QME Exam California Qualified Medical
Evaluator Certification DWC Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: DWC REGULATIONS & MEDICAL-LEGAL FRAMEWORK Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old warehouse worker sustains a low back injury while lifting a heavy pallet. The
primary treating physician (PTP) determines the worker is temporarily totally disabled and
assigns work restrictions that the employer cannot accommodate. The claims administrator
disputes the PTP's opinion regarding the extent of temporary disability and requests a
comprehensive medical-legal evaluation to resolve the disagreement. Under California
workers' compensation regulations, what is the proper role of the Qualified Medical Evaluator
(QME) in this dispute?
A. The QME must defer to the PTP's opinion because the treating physician has the primary
authority over all medical decisions.
B. The QME serves as an independent evaluator to address medical-legal disputes when
parties disagree on issues such as temporary disability or work restrictions. ✓ CORRECT
C. The QME is required to side with the claims administrator since they requested the
evaluation and are paying the QME's fees.
D. The QME should only evaluate permanent disability and has no jurisdiction over temporary
disability disputes.
Correct Answer: B
Rationale: California Labor Code Section 4060 and DWC regulations establish that the QME is
an independent physician certified to resolve medical-legal disputes between the parties,
including disagreements over temporary disability and work restrictions. The QME does not
defer to the PTP or the claims administrator but instead provides an independent medical
opinion based on the evidence. A common exam trap is confusing the QME's broad
dispute-resolution role with a limited permanent disability-only function.
,Question 2 of 50
An injured construction worker has been treating with an orthopedic surgeon for a knee injury
sustained on the job. The PTP has issued multiple reports addressing the worker's treatment
plan, work status, and need for future medical care. The claims administrator and the injured
worker's attorney disagree on whether the injury is industrially caused and whether the
recommended surgery is reasonable. They jointly agree to obtain a QME evaluation. What is
the fundamental distinction between the PTP and the QME in this medical-legal framework?
A. The PTP is only responsible for initial emergency care, while the QME manages all
long-term treatment decisions.
B. The PTP and QME have identical roles, and either may issue binding decisions on all
medical and legal issues in the claim.
C. The PTP provides ongoing treatment and medical reports, while the QME is an independent
evaluator who does not treat the patient. ✓ CORRECT
D. The QME must approve all treatment recommendations made by the PTP before the
claims administrator authorizes payment.
Correct Answer: C
Rationale: Under California workers' compensation law, the primary treating physician
provides initial and ongoing medical care and may issue medical-legal reports, whereas the
QME is a separate, independent evaluator who addresses disputes without establishing a
treating relationship. The QME does not approve or deny treatment but instead provides
opinions on contested medical-legal issues. Confusing the treating role with the evaluating
role is a frequent source of error on the QME exam.
Question 3 of 50
A physician certified as a QME receives a request to evaluate an injured worker for a disputed
shoulder injury. Upon reviewing the referral documents, the physician realizes they previously
treated this same worker for a non-industrial shoulder condition three years ago. The
physician's office has detailed medical records from that prior treatment relationship. What is
the physician's proper course of action under DWC regulations?
A. The physician must decline the QME evaluation because they have a prior treating
relationship with the injured worker. ✓ CORRECT
B. The physician may accept the evaluation because the prior treatment ended more than one
year ago and was for a different condition.
C. The physician should proceed with the evaluation but disclose the prior relationship only if
the parties ask about it.
D. The physician can accept the case and simply recuse themselves from opining on the
specific shoulder condition they previously treated.
Correct Answer: A
, Rationale: DWC regulations and ethical guidelines prohibit a QME from evaluating an injured
worker when the physician has a prior or current treating relationship with that individual, as
this creates a conflict of interest and undermines the independence of the medical-legal
process. The prohibition is not limited by the passage of time or the similarity of conditions.
Attempting to compartmentalize the evaluation or delay disclosure violates the QME's duty of
impartiality.
Question 4 of 50
A QME completes a comprehensive evaluation of an injured worker on March 1. The
evaluation addressed multiple medical-legal issues including permanent impairment, future
medical care, and the need for work restrictions. The QME's office is preparing the formal
report for submission to the parties. Under Title 8 of the California Code of Regulations, what
is the standard timeline within which the QME must issue this medical-legal report?
A. The QME has 60 calendar days from the date of the evaluation to submit the report to the
DWC.
B. The QME must submit the report within 10 business days regardless of the complexity of
the case.
C. The QME must issue the report within 30 calendar days from the date of the examination
unless an extension is granted. ✓ CORRECT
D. The QME has no specific deadline as long as the report is submitted before the mandatory
settlement conference.
Correct Answer: C
Rationale: Title 8, California Code of Regulations Section 9793 requires that a QME issue a
medical-legal report within 30 calendar days of the evaluation, though extensions may be
granted under specific circumstances. This deadline ensures timely resolution of disputes
and prevents unnecessary delay in the claims process. The 30-day rule is frequently tested
because examinees often confuse it with other workers' compensation timelines.
Question 5 of 50
An applicant attorney requests a QME evaluation to address a dispute over the industrial
causation of a respiratory condition. The claims administrator objects, arguing that the
treating physician has already issued a comprehensive report and that a QME is unnecessary.
The parties are unable to agree on a medical evaluator. Under the DWC medical-legal
process, how is a QME typically selected when the parties cannot reach an agreement?
A. The injured worker unilaterally selects any physician from the local yellow pages who
accepts workers' compensation cases.
B. The DWC provides a panel of three QMEs from the appropriate medical specialty, and the
parties follow the statutory selection process. ✓ CORRECT
Evaluator Certification DWC Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: DWC REGULATIONS & MEDICAL-LEGAL FRAMEWORK Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old warehouse worker sustains a low back injury while lifting a heavy pallet. The
primary treating physician (PTP) determines the worker is temporarily totally disabled and
assigns work restrictions that the employer cannot accommodate. The claims administrator
disputes the PTP's opinion regarding the extent of temporary disability and requests a
comprehensive medical-legal evaluation to resolve the disagreement. Under California
workers' compensation regulations, what is the proper role of the Qualified Medical Evaluator
(QME) in this dispute?
A. The QME must defer to the PTP's opinion because the treating physician has the primary
authority over all medical decisions.
B. The QME serves as an independent evaluator to address medical-legal disputes when
parties disagree on issues such as temporary disability or work restrictions. ✓ CORRECT
C. The QME is required to side with the claims administrator since they requested the
evaluation and are paying the QME's fees.
D. The QME should only evaluate permanent disability and has no jurisdiction over temporary
disability disputes.
Correct Answer: B
Rationale: California Labor Code Section 4060 and DWC regulations establish that the QME is
an independent physician certified to resolve medical-legal disputes between the parties,
including disagreements over temporary disability and work restrictions. The QME does not
defer to the PTP or the claims administrator but instead provides an independent medical
opinion based on the evidence. A common exam trap is confusing the QME's broad
dispute-resolution role with a limited permanent disability-only function.
,Question 2 of 50
An injured construction worker has been treating with an orthopedic surgeon for a knee injury
sustained on the job. The PTP has issued multiple reports addressing the worker's treatment
plan, work status, and need for future medical care. The claims administrator and the injured
worker's attorney disagree on whether the injury is industrially caused and whether the
recommended surgery is reasonable. They jointly agree to obtain a QME evaluation. What is
the fundamental distinction between the PTP and the QME in this medical-legal framework?
A. The PTP is only responsible for initial emergency care, while the QME manages all
long-term treatment decisions.
B. The PTP and QME have identical roles, and either may issue binding decisions on all
medical and legal issues in the claim.
C. The PTP provides ongoing treatment and medical reports, while the QME is an independent
evaluator who does not treat the patient. ✓ CORRECT
D. The QME must approve all treatment recommendations made by the PTP before the
claims administrator authorizes payment.
Correct Answer: C
Rationale: Under California workers' compensation law, the primary treating physician
provides initial and ongoing medical care and may issue medical-legal reports, whereas the
QME is a separate, independent evaluator who addresses disputes without establishing a
treating relationship. The QME does not approve or deny treatment but instead provides
opinions on contested medical-legal issues. Confusing the treating role with the evaluating
role is a frequent source of error on the QME exam.
Question 3 of 50
A physician certified as a QME receives a request to evaluate an injured worker for a disputed
shoulder injury. Upon reviewing the referral documents, the physician realizes they previously
treated this same worker for a non-industrial shoulder condition three years ago. The
physician's office has detailed medical records from that prior treatment relationship. What is
the physician's proper course of action under DWC regulations?
A. The physician must decline the QME evaluation because they have a prior treating
relationship with the injured worker. ✓ CORRECT
B. The physician may accept the evaluation because the prior treatment ended more than one
year ago and was for a different condition.
C. The physician should proceed with the evaluation but disclose the prior relationship only if
the parties ask about it.
D. The physician can accept the case and simply recuse themselves from opining on the
specific shoulder condition they previously treated.
Correct Answer: A
, Rationale: DWC regulations and ethical guidelines prohibit a QME from evaluating an injured
worker when the physician has a prior or current treating relationship with that individual, as
this creates a conflict of interest and undermines the independence of the medical-legal
process. The prohibition is not limited by the passage of time or the similarity of conditions.
Attempting to compartmentalize the evaluation or delay disclosure violates the QME's duty of
impartiality.
Question 4 of 50
A QME completes a comprehensive evaluation of an injured worker on March 1. The
evaluation addressed multiple medical-legal issues including permanent impairment, future
medical care, and the need for work restrictions. The QME's office is preparing the formal
report for submission to the parties. Under Title 8 of the California Code of Regulations, what
is the standard timeline within which the QME must issue this medical-legal report?
A. The QME has 60 calendar days from the date of the evaluation to submit the report to the
DWC.
B. The QME must submit the report within 10 business days regardless of the complexity of
the case.
C. The QME must issue the report within 30 calendar days from the date of the examination
unless an extension is granted. ✓ CORRECT
D. The QME has no specific deadline as long as the report is submitted before the mandatory
settlement conference.
Correct Answer: C
Rationale: Title 8, California Code of Regulations Section 9793 requires that a QME issue a
medical-legal report within 30 calendar days of the evaluation, though extensions may be
granted under specific circumstances. This deadline ensures timely resolution of disputes
and prevents unnecessary delay in the claims process. The 30-day rule is frequently tested
because examinees often confuse it with other workers' compensation timelines.
Question 5 of 50
An applicant attorney requests a QME evaluation to address a dispute over the industrial
causation of a respiratory condition. The claims administrator objects, arguing that the
treating physician has already issued a comprehensive report and that a QME is unnecessary.
The parties are unable to agree on a medical evaluator. Under the DWC medical-legal
process, how is a QME typically selected when the parties cannot reach an agreement?
A. The injured worker unilaterally selects any physician from the local yellow pages who
accepts workers' compensation cases.
B. The DWC provides a panel of three QMEs from the appropriate medical specialty, and the
parties follow the statutory selection process. ✓ CORRECT
