QME EXAM 2026/2027: 200 PRACTICE QUESTIONS WITH
VERIFIED ANSWERS & RATIONALES
Exams of Medical Sciences • State of California Division of Workers' Compensation — Qualified Medical Evaluator
─────────────────────────────────────────────────────────────────────────────────────
California Labor Code & Title 8 CCR §§30-44 • AMA Guides 5th Edition • MTUS • 200 Questions • Randomized Key • For Study Purposes
Only
IMPORTANT NOTICE: This document is an independent study aid reflecting the current California workers' compensation system, QME regulations (Title 8
CCR §§30–44), AMA Guides to the Evaluation of Permanent Impairment 5th Edition (Labor Code §4660), and MTUS/evidence-based guidelines (2025-
2026). It is NOT an actual, leaked, or reproduced DWC examination and does not guarantee QME certification. QME competence exams are administered
by the DWC; verify current regulations and guides before testing.
Section 1: Brief Introduction
The QME (Qualified Medical Evaluator) examination validates competency for California workers'
compensation medical-legal evaluation, emphasizing workers' compensation law, QME regulations
and ethics, impairment rating per the AMA Guides 5th Edition, and medical-legal reporting. This 200-
question practice exam simulates actual DWC conditions with case-based impairment, apportionment,
MTUS, and deposition scenarios aligned to current statutes.
Instructions: Select the single best answer for each medical-legal scenario. Correct answers are shown in bold cyan and are randomized
across A–D (50 each). Review rationales immediately after each item, noting Labor Code, Title 8 CCR, and AMA Guides 5th principles. Time
allocation: ~75 seconds per item (≈ 4.2 hours total).
Section 2: The Complete Exam — 200 Questions with Rationales
1. Under the California workers' compensation system, the ‘no-fault’ principle means:
A. Employer can deny all injuries if employee was partially at fault
B. Employee receives benefits for industrial injury regardless of fault, with negligence
generally not litigated, in exchange for limited exclusive remedy
C. Only intentional employer torts are covered
D. Employee must prove employer negligence to receive benefits
Rationale: Labor Code §3600 establishes no-fault: benefits without proving fault, with exclusive
remedy barring civil suit except narrow exceptions. This is the historic quid pro quo.
2. An injured worker in California is entitled to which of the following benefits as a matter of right?
A. Unlimited wage loss without cap
B. Pain and suffering damages
C. Punitive damages against employer
D. Medical treatment, temporary disability, permanent disability, and supplemental job
displacement where applicable (Labor Code §4650 et seq.)
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, Rationale: Core benefits are medical, TD, PD, SJDB/voucher, plus death benefits. Pain/suffering and
punitive damages are not workers' comp benefits.
3. Employer responsibilities under Labor Code §5400-§5404 include:
A. Provide DWC-1 claim form within one working day of notice of injury and authorize up to
$10,000 in treatment pending claims decision within 90 days per §5402
B. Deny treatment until applicant hires attorney
C. No requirement to provide claim form
D. Wait 90 days before providing any medical care
Rationale: §5401 requires DWC-1 promptly; §5402 presumption and $10k pre-decision treatment.
Early treatment authorization is mandated.
4. The 90-day delay period under Labor Code §5402 provides that:
A. No presumption applies in California
B. Claim is automatically denied after 90 days
C. Employee must pay for own treatment during 90 days
D. If employer fails to deny liability within 90 days after DWC-1 filing, injury is presumed
compensable (rebuttable only with evidence not available earlier)
Rationale: §5402 presumption after 90 days without rejection shifts burden. It is preventable by timely
investigation and denial notice.
5. The Division of Workers' Compensation (DWC) primarily:
A. Represents injured workers as attorneys
B. Administers the system: adjudicates disputes via WCAB, regulates QMEs, and enforces
workers' compensation laws
C. Sets employer wages
D. Provides private health insurance
Rationale: DWC is the administrative agency (within DIR), overseeing WCAB judges, EDD integration,
and QME program.
6. An ‘industrial injury’ under Labor Code §3208 includes:
A. Only traumatic injuries occurring at fixed workplace
B. Only injuries with witnesses
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, C. Any injury arising out of and in course of employment (AOE/COE), including specific
injury, cumulative trauma (CT), and occupational disease
D. Only injuries requiring hospitalization
Rationale: AOE/COE defines compensability; CT per §3208.1 is repetitive exposures; occupational
disease is compensable where work is causative.
7. Cumulative trauma (CT) claim date is:
A. Date of hiring
B. Date claim form printed
C. Date employee knew or should have known injury was industrially caused and suffered
disability or need for treatment (Labor Code §5412)
D. Date of first exposure only
Rationale: §5412 CT date is knowledge + disability/need for treatment; determines statute of
limitations and triggers reporting.
8. Statute of limitations for filing an Application for Adjudication of Claim is generally:
A. 30 days from injury
B. No limit
C. One year from date of injury, last benefit, or knowledge for CT, per Labor Code §5405
D. Five years automatically
Rationale: §5405: 1 year from injury or last benefit or date benefits should have been provided;
minor/tolling exceptions apply.
9. An employer who is illegally uninsured for workers' compensation:
A. Faces no penalty
B. Is liable under Labor Code §3706 for civil suit (employee may sue in superior court),
penalties, and possible criminal liability, and the Uninsured Employers Benefits Trust Fund
(UEBTF) may pay benefits
C. Can still use exclusive remedy defense fully
D. Has no liability
Rationale: Uninsured employer loses exclusive remedy protection and faces §3715 penalties and stop
orders; UEBTF is backup payer.
10. The Workers’ Compensation Appeals Board (WCAB) is:
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, A. A private arbitration panel
B. A federal court
C. A seven-member adjudicatory body appointed by the Governor that en banc reviews and
reconsiders WCJ decisions
D. The same as DWC’s Information & Assistance
Rationale: WCAB commissioners review petitions for reconsideration; WCJs are trial judges at district
offices.
11. An injured worker’s right to predesignate a personal physician for treatment requires:
A. Oral designation at time of injury
B. Only after injury notice
C. Prior written notice to employer before injury with physician’s agreement, per Labor
Code §4600(d)
D. No prior notification
Rationale: Predesignation must be pre-injury, in writing, with carrier notice and physician agreement
to treat for workers' comp. MPN otherwise controls.
12. Medical Provider Network (MPN) rules under Labor Code §4616 provide:
A. No regulation of MPN
B. Employee may use any doctor regardless of MPN
C. Employee must always use MPN physicians after employer notice, except for emergency
or predesignation
D. MPN is optional for employers
Rationale: If valid MPN noticed, injured worker generally treats within network; non-MPN reporting
may lead to nonpayment. Predesignation and emergency are exceptions.
13. An ‘applicant’ and ‘defendant’ in workers' compensation nomenclature are:
A. Defendant is always QME
B. No distinction exists
C. Both are physicians
D. Applicant is injured worker; defendant is employer/insurer (and sometimes UEBTF or
Subsequent Injuries Benefits Trust Fund)
Rationale: Parties are applicant vs defendant(s); QMEs are neutrals, not parties.
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
VERIFIED ANSWERS & RATIONALES
Exams of Medical Sciences • State of California Division of Workers' Compensation — Qualified Medical Evaluator
─────────────────────────────────────────────────────────────────────────────────────
California Labor Code & Title 8 CCR §§30-44 • AMA Guides 5th Edition • MTUS • 200 Questions • Randomized Key • For Study Purposes
Only
IMPORTANT NOTICE: This document is an independent study aid reflecting the current California workers' compensation system, QME regulations (Title 8
CCR §§30–44), AMA Guides to the Evaluation of Permanent Impairment 5th Edition (Labor Code §4660), and MTUS/evidence-based guidelines (2025-
2026). It is NOT an actual, leaked, or reproduced DWC examination and does not guarantee QME certification. QME competence exams are administered
by the DWC; verify current regulations and guides before testing.
Section 1: Brief Introduction
The QME (Qualified Medical Evaluator) examination validates competency for California workers'
compensation medical-legal evaluation, emphasizing workers' compensation law, QME regulations
and ethics, impairment rating per the AMA Guides 5th Edition, and medical-legal reporting. This 200-
question practice exam simulates actual DWC conditions with case-based impairment, apportionment,
MTUS, and deposition scenarios aligned to current statutes.
Instructions: Select the single best answer for each medical-legal scenario. Correct answers are shown in bold cyan and are randomized
across A–D (50 each). Review rationales immediately after each item, noting Labor Code, Title 8 CCR, and AMA Guides 5th principles. Time
allocation: ~75 seconds per item (≈ 4.2 hours total).
Section 2: The Complete Exam — 200 Questions with Rationales
1. Under the California workers' compensation system, the ‘no-fault’ principle means:
A. Employer can deny all injuries if employee was partially at fault
B. Employee receives benefits for industrial injury regardless of fault, with negligence
generally not litigated, in exchange for limited exclusive remedy
C. Only intentional employer torts are covered
D. Employee must prove employer negligence to receive benefits
Rationale: Labor Code §3600 establishes no-fault: benefits without proving fault, with exclusive
remedy barring civil suit except narrow exceptions. This is the historic quid pro quo.
2. An injured worker in California is entitled to which of the following benefits as a matter of right?
A. Unlimited wage loss without cap
B. Pain and suffering damages
C. Punitive damages against employer
D. Medical treatment, temporary disability, permanent disability, and supplemental job
displacement where applicable (Labor Code §4650 et seq.)
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, Rationale: Core benefits are medical, TD, PD, SJDB/voucher, plus death benefits. Pain/suffering and
punitive damages are not workers' comp benefits.
3. Employer responsibilities under Labor Code §5400-§5404 include:
A. Provide DWC-1 claim form within one working day of notice of injury and authorize up to
$10,000 in treatment pending claims decision within 90 days per §5402
B. Deny treatment until applicant hires attorney
C. No requirement to provide claim form
D. Wait 90 days before providing any medical care
Rationale: §5401 requires DWC-1 promptly; §5402 presumption and $10k pre-decision treatment.
Early treatment authorization is mandated.
4. The 90-day delay period under Labor Code §5402 provides that:
A. No presumption applies in California
B. Claim is automatically denied after 90 days
C. Employee must pay for own treatment during 90 days
D. If employer fails to deny liability within 90 days after DWC-1 filing, injury is presumed
compensable (rebuttable only with evidence not available earlier)
Rationale: §5402 presumption after 90 days without rejection shifts burden. It is preventable by timely
investigation and denial notice.
5. The Division of Workers' Compensation (DWC) primarily:
A. Represents injured workers as attorneys
B. Administers the system: adjudicates disputes via WCAB, regulates QMEs, and enforces
workers' compensation laws
C. Sets employer wages
D. Provides private health insurance
Rationale: DWC is the administrative agency (within DIR), overseeing WCAB judges, EDD integration,
and QME program.
6. An ‘industrial injury’ under Labor Code §3208 includes:
A. Only traumatic injuries occurring at fixed workplace
B. Only injuries with witnesses
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, C. Any injury arising out of and in course of employment (AOE/COE), including specific
injury, cumulative trauma (CT), and occupational disease
D. Only injuries requiring hospitalization
Rationale: AOE/COE defines compensability; CT per §3208.1 is repetitive exposures; occupational
disease is compensable where work is causative.
7. Cumulative trauma (CT) claim date is:
A. Date of hiring
B. Date claim form printed
C. Date employee knew or should have known injury was industrially caused and suffered
disability or need for treatment (Labor Code §5412)
D. Date of first exposure only
Rationale: §5412 CT date is knowledge + disability/need for treatment; determines statute of
limitations and triggers reporting.
8. Statute of limitations for filing an Application for Adjudication of Claim is generally:
A. 30 days from injury
B. No limit
C. One year from date of injury, last benefit, or knowledge for CT, per Labor Code §5405
D. Five years automatically
Rationale: §5405: 1 year from injury or last benefit or date benefits should have been provided;
minor/tolling exceptions apply.
9. An employer who is illegally uninsured for workers' compensation:
A. Faces no penalty
B. Is liable under Labor Code §3706 for civil suit (employee may sue in superior court),
penalties, and possible criminal liability, and the Uninsured Employers Benefits Trust Fund
(UEBTF) may pay benefits
C. Can still use exclusive remedy defense fully
D. Has no liability
Rationale: Uninsured employer loses exclusive remedy protection and faces §3715 penalties and stop
orders; UEBTF is backup payer.
10. The Workers’ Compensation Appeals Board (WCAB) is:
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
, A. A private arbitration panel
B. A federal court
C. A seven-member adjudicatory body appointed by the Governor that en banc reviews and
reconsiders WCJ decisions
D. The same as DWC’s Information & Assistance
Rationale: WCAB commissioners review petitions for reconsideration; WCJs are trial judges at district
offices.
11. An injured worker’s right to predesignate a personal physician for treatment requires:
A. Oral designation at time of injury
B. Only after injury notice
C. Prior written notice to employer before injury with physician’s agreement, per Labor
Code §4600(d)
D. No prior notification
Rationale: Predesignation must be pre-injury, in writing, with carrier notice and physician agreement
to treat for workers' comp. MPN otherwise controls.
12. Medical Provider Network (MPN) rules under Labor Code §4616 provide:
A. No regulation of MPN
B. Employee may use any doctor regardless of MPN
C. Employee must always use MPN physicians after employer notice, except for emergency
or predesignation
D. MPN is optional for employers
Rationale: If valid MPN noticed, injured worker generally treats within network; non-MPN reporting
may lead to nonpayment. Predesignation and emergency are exceptions.
13. An ‘applicant’ and ‘defendant’ in workers' compensation nomenclature are:
A. Defendant is always QME
B. No distinction exists
C. Both are physicians
D. Applicant is injured worker; defendant is employer/insurer (and sometimes UEBTF or
Subsequent Injuries Benefits Trust Fund)
Rationale: Parties are applicant vs defendant(s); QMEs are neutrals, not parties.
QME EXAM 2026/2027: 200 PRACTICE QUESTIONS — Qualified Medical Evaluator — State of California DWC • For Study Use Only — Not an Actual DWC Examination
