QME Exam 2026/2027 | Qualified Medical
Evaluator Practice Questions & Verified
Answers | Complete Exam Study Guide &
Detailed Rationales
QME EXAM 2026/2027 | QUALIFIED MEDICAL EVALUATOR PRACTICE QUESTIONS
& VERIFIED ANSWERS
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 carefully crafted multiple-choice
questions designed to prepare you for the QME examination by testing your
knowledge across all major exam domains including medical-legal principles,
workers' compensation regulations, causation analysis, impairment ratings, and
professional ethics.
• Use this material by working through questions systematically, reviewing detailed
rationales for each answer to strengthen conceptual understanding and identify
knowledge gaps; focus particularly on areas where you consistently select incorrect
options.
PRACTICE QUESTIONS
Question 1: What is the primary purpose of a Qualified Medical Evaluator
(QME) in workers' compensation cases?
A) To represent the interests of the employer
B) To provide an objective medical evaluation and opinion on medical issues in
dispute
C) To minimize medical treatment costs for the injured worker
D) To determine the amount of disability benefits awarded
E) To negotiate settlements between parties
,✓ CORRECT ANSWER: B) To provide an objective medical evaluation and
opinion on medical issues in dispute
RATIONALE: The fundamental role of a QME is to serve as a neutral evaluator who
provides objective medical opinions on issues that cannot be resolved between the
treating physician and the claims administrator. QMEs are selected from a panel
and must remain impartial, avoiding representation of either party's interests. Their
evaluations are critical in workers' compensation disputes where medical
causation, current medical status, or need for future treatment is contested.
Question 2: Which of the following is NOT a requirement for a physician to be
qualified as a QME?
A) Valid unrestricted California medical license
B) Specialization exclusively in orthopedic surgery
C) Willingness to examine injured workers and provide reports
D) Compliance with specific reporting requirements and timelines
E) Maintenance of professional liability insurance
✓ CORRECT ANSWER: B) Specialization exclusively in orthopedic surgery
RATIONALE: While QMEs must possess a valid unrestricted California medical
license, compliance with reporting requirements, willingness to perform
evaluations, and maintain professional liability insurance, they are NOT required to
specialize exclusively in orthopedic surgery. QMEs can practice in various medical
specialties. The requirement is that they maintain expertise relevant to the medical
issues they evaluate, but there is no exclusive specialization mandate.
Question 3: Under California Workers' Compensation law, what is the
definition of medical causation?
A) Any medical condition that occurs after an industrial injury
,B) A reasonable medical probability, based on competent medical evidence, that
the condition was caused by the industrial injury or occupational exposure
C) A 100% certainty that a condition resulted from workplace exposure
D) Any condition documented in the medical record following an accident
E) A medical opinion that is supported by the majority of treating physicians
✓ CORRECT ANSWER: B) A reasonable medical probability, based on
competent medical evidence, that the condition was caused by the industrial
injury or occupational exposure
RATIONALE: Medical causation in workers' compensation requires establishing that
there is a reasonable medical probability—not mere possibility—that the condition
arose from the industrial injury or occupational exposure. This standard is based
on competent medical evidence and expert opinion. It does not require absolute
certainty (100%), nor does temporal relationship alone establish causation. The
evaluation must be grounded in recognized medical principles and literature.
Question 4: What does the term "apportionment" mean in the context of
workers' compensation?
A) Dividing payment of benefits equally among multiple insurers
B) The reduction in permanent disability benefits by the percentage of permanent
disability caused by conditions not related to the industrial injury
C) Allocating medical treatment costs between employer and employee
D) Determining which body part was injured in a multi-system injury
E) Distributing settlement funds to medical providers
✓ CORRECT ANSWER: B) The reduction in permanent disability benefits by the
percentage of permanent disability caused by conditions not related to the
industrial injury
RATIONALE: Apportionment is a critical legal concept in California workers'
compensation that requires evaluators to determine what percentage of the
, permanent disability is attributable to the industrial injury versus pre-existing
conditions or other non-occupational factors. When apportionment is applied,
permanent disability benefits are reduced accordingly, with only the injury-related
percentage being compensable. This requires detailed analysis of the employee's
prior medical history.
Question 5: Which of the following statements regarding impairment ratings
is correct?
A) Impairment ratings must be based solely on the employee's subjective
complaints
B) The Permanent Disability Rating Schedule (PDRS) provides a range of disability
percentages for various conditions
C) Impairment ratings are always the same regardless of the employee's age and
occupation
D) An impairment rating cannot be assigned until the employee reaches maximum
medical improvement
E) Both B and D are correct
✓ CORRECT ANSWER: E) Both B and D are correct
RATIONALE: California law requires two key components for proper impairment
rating assignment: first, the employee must reach Maximum Medical Improvement
(MMI)—the point when the condition has stabilized and no further improvement is
expected; second, ratings must be assigned using the Permanent Disability Rating
Schedule, which provides specific ranges for conditions organized by body part and
severity level. The PDRS incorporates factors such as age, occupation, and the
specific nature of the disability to determine appropriate disability percentages.
Question 6: What is Maximum Medical Improvement (MMI)?
A) The point at which the employee returns to full-time work
Evaluator Practice Questions & Verified
Answers | Complete Exam Study Guide &
Detailed Rationales
QME EXAM 2026/2027 | QUALIFIED MEDICAL EVALUATOR PRACTICE QUESTIONS
& VERIFIED ANSWERS
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 carefully crafted multiple-choice
questions designed to prepare you for the QME examination by testing your
knowledge across all major exam domains including medical-legal principles,
workers' compensation regulations, causation analysis, impairment ratings, and
professional ethics.
• Use this material by working through questions systematically, reviewing detailed
rationales for each answer to strengthen conceptual understanding and identify
knowledge gaps; focus particularly on areas where you consistently select incorrect
options.
PRACTICE QUESTIONS
Question 1: What is the primary purpose of a Qualified Medical Evaluator
(QME) in workers' compensation cases?
A) To represent the interests of the employer
B) To provide an objective medical evaluation and opinion on medical issues in
dispute
C) To minimize medical treatment costs for the injured worker
D) To determine the amount of disability benefits awarded
E) To negotiate settlements between parties
,✓ CORRECT ANSWER: B) To provide an objective medical evaluation and
opinion on medical issues in dispute
RATIONALE: The fundamental role of a QME is to serve as a neutral evaluator who
provides objective medical opinions on issues that cannot be resolved between the
treating physician and the claims administrator. QMEs are selected from a panel
and must remain impartial, avoiding representation of either party's interests. Their
evaluations are critical in workers' compensation disputes where medical
causation, current medical status, or need for future treatment is contested.
Question 2: Which of the following is NOT a requirement for a physician to be
qualified as a QME?
A) Valid unrestricted California medical license
B) Specialization exclusively in orthopedic surgery
C) Willingness to examine injured workers and provide reports
D) Compliance with specific reporting requirements and timelines
E) Maintenance of professional liability insurance
✓ CORRECT ANSWER: B) Specialization exclusively in orthopedic surgery
RATIONALE: While QMEs must possess a valid unrestricted California medical
license, compliance with reporting requirements, willingness to perform
evaluations, and maintain professional liability insurance, they are NOT required to
specialize exclusively in orthopedic surgery. QMEs can practice in various medical
specialties. The requirement is that they maintain expertise relevant to the medical
issues they evaluate, but there is no exclusive specialization mandate.
Question 3: Under California Workers' Compensation law, what is the
definition of medical causation?
A) Any medical condition that occurs after an industrial injury
,B) A reasonable medical probability, based on competent medical evidence, that
the condition was caused by the industrial injury or occupational exposure
C) A 100% certainty that a condition resulted from workplace exposure
D) Any condition documented in the medical record following an accident
E) A medical opinion that is supported by the majority of treating physicians
✓ CORRECT ANSWER: B) A reasonable medical probability, based on
competent medical evidence, that the condition was caused by the industrial
injury or occupational exposure
RATIONALE: Medical causation in workers' compensation requires establishing that
there is a reasonable medical probability—not mere possibility—that the condition
arose from the industrial injury or occupational exposure. This standard is based
on competent medical evidence and expert opinion. It does not require absolute
certainty (100%), nor does temporal relationship alone establish causation. The
evaluation must be grounded in recognized medical principles and literature.
Question 4: What does the term "apportionment" mean in the context of
workers' compensation?
A) Dividing payment of benefits equally among multiple insurers
B) The reduction in permanent disability benefits by the percentage of permanent
disability caused by conditions not related to the industrial injury
C) Allocating medical treatment costs between employer and employee
D) Determining which body part was injured in a multi-system injury
E) Distributing settlement funds to medical providers
✓ CORRECT ANSWER: B) The reduction in permanent disability benefits by the
percentage of permanent disability caused by conditions not related to the
industrial injury
RATIONALE: Apportionment is a critical legal concept in California workers'
compensation that requires evaluators to determine what percentage of the
, permanent disability is attributable to the industrial injury versus pre-existing
conditions or other non-occupational factors. When apportionment is applied,
permanent disability benefits are reduced accordingly, with only the injury-related
percentage being compensable. This requires detailed analysis of the employee's
prior medical history.
Question 5: Which of the following statements regarding impairment ratings
is correct?
A) Impairment ratings must be based solely on the employee's subjective
complaints
B) The Permanent Disability Rating Schedule (PDRS) provides a range of disability
percentages for various conditions
C) Impairment ratings are always the same regardless of the employee's age and
occupation
D) An impairment rating cannot be assigned until the employee reaches maximum
medical improvement
E) Both B and D are correct
✓ CORRECT ANSWER: E) Both B and D are correct
RATIONALE: California law requires two key components for proper impairment
rating assignment: first, the employee must reach Maximum Medical Improvement
(MMI)—the point when the condition has stabilized and no further improvement is
expected; second, ratings must be assigned using the Permanent Disability Rating
Schedule, which provides specific ranges for conditions organized by body part and
severity level. The PDRS incorporates factors such as age, occupation, and the
specific nature of the disability to determine appropriate disability percentages.
Question 6: What is Maximum Medical Improvement (MMI)?
A) The point at which the employee returns to full-time work
