payable for the first 3 days of disability
unless it lasts more than 14 days or the worker is hospitalized.
11. Temporary disability (TD) benefits are paid at:
A. Full wages
B. A flat rate for everyone
C. Half the average weekly wage
D. Two-thirds of the worker's average weekly earnings, subject to statutory minimums
and maximums
Correct Answer: D. Two-thirds of the worker's average weekly earnings, subject
to statutory minimums and maximums
Rationale: TD is generally two-thirds of average weekly earnings within statutory
minimum and maximum limits under Labor Code 4653.
, 12. Under Labor Code 4656, aggregate temporary disability benefits are generally
capped at:
A. 104 weeks within a five-year period
B. 52 weeks
C. 10 years
D. No cap at all
Correct Answer: A. 104 weeks within a five-year period
Rationale: Labor Code 4656 caps aggregate TD at 104 weeks within five years from the
date of injury (with exceptions for certain severe injuries).
13. Permanent disability (PD) is:
A. A temporary inability to work
B. A psychological reaction only
C. The same as temporary disability
D. The residual impairment remaining after the worker reaches maximum medical
improvement
Correct Answer: D. The residual impairment remaining after the worker reaches
maximum medical improvement
Rationale: PD compensates for the lasting impairment that remains once the condition
is permanent and stationary, unlike temporary disability.
14. Permanent and stationary (P&S) status refers to:
A. The point at which the condition has stabilized and is unlikely to change substantially
within the next year with or without treatment
B. The first day off work
C. A temporary flare-up
D. The date of injury
Correct Answer: A. The point at which the condition has stabilized and is unlikely
to change substantially within the next year with or without treatment
Rationale: P&S (maximum medical improvement) means the condition has reached a
stable plateau, which is the basis for rating permanent disability.
15. The Medical Provider Network (MPN) is:
A. A labor union organization
B. A court of appeal
C. A billing agency
D. A network of approved providers an employer may establish to deliver medical care
to injured workers
Correct Answer: D. A network of approved providers an employer may establish
to deliver medical care to injured workers
Rationale: An MPN is an approved network of providers through which employers may
direct medical treatment of injured workers under Labor Code 4616.
16. Utilization Review (UR) is the process of:
Rationales California Qualified Medical Evaluator
Updated Questions and Verified Answers | 335 Questions | 100% VERIFIED
Introduction
The California Qualified Medical Evaluator (QME) examination evaluates the knowledge and
professional judgment required for competent medical-legal evaluation in the state
workers' compensation system. This comprehensive assessment spans eight core domains:
California Workers' Compensation System and Labor Code; Medical-Legal Evaluation and
QME Panel Process; Causation, Apportionment, and Aggravation; Impairment Rating and
the AMA Guides; QME Ethics, Regulations, and Billing; Med-Legal Report Writing and
Documentation; Legal Testimony and Deposition Preparation; and Nursing and Clinical
Roles in Workers' Compensation. Each question that follows targets a distinct sub-topic
within this blueprint. Mastery of these domains supports state certification and strengthens
medical-legal operational execution and clinical decision-making in workers' compensation.
1. Workers' compensation in California is fundamentally which type of system?
A. A tort-based system
B. A no-fault system
C. A criminal system
D. A contract system
Correct Answer: B. A no-fault system
Rationale: Workers' compensation provides benefits without regard to fault in
exchange for the exclusive remedy bar against civil suits. It is not a tort, criminal, or
contract system.
2. The 'exclusive remedy' doctrine means that an injured worker:
A. May sue the employer for any injury
B. May only sue the state
C. Has no benefits available
D. Generally cannot sue the employer in civil court and must seek benefits through
workers' compensation
Correct Answer: D. Generally cannot sue the employer in civil court and must seek
benefits through workers' compensation
Rationale: The exclusive remedy doctrine channels workplace injury claims into
workers' compensation and bars most civil suits against the employer. It does not
eliminate benefits.
3. Under Labor Code 3208, an 'injury' includes:
A. Only catastrophic injuries
B. Any injury or disease arising out of and in the course of employment
C. Only single-accident injuries
, D. Only injuries occurring off duty
Correct Answer: B. Any injury or disease arising out of and in the course of
employment
Rationale: Labor Code 3208 broadly defines injury to include injury or disease arising
out of and in the course of employment, including cumulative trauma.
4. 'Arising out of employment' (AOE) refers to:
A. The geographic location of the injury only
B. A causal connection between the employment and the injury
C. The time of day only
D. The worker's seniority
Correct Answer: B. A causal connection between the employment and the injury
Rationale: AOE concerns the causal relationship between the work and the injury.
Location, time, and seniority do not alone establish AOE.
5. 'In the course of employment' (COE) refers to:
A. Whether the injury was foreseeable
B. The worker's job title
C. The time, place, and circumstances under which the injury occurs
D. The employer's profitability
Correct Answer: C. The time, place, and circumstances under which the injury
occurs
Rationale: COE examines when, where, and under what circumstances the injury
occurred. It is distinct from foreseeability, title, or profitability.
6. A 'specific injury' is:
A. An injury developing gradually over time
B. A psychological injury only
C. An injury with no known cause
D. An injury resulting from a single identifiable event
Correct Answer: D. An injury resulting from a single identifiable event
Rationale: A specific injury arises from one identifiable incident. Gradual development
describes cumulative trauma.
7. A cumulative trauma (CT) injury is:
A. A single sudden accident
B. An injury caused by repetitive mentally or physically traumatic activities over time
C. An injury occurring during a car crash only
D. A congenital condition present at birth
Correct Answer: B. An injury caused by repetitive mentally or physically
traumatic activities over time
Rationale: Cumulative trauma results from repeated activities over time rather than a
single event. A single accident is a specific injury.
,8. Under Labor Code 5412, the date of injury for a cumulative trauma is:
A. The date the employee first suffered disability and knew or should have known it was
work-related
B. The date of hire
C. The date of the last treatment
D. The date of retirement
Correct Answer: A. The date the employee first suffered disability and knew or
should have known it was work-related
Rationale: Labor Code 5412 sets the CT date of injury as when the employee first had
disability and knew or should have known the injury was work-related.
9. Under Labor Code 5402, if a claim is not denied within 90 days of the claim form
being filed, the injury is:
A. Presumed compensable, subject to rebuttal
B. Automatically denied
C. Dismissed
D. Converted to a civil lawsuit
Correct Answer: A. Presumed compensable, subject to rebuttal
Rationale: Labor Code 5402 creates a rebuttable presumption of compensability when
the claim is not denied within 90 days of filing.
10. The waiting period for temporary disability benefits means that:
A. TD begins immediately for every injury
B. No TD is paid for the first 3 days unless the disability exceeds 14 days or the worker
is hospitalized
C. TD is never paid
D. TD is paid only after 30 days
Correct Answer: B. No TD is paid for the first 3 days unless the disability exceeds
14 days or the worker is hospitalized
Rationale: Under Labor Code 4650, no TD is payable for the first 3 days of disability
unless it lasts more than 14 days or the worker is hospitalized.
11. Temporary disability (TD) benefits are paid at:
A. Full wages
B. A flat rate for everyone
C. Half the average weekly wage
D. Two-thirds of the worker's average weekly earnings, subject to statutory minimums
and maximums
Correct Answer: D. Two-thirds of the worker's average weekly earnings, subject
to statutory minimums and maximums
Rationale: TD is generally two-thirds of average weekly earnings within statutory
minimum and maximum limits under Labor Code 4653.
, 12. Under Labor Code 4656, aggregate temporary disability benefits are generally
capped at:
A. 104 weeks within a five-year period
B. 52 weeks
C. 10 years
D. No cap at all
Correct Answer: A. 104 weeks within a five-year period
Rationale: Labor Code 4656 caps aggregate TD at 104 weeks within five years from the
date of injury (with exceptions for certain severe injuries).
13. Permanent disability (PD) is:
A. A temporary inability to work
B. A psychological reaction only
C. The same as temporary disability
D. The residual impairment remaining after the worker reaches maximum medical
improvement
Correct Answer: D. The residual impairment remaining after the worker reaches
maximum medical improvement
Rationale: PD compensates for the lasting impairment that remains once the condition
is permanent and stationary, unlike temporary disability.
14. Permanent and stationary (P&S) status refers to:
A. The point at which the condition has stabilized and is unlikely to change substantially
within the next year with or without treatment
B. The first day off work
C. A temporary flare-up
D. The date of injury
Correct Answer: A. The point at which the condition has stabilized and is unlikely
to change substantially within the next year with or without treatment
Rationale: P&S (maximum medical improvement) means the condition has reached a
stable plateau, which is the basis for rating permanent disability.
15. The Medical Provider Network (MPN) is:
A. A labor union organization
B. A court of appeal
C. A billing agency
D. A network of approved providers an employer may establish to deliver medical care
to injured workers
Correct Answer: D. A network of approved providers an employer may establish
to deliver medical care to injured workers
Rationale: An MPN is an approved network of providers through which employers may
direct medical treatment of injured workers under Labor Code 4616.
16. Utilization Review (UR) is the process of:
