QME Exam | Ultimate Study Guide with Comprehensive
Questions, Correct Answer & Detailed Explanations – Latest
Update 2026/2027 | Graded A+
1. What is the primary role of a Qualified Medical Evaluator (QME) in the
California workers’ compensation system?
A. To provide ongoing treatment to the injured worker
B. To represent the employer in a workers’ compensation dispute
C. To provide an objective medical-legal evaluation
D. To determine the worker's insurance premium
Correct Answer: C
Explanation: A QME provides an independent medical-legal evaluation
concerning issues relevant to a workers’ compensation claim. The QME's role
is evaluative rather than advocacy-based. The evaluator should provide
objective medical opinions supported by the history, examination, records,
diagnostic information, and applicable California workers’ compensation
standards.
2. Which organization administers the California QME program?
A. California Department of Insurance
B. Division of Workers’ Compensation Medical Unit
C. Workers’ Compensation Appeals Board exclusively
D. California Employment Development Department
Correct Answer: B
Explanation: The Division of Workers’ Compensation (DWC) Medical Unit
administers the QME program. It is responsible for functions such as QME
certification and appointment and provides resources concerning the QME
process.
3. Which principle is most important when a QME formulates a medical-
legal opinion?
A. The evaluator should support the party who requested the examination
B. The opinion should be based on substantial medical evidence
1
,C. The patient's preferred diagnosis should always be accepted
D. The evaluator should avoid reviewing previous medical records
Correct Answer: B
Explanation: A QME opinion should be medically reasoned and supported by
appropriate evidence. The evaluator should consider the history, physical
examination, diagnostic studies, medical records, and other relevant
information. The QME's responsibility is to provide an objective opinion
rather than advocate for either side.
4. During a QME evaluation, the patient reports severe pain that is not
fully explained by objective findings. What is the most appropriate
approach?
A. Automatically conclude that the patient is malingering
B. Ignore the patient's subjective complaints
C. Document the complaints, perform an appropriate evaluation, and consider
all relevant clinical information
D. Automatically assign permanent disability
Correct Answer: C
Explanation: Subjective symptoms should neither automatically be accepted
as proof of impairment nor dismissed as fraudulent. The evaluator should
document the patient's complaints, perform an appropriate examination,
review relevant records and testing, and determine whether the available
evidence supports the claimed condition and impairment.
5. What is the purpose of the AMA Guides in a California QME evaluation?
A. To determine an employee's hourly wage
B. To provide a standardized framework for evaluating impairment
C. To determine the employer's insurance premium
D. To establish the patient's treatment schedule independently of medical
evidence
Correct Answer: B
2
,Explanation: The AMA Guides provide a standardized methodology for
evaluating medical impairment. A QME uses the applicable California workers’
compensation rules together with the required edition and methodology of
the Guides when determining impairment. Impairment is distinct from
disability and is not simply a measure of whether a person can work.
6. Which statement best distinguishes impairment from disability?
A. They always mean exactly the same thing
B. Impairment concerns loss of function, while disability involves the impact
on the person's ability to perform activities or work
C. Disability is determined only from laboratory results
D. Impairment refers exclusively to lost wages
Correct Answer: B
Explanation: Impairment refers to a medical loss, loss of use, or abnormality
involving a body part, organ system, or function. Disability is a broader
concept involving the effects of a condition on a person's ability to perform
activities or work. A QME must understand this distinction when preparing a
medical-legal report.
7. A QME is asked whether an injury was caused by employment. Which
information is most important?
A. Only the patient's current symptoms
B. Only the employer's description of the incident
C. History, medical records, examination findings, diagnostic studies, and
occupational exposure
D. The patient's desired workers’ compensation outcome
Correct Answer: C
Explanation: Causation requires a medically reasoned evaluation of the
available evidence. The QME should consider the mechanism of injury or
occupational exposure, timing of symptoms, prior and subsequent conditions,
examination findings, diagnostic studies, and relevant medical records.
8. What does apportionment generally address?
3
, A. How responsibility for permanent disability is allocated among causative
factors
B. How the patient's medical bills are divided between hospitals
C. How many medications a patient should receive
D. How an employer schedules employees
Correct Answer: A
Explanation: Apportionment concerns the causation of permanent disability
and the extent to which different factors contributed to that disability. A QME
must provide a medically supported explanation rather than simply assigning
an arbitrary percentage.
9. A worker had a significant preexisting condition before the claimed
industrial injury. What should the QME do?
A. Automatically attribute all disability to the industrial injury
B. Automatically attribute all disability to the preexisting condition
C. Evaluate the evidence and explain any medically appropriate
apportionment
D. Ignore the preexisting condition
Correct Answer: C
Explanation: A preexisting condition may be relevant to apportionment, but
its existence alone does not determine the final allocation of disability. The
QME should evaluate the medical evidence and explain how, if at all, the
preexisting condition contributed to the current permanent disability.
10. Which characteristic is essential in a QME report?
A. Advocacy for the injured worker
B. Advocacy for the insurance carrier
C. Clear reasoning connecting the medical evidence to the conclusions
D. Avoidance of unfavorable evidence
Correct Answer: C
Explanation: A strong medical-legal report explains how the evaluator moved
from the evidence to the conclusions. The report should identify relevant
4
Questions, Correct Answer & Detailed Explanations – Latest
Update 2026/2027 | Graded A+
1. What is the primary role of a Qualified Medical Evaluator (QME) in the
California workers’ compensation system?
A. To provide ongoing treatment to the injured worker
B. To represent the employer in a workers’ compensation dispute
C. To provide an objective medical-legal evaluation
D. To determine the worker's insurance premium
Correct Answer: C
Explanation: A QME provides an independent medical-legal evaluation
concerning issues relevant to a workers’ compensation claim. The QME's role
is evaluative rather than advocacy-based. The evaluator should provide
objective medical opinions supported by the history, examination, records,
diagnostic information, and applicable California workers’ compensation
standards.
2. Which organization administers the California QME program?
A. California Department of Insurance
B. Division of Workers’ Compensation Medical Unit
C. Workers’ Compensation Appeals Board exclusively
D. California Employment Development Department
Correct Answer: B
Explanation: The Division of Workers’ Compensation (DWC) Medical Unit
administers the QME program. It is responsible for functions such as QME
certification and appointment and provides resources concerning the QME
process.
3. Which principle is most important when a QME formulates a medical-
legal opinion?
A. The evaluator should support the party who requested the examination
B. The opinion should be based on substantial medical evidence
1
,C. The patient's preferred diagnosis should always be accepted
D. The evaluator should avoid reviewing previous medical records
Correct Answer: B
Explanation: A QME opinion should be medically reasoned and supported by
appropriate evidence. The evaluator should consider the history, physical
examination, diagnostic studies, medical records, and other relevant
information. The QME's responsibility is to provide an objective opinion
rather than advocate for either side.
4. During a QME evaluation, the patient reports severe pain that is not
fully explained by objective findings. What is the most appropriate
approach?
A. Automatically conclude that the patient is malingering
B. Ignore the patient's subjective complaints
C. Document the complaints, perform an appropriate evaluation, and consider
all relevant clinical information
D. Automatically assign permanent disability
Correct Answer: C
Explanation: Subjective symptoms should neither automatically be accepted
as proof of impairment nor dismissed as fraudulent. The evaluator should
document the patient's complaints, perform an appropriate examination,
review relevant records and testing, and determine whether the available
evidence supports the claimed condition and impairment.
5. What is the purpose of the AMA Guides in a California QME evaluation?
A. To determine an employee's hourly wage
B. To provide a standardized framework for evaluating impairment
C. To determine the employer's insurance premium
D. To establish the patient's treatment schedule independently of medical
evidence
Correct Answer: B
2
,Explanation: The AMA Guides provide a standardized methodology for
evaluating medical impairment. A QME uses the applicable California workers’
compensation rules together with the required edition and methodology of
the Guides when determining impairment. Impairment is distinct from
disability and is not simply a measure of whether a person can work.
6. Which statement best distinguishes impairment from disability?
A. They always mean exactly the same thing
B. Impairment concerns loss of function, while disability involves the impact
on the person's ability to perform activities or work
C. Disability is determined only from laboratory results
D. Impairment refers exclusively to lost wages
Correct Answer: B
Explanation: Impairment refers to a medical loss, loss of use, or abnormality
involving a body part, organ system, or function. Disability is a broader
concept involving the effects of a condition on a person's ability to perform
activities or work. A QME must understand this distinction when preparing a
medical-legal report.
7. A QME is asked whether an injury was caused by employment. Which
information is most important?
A. Only the patient's current symptoms
B. Only the employer's description of the incident
C. History, medical records, examination findings, diagnostic studies, and
occupational exposure
D. The patient's desired workers’ compensation outcome
Correct Answer: C
Explanation: Causation requires a medically reasoned evaluation of the
available evidence. The QME should consider the mechanism of injury or
occupational exposure, timing of symptoms, prior and subsequent conditions,
examination findings, diagnostic studies, and relevant medical records.
8. What does apportionment generally address?
3
, A. How responsibility for permanent disability is allocated among causative
factors
B. How the patient's medical bills are divided between hospitals
C. How many medications a patient should receive
D. How an employer schedules employees
Correct Answer: A
Explanation: Apportionment concerns the causation of permanent disability
and the extent to which different factors contributed to that disability. A QME
must provide a medically supported explanation rather than simply assigning
an arbitrary percentage.
9. A worker had a significant preexisting condition before the claimed
industrial injury. What should the QME do?
A. Automatically attribute all disability to the industrial injury
B. Automatically attribute all disability to the preexisting condition
C. Evaluate the evidence and explain any medically appropriate
apportionment
D. Ignore the preexisting condition
Correct Answer: C
Explanation: A preexisting condition may be relevant to apportionment, but
its existence alone does not determine the final allocation of disability. The
QME should evaluate the medical evidence and explain how, if at all, the
preexisting condition contributed to the current permanent disability.
10. Which characteristic is essential in a QME report?
A. Advocacy for the injured worker
B. Advocacy for the insurance carrier
C. Clear reasoning connecting the medical evidence to the conclusions
D. Avoidance of unfavorable evidence
Correct Answer: C
Explanation: A strong medical-legal report explains how the evaluator moved
from the evidence to the conclusions. The report should identify relevant
4
