QME EXAM NEWEST ACTUAL EXAM QUESTIONS &
ANSWERS| GRADE A| 100% CORRECT (VERIFIED
SOLUTIONS)
COMPETENCY AREA I: CLINICAL ASSESSMENT/EVALUATION AND MEDICAL
TREATMENT (Questions 1–90)
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 advocate for the insurance carrier's position
C) To serve as an objective, impartial medical-legal evaluator
D) To settle the workers' compensation, claim directly
Correct Answer: C
Rationale: A QME is an impartial evaluator appointed by the DWC Medical
Unit to assess medical conditions, causation, disability, and need for
treatment. The QME is not a treating physician, does not advocate for either
party, and does not settle claims.
2. When must a QME's opinions and conclusions in a medical-legal report be
stated with reasons constituting?
A) Medical possibility
B) Medical certainty
C) Medical probability
D) Medical speculation
,Correct Answer: C
Rationale: Under the Escobedo standard, QME opinions must be based on
reasonable medical probability, meaning the conclusion is "more likely than
not" (greater than 50% likelihood). Medical possibility (less than 50%) does
not meet the evidentiary standard for workers' compensation determinations.
3. Which of the following statements would NOT meet the standard of medical
probability?
A) "It is more likely than not that the industrial injury caused the lumbar disc
herniation."
B) "Based on the mechanism of injury, the work event probably caused the
condition."
C) "It is possible that the work injury contributed to the current symptoms."
D) "The injury is probably related to the industrial event."
Correct Answer: C
Rationale: The opinion must be stated in terms of medical probability (more
likely than not). "Possible," "may," or "could" indicate medical possibility,
which is insufficient for compensability.
4. What is the evidentiary standard used in QME reports to establish
causation?
A) Beyond a reasonable doubt
B) Preponderance of the evidence
C) Clear and convincing evidence
D) Reasonable medical probability
Correct Answer: D
Rationale: The Escobedo case set the standard of reasonable medical
probability. These words turn the report into substantial evidence.
,5. Which of the following would meet the substantial evidence standard for a
QME report?
A) "In my opinion, the injury is work-related."
B) "Based on the mechanism of injury, temporal relationship, absence of pre-
existing symptoms, and review of medical literature, it is more likely than not
that the industrial event caused the lumbar disc herniation."
C) "It seems like the job caused the problem."
D) "The patient believes his work caused his condition."
Correct Answer: B
Rationale: Substantial evidence requires a reasoned medical opinion based on
objective findings, not merely a conclusory statement. The opinion must
explain the factual and medical basis for the conclusion.
6. A QME is primarily appointed to:
A) Treat the injured worker
B) Advocate for the insurance carrier
C) Provide an objective medical-legal opinion
D) Settle the claim directly
Correct Answer: C
Rationale: The QME is an impartial evaluator who assesses medical
conditions, causation, disability, and need for treatment, not a treating
physician or advocate.
7. Which entity maintains the QME list in California?
A) Medical Board of California
B) Division of Workers' Compensation (DWC)
, C) California Department of Insurance
D) Workers' Compensation Appeals Board
Correct Answer: B
Rationale: DWC's Medical Unit administers the QME program, including
certification, listing, and discipline.
8. What should a QME do if an injured worker brings a family member into the
exam room without prior request?
A) Allow the family member to stay
B) Cancel the exam
C) Ask the family member to leave unless needed for
communication/disability assistance
D) Complete the exam but note in report
Correct Answer: C
Rationale: QMEs have the right to a private exam unless the worker needs
assistance due to language, cognitive, or physical disability.
9. A QME's fee for a comprehensive medical-legal evaluation is set by:
A) The insurance carrier
B) The injured worker
C) The DWC Official Medical Fee Schedule (OMFS)
D) The QME's usual and customary rate
Correct Answer: C
Rationale: QME fees are regulated by OMFS, Labor Code § 5307.1.
10. If a QME fails to submit a report on time, the DWC may:
ANSWERS| GRADE A| 100% CORRECT (VERIFIED
SOLUTIONS)
COMPETENCY AREA I: CLINICAL ASSESSMENT/EVALUATION AND MEDICAL
TREATMENT (Questions 1–90)
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 advocate for the insurance carrier's position
C) To serve as an objective, impartial medical-legal evaluator
D) To settle the workers' compensation, claim directly
Correct Answer: C
Rationale: A QME is an impartial evaluator appointed by the DWC Medical
Unit to assess medical conditions, causation, disability, and need for
treatment. The QME is not a treating physician, does not advocate for either
party, and does not settle claims.
2. When must a QME's opinions and conclusions in a medical-legal report be
stated with reasons constituting?
A) Medical possibility
B) Medical certainty
C) Medical probability
D) Medical speculation
,Correct Answer: C
Rationale: Under the Escobedo standard, QME opinions must be based on
reasonable medical probability, meaning the conclusion is "more likely than
not" (greater than 50% likelihood). Medical possibility (less than 50%) does
not meet the evidentiary standard for workers' compensation determinations.
3. Which of the following statements would NOT meet the standard of medical
probability?
A) "It is more likely than not that the industrial injury caused the lumbar disc
herniation."
B) "Based on the mechanism of injury, the work event probably caused the
condition."
C) "It is possible that the work injury contributed to the current symptoms."
D) "The injury is probably related to the industrial event."
Correct Answer: C
Rationale: The opinion must be stated in terms of medical probability (more
likely than not). "Possible," "may," or "could" indicate medical possibility,
which is insufficient for compensability.
4. What is the evidentiary standard used in QME reports to establish
causation?
A) Beyond a reasonable doubt
B) Preponderance of the evidence
C) Clear and convincing evidence
D) Reasonable medical probability
Correct Answer: D
Rationale: The Escobedo case set the standard of reasonable medical
probability. These words turn the report into substantial evidence.
,5. Which of the following would meet the substantial evidence standard for a
QME report?
A) "In my opinion, the injury is work-related."
B) "Based on the mechanism of injury, temporal relationship, absence of pre-
existing symptoms, and review of medical literature, it is more likely than not
that the industrial event caused the lumbar disc herniation."
C) "It seems like the job caused the problem."
D) "The patient believes his work caused his condition."
Correct Answer: B
Rationale: Substantial evidence requires a reasoned medical opinion based on
objective findings, not merely a conclusory statement. The opinion must
explain the factual and medical basis for the conclusion.
6. A QME is primarily appointed to:
A) Treat the injured worker
B) Advocate for the insurance carrier
C) Provide an objective medical-legal opinion
D) Settle the claim directly
Correct Answer: C
Rationale: The QME is an impartial evaluator who assesses medical
conditions, causation, disability, and need for treatment, not a treating
physician or advocate.
7. Which entity maintains the QME list in California?
A) Medical Board of California
B) Division of Workers' Compensation (DWC)
, C) California Department of Insurance
D) Workers' Compensation Appeals Board
Correct Answer: B
Rationale: DWC's Medical Unit administers the QME program, including
certification, listing, and discipline.
8. What should a QME do if an injured worker brings a family member into the
exam room without prior request?
A) Allow the family member to stay
B) Cancel the exam
C) Ask the family member to leave unless needed for
communication/disability assistance
D) Complete the exam but note in report
Correct Answer: C
Rationale: QMEs have the right to a private exam unless the worker needs
assistance due to language, cognitive, or physical disability.
9. A QME's fee for a comprehensive medical-legal evaluation is set by:
A) The insurance carrier
B) The injured worker
C) The DWC Official Medical Fee Schedule (OMFS)
D) The QME's usual and customary rate
Correct Answer: C
Rationale: QME fees are regulated by OMFS, Labor Code § 5307.1.
10. If a QME fails to submit a report on time, the DWC may:
