California QME Exam Test Bank:
Actual Questions & Verified Answers
(Latest Graded A+ Version)
Question 1
A 45-year-old warehouse worker claims a lower back injury due to a single
heavy lifting incident at work. The employer denies the claim, stating the
,worker had a pre-existing degenerative disc disease. As a QME, which legal
framework must you apply to determine if the injury is compensable?
A) Labor Code § 4663
B) AOE/COE (Arising Out of Employment / Course of Employment)
C) AMA Guides 5th Edition Chapter 15
D) Utilization Review (UR) Guidelines
Verified Answer: B) AOE/COE (Arising Out of Employment / Course of
Employment)
Explanation: To establish a compensable workers' compensation claim in
California, the injury must arise out of employment and occur in the course
of employment (AOE/COE). Pre-existing conditions do not automatically
invalidate a claim if employment factors substantially caused the specific
acute injury event.
Question 2
An unrepresented injured worker receives a 3-doctor QME panel in
Chiropractic medicine. How many days does the worker have to select a doctor
from the panel and schedule an appointment before the employer can make the
selection?
A) 5 days
B) 10 days
C) 30 days
D) 90 days
Verified Answer: B) 10 days
Explanation: Under California Labor Code regulations, an unrepresented
worker has 10 days from the date the panel was issued to select a QME and
schedule the exam. If they fail to do so within this timeframe, the
employer/insurer gains the legal right to choose the QME from that panel.
Question 3
,During a QME evaluation, the defense attorney calls your office directly to
verbally explain their theory of the case without the applicant attorney's
knowledge. What type of communication is this, and what is the required
remedy?
A) Allowed communication; no remedy needed.
B) Ex parte communication; the QME must proceed but disclose it in the report.
C) Ex parte communication; it is strictly prohibited and constitutes grounds for
panel disqualification.
D) Dual communication; it requires a follow-up email to both parties.
Verified Answer: C) Ex parte communication; it is strictly prohibited and
constitutes grounds for panel disqualification.
Explanation: Ex parte communication (any communication with one party
without the presence or written consent of the opposing party) is strictly
prohibited under California Labor Code § 139.2. Violating this rule can result
in the entire evaluation being thrown out and the QME being disqualified
from the panel.
Question 4
A QME is evaluating an injured worker's permanent impairment following a
knee arthroscopy. The worker has completely recovered except for a mild loss
of range of motion. Which edition of the AMA Guides must the QME use to
calculate the Whole Person Impairment (WPI)?
A) AMA Guides 4th Edition
B) AMA Guides 5th Edition
C) AMA Guides 6th Edition
D) The QME may choose whichever edition favors the worker
Verified Answer: B) AMA Guides 5th Edition
Explanation: By statutory mandate in California, all permanent impairments
for injuries occurring on or after January 1, 2005, must be rated using the
, American Medical Association (AMA) Guides to the Evaluation of Permanent
Impairment, 5th Edition.
Question 5
An injured employee sustains a cumulative trauma injury to both wrists
(bilateral carpal tunnel syndrome). The AMA Guides yield a 5% WPI for the
left wrist and a 5% WPI for the right wrist. How should the QME determine the
total Whole Person Impairment?
A) Add them together directly (5% + 5% = 10% WPI)
B) Take the highest value only (5% WPI)
C) Use the Combined Values Chart (CVC) in the AMA Guides
D) Average the two values (5% WPI)
Verified Answer: C) Use the Combined Values Chart (CVC) in the AMA
Guides
Explanation: Multiple impairments must never be simply added together. The
QME must use the Combined Values Chart (CVC) located at the back of the
AMA Guides 5th Edition to combine multiple disabilities so that the total
impairment never exceeds 100% of the whole person.
Question 6
Under California Labor Code Section 4663, what must a QME address when
writing the medical-legal report for an injured worker who has permanent
disability?
A) The cost of the future medical treatments
B) The exact percentage of disability caused by industrial factors vs. non-
industrial factors (Apportionment)
C) The worker's eligibility for state disability insurance
D) The fault or negligence of the employer
Verified Answer: B) The exact percentage of disability caused by industrial
Actual Questions & Verified Answers
(Latest Graded A+ Version)
Question 1
A 45-year-old warehouse worker claims a lower back injury due to a single
heavy lifting incident at work. The employer denies the claim, stating the
,worker had a pre-existing degenerative disc disease. As a QME, which legal
framework must you apply to determine if the injury is compensable?
A) Labor Code § 4663
B) AOE/COE (Arising Out of Employment / Course of Employment)
C) AMA Guides 5th Edition Chapter 15
D) Utilization Review (UR) Guidelines
Verified Answer: B) AOE/COE (Arising Out of Employment / Course of
Employment)
Explanation: To establish a compensable workers' compensation claim in
California, the injury must arise out of employment and occur in the course
of employment (AOE/COE). Pre-existing conditions do not automatically
invalidate a claim if employment factors substantially caused the specific
acute injury event.
Question 2
An unrepresented injured worker receives a 3-doctor QME panel in
Chiropractic medicine. How many days does the worker have to select a doctor
from the panel and schedule an appointment before the employer can make the
selection?
A) 5 days
B) 10 days
C) 30 days
D) 90 days
Verified Answer: B) 10 days
Explanation: Under California Labor Code regulations, an unrepresented
worker has 10 days from the date the panel was issued to select a QME and
schedule the exam. If they fail to do so within this timeframe, the
employer/insurer gains the legal right to choose the QME from that panel.
Question 3
,During a QME evaluation, the defense attorney calls your office directly to
verbally explain their theory of the case without the applicant attorney's
knowledge. What type of communication is this, and what is the required
remedy?
A) Allowed communication; no remedy needed.
B) Ex parte communication; the QME must proceed but disclose it in the report.
C) Ex parte communication; it is strictly prohibited and constitutes grounds for
panel disqualification.
D) Dual communication; it requires a follow-up email to both parties.
Verified Answer: C) Ex parte communication; it is strictly prohibited and
constitutes grounds for panel disqualification.
Explanation: Ex parte communication (any communication with one party
without the presence or written consent of the opposing party) is strictly
prohibited under California Labor Code § 139.2. Violating this rule can result
in the entire evaluation being thrown out and the QME being disqualified
from the panel.
Question 4
A QME is evaluating an injured worker's permanent impairment following a
knee arthroscopy. The worker has completely recovered except for a mild loss
of range of motion. Which edition of the AMA Guides must the QME use to
calculate the Whole Person Impairment (WPI)?
A) AMA Guides 4th Edition
B) AMA Guides 5th Edition
C) AMA Guides 6th Edition
D) The QME may choose whichever edition favors the worker
Verified Answer: B) AMA Guides 5th Edition
Explanation: By statutory mandate in California, all permanent impairments
for injuries occurring on or after January 1, 2005, must be rated using the
, American Medical Association (AMA) Guides to the Evaluation of Permanent
Impairment, 5th Edition.
Question 5
An injured employee sustains a cumulative trauma injury to both wrists
(bilateral carpal tunnel syndrome). The AMA Guides yield a 5% WPI for the
left wrist and a 5% WPI for the right wrist. How should the QME determine the
total Whole Person Impairment?
A) Add them together directly (5% + 5% = 10% WPI)
B) Take the highest value only (5% WPI)
C) Use the Combined Values Chart (CVC) in the AMA Guides
D) Average the two values (5% WPI)
Verified Answer: C) Use the Combined Values Chart (CVC) in the AMA
Guides
Explanation: Multiple impairments must never be simply added together. The
QME must use the Combined Values Chart (CVC) located at the back of the
AMA Guides 5th Edition to combine multiple disabilities so that the total
impairment never exceeds 100% of the whole person.
Question 6
Under California Labor Code Section 4663, what must a QME address when
writing the medical-legal report for an injured worker who has permanent
disability?
A) The cost of the future medical treatments
B) The exact percentage of disability caused by industrial factors vs. non-
industrial factors (Apportionment)
C) The worker's eligibility for state disability insurance
D) The fault or negligence of the employer
Verified Answer: B) The exact percentage of disability caused by industrial
