QME EXAM ACTUAL EXAM [QUESTION 1- 200] AND
ANSWERS UPDATED 2026/2027| 100% VERIFIED|DETAILED
RATIONALES –PASS GUARANTEED A+ GRADED |INSTANT
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INTRODUCTION
The California Qualified Medical Evaluator (QME) Competency Examination is the
certification examination administered for the California Division of Workers’ Compensation
(DWC) Medical Unit. QMEs conduct independent medical evaluations of injured workers and
prepare medical-legal reports used in California’s workers’ compensation system. The current
DWC materials identify four competency areas: clinical assessment/evaluation and medical
treatment; disability and impairment issues/MMI and permanent disability; causation and
apportionment; and basic laws, regulations, and medical-legal report writing. (CalDIR)
Eligibility is directed primarily toward qualified medical professionals seeking appointment as
QMEs. DWC identifies eligible QME disciplines including physicians (MD/DO), chiropractors,
dentists, optometrists, podiatrists, psychologists, and acupuncturists, subject to the applicable
statutory and regulatory requirements. Additional education requirements apply to appointment
and reappointment, including required disability-evaluation/report-writing education for
applicable applicants. (CalDIR)
QME certification is professionally important because the QME serves as an independent
medical evaluator within California's workers' compensation dispute-resolution framework. The
examination is designed to establish competency in evaluating medical issues, California
workers' compensation terminology and law, medical-legal procedures, impairment, disability,
causation, apportionment, and preparation of medical-legal reports. (CalDIR)
For the current examination format, DWC states that the examination is computer-based and
administered through Pearson VUE. The exam contains 200 scored multiple-choice questions,
all of which are scored, and candidates have three hours to complete it. The official 2026 DWC
notice identifies the October 2026 examination as an in-person computer-based examination.
(CalDIR)
Core Domains Tested in QME Exam
Clinical Assessment, Evaluation, and Medical Treatment
Disability and Impairment Evaluation
Maximum Medical Improvement (MMI) / Permanent and Stationary (P&S) Status
Permanent Disability and Functional Limitations
Causation and Apportionment
California Workers’ Compensation Laws and Regulations
Medical-Legal Report Writing and Substantial Medical Evidence
QME Panel, Appointment, and Medical-Legal Procedures
, Ethics, Conflicts of Interest, and Professional Responsibilities
Medical-Legal Fees, Forms, Timelines, and Administrative Requirements
CONTENT AREA TABLE
The official QME Information Booklet identifies four competency areas, but it does not
publish a percentage allocation for each area. Accordingly, the table below uses a study-
oriented distribution rather than presenting invented percentages as an official DWC blueprint.
The questions are aligned to the official competency areas and their listed tasks and
knowledge/skills. (CalDIR)
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
History, examination, diagnosis,
Clinical Assessment/Evaluation
25% 50 records, treatment, occupational
and Medical Treatment
history
Disability and Impairment AMA Guides, impairment, disability,
25% 50
Issues/MMI & P&S MMI, functional limitations, ratings
AOE/COE, specific/cumulative injury,
Causation and Apportionment 25% 50 aggravation, natural progression,
apportionment
QME procedures, reports, substantial
Basic Laws, Regulations and
25% 50 medical evidence, ethics, forms,
Report Writing
timelines
QUESTIONS 1-200
Q1: A QME reviews a worker's records and finds that the worker reports persistent
shoulder pain after a lifting incident. MRI findings show a chronic rotator-cuff tear, but
the records also document substantial shoulder symptoms for two years before the alleged
injury. Which approach best supports a defensible QME opinion?
A) Attribute all current impairment to the lifting incident because it was the most recent event
B) Integrate the pre-injury history, mechanism, objective findings, treatment history, and
chronology before determining causation and impairment
C) Exclude all pre-injury records because they concern a nonindustrial condition
D) Defer causation entirely to the treating physician
Correct Answer: B
Rationale: A defensible QME opinion must integrate the relevant medical history, occupational
history, records, examination, mechanism, and chronology. Preexisting findings cannot simply
,be ignored. A is overly categorical, C improperly excludes potentially material evidence, and D
improperly delegates the QME's independent medical-legal responsibility.
Q2: During an evaluation, an injured worker gives a history that materially conflicts with
contemporaneous emergency-department records. What should the QME do first?
A) Automatically conclude that the worker is malingering
B) Identify the discrepancy, review the relevant records, and explain how the conflicting
information affects the medical opinion
C) Ignore the records because the worker's current history is more recent
D) Accept the emergency-department record as conclusive proof of causation
Correct Answer: B
Rationale: The QME should identify and analyze inconsistencies rather than automatically
assigning a motive or credibility finding. The official competency material emphasizes
correlating records with reported history and stating the medical facts supporting opinions. A
and D are premature conclusions, while C improperly disregards objective historical evidence.
Q3: A worker asks the QME to recommend a particular surgical procedure because the
worker believes surgery will increase the disability rating. What is the most appropriate
response?
A) Recommend surgery because it may improve the worker's rating
B) Recommend surgery whenever the worker requests it
C) Refuse to discuss treatment under any circumstances
D) Address future medical care based on the medical evidence and applicable standards,
independent of the potential effect on a disability rating
Correct Answer: D
Rationale: The QME's medical opinion must be based on medical evidence, not on an attempt to
manipulate a compensation outcome. Treatment recommendations should address reasonable
and necessary care related to the condition. A and B improperly link treatment to compensation,
while C is too broad because future medical care may appropriately be addressed in a QME
report.
Q4: A QME is evaluating a lumbar injury and discovers that the worker previously
underwent lumbar surgery for a condition involving the same spinal level. Which
additional information is most important before forming an apportionment opinion?
A) The worker's current attorney's preferred conclusion
B) Only the most recent MRI
C) The preexisting diagnosis, prior functional status, prior treatment, prior impairment,
and subsequent course
D) The worker's current job title alone
, Correct Answer: C
Rationale: Apportionment requires a medically reasoned assessment of the factors contributing
to the current permanent disability. Prior diagnosis, treatment, functional status, impairment,
and subsequent history are therefore highly relevant. A is legally irrelevant to medical
causation, D is insufficient by itself, and B provides only one piece of the evidence.
Q5: A QME concludes that a worker has reached maximum medical improvement but the
report does not explain why no additional treatment is expected to materially change the
condition. Which revision would most improve the report?
A) Add a statement that the worker is permanently disabled
B) Explain the medical evidence supporting the MMI determination and why further
material improvement is not reasonably anticipated
C) Remove the MMI conclusion
D) Substitute the worker's subjective assessment for the medical evidence
Correct Answer: B
Rationale: MMI/P&S conclusions require medical reasoning supported by the clinical course,
examination, records, and treatment status. Merely declaring permanent disability does not
establish MMI. Removing the conclusion avoids rather than solves the problem, and subjective
preference cannot substitute for medical evidence.
Q6: A QME is asked to determine whether a worker's current symptoms are consistent
with the claimed mechanism of injury. Which sequence is most appropriate?
A) Determine the disability percentage first and then infer causation
B) Accept the claimed mechanism without clinical analysis
C) Review only the worker's current symptoms
D) Compare the reported mechanism with the anatomy, pathophysiology, objective
findings, chronology, and relevant medical literature
Correct Answer: D
Rationale: Causation requires a medically reasoned connection between the alleged exposure or
event and the diagnosed condition. Mechanism, anatomy, chronology, objective findings, and
scientific evidence all contribute. A reverses the analytical process, B lacks independent
evaluation, and C is too narrow.
Q7: A QME's physical examination demonstrates substantially reduced lumbar range of
motion, but the worker's effort varies markedly between repeated measurements without a
corresponding clinical explanation. What should the QME do?
A) Automatically assign the highest possible impairment
B) Disregard the examination entirely
ANSWERS UPDATED 2026/2027| 100% VERIFIED|DETAILED
RATIONALES –PASS GUARANTEED A+ GRADED |INSTANT
DOWNLOAD
INTRODUCTION
The California Qualified Medical Evaluator (QME) Competency Examination is the
certification examination administered for the California Division of Workers’ Compensation
(DWC) Medical Unit. QMEs conduct independent medical evaluations of injured workers and
prepare medical-legal reports used in California’s workers’ compensation system. The current
DWC materials identify four competency areas: clinical assessment/evaluation and medical
treatment; disability and impairment issues/MMI and permanent disability; causation and
apportionment; and basic laws, regulations, and medical-legal report writing. (CalDIR)
Eligibility is directed primarily toward qualified medical professionals seeking appointment as
QMEs. DWC identifies eligible QME disciplines including physicians (MD/DO), chiropractors,
dentists, optometrists, podiatrists, psychologists, and acupuncturists, subject to the applicable
statutory and regulatory requirements. Additional education requirements apply to appointment
and reappointment, including required disability-evaluation/report-writing education for
applicable applicants. (CalDIR)
QME certification is professionally important because the QME serves as an independent
medical evaluator within California's workers' compensation dispute-resolution framework. The
examination is designed to establish competency in evaluating medical issues, California
workers' compensation terminology and law, medical-legal procedures, impairment, disability,
causation, apportionment, and preparation of medical-legal reports. (CalDIR)
For the current examination format, DWC states that the examination is computer-based and
administered through Pearson VUE. The exam contains 200 scored multiple-choice questions,
all of which are scored, and candidates have three hours to complete it. The official 2026 DWC
notice identifies the October 2026 examination as an in-person computer-based examination.
(CalDIR)
Core Domains Tested in QME Exam
Clinical Assessment, Evaluation, and Medical Treatment
Disability and Impairment Evaluation
Maximum Medical Improvement (MMI) / Permanent and Stationary (P&S) Status
Permanent Disability and Functional Limitations
Causation and Apportionment
California Workers’ Compensation Laws and Regulations
Medical-Legal Report Writing and Substantial Medical Evidence
QME Panel, Appointment, and Medical-Legal Procedures
, Ethics, Conflicts of Interest, and Professional Responsibilities
Medical-Legal Fees, Forms, Timelines, and Administrative Requirements
CONTENT AREA TABLE
The official QME Information Booklet identifies four competency areas, but it does not
publish a percentage allocation for each area. Accordingly, the table below uses a study-
oriented distribution rather than presenting invented percentages as an official DWC blueprint.
The questions are aligned to the official competency areas and their listed tasks and
knowledge/skills. (CalDIR)
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
History, examination, diagnosis,
Clinical Assessment/Evaluation
25% 50 records, treatment, occupational
and Medical Treatment
history
Disability and Impairment AMA Guides, impairment, disability,
25% 50
Issues/MMI & P&S MMI, functional limitations, ratings
AOE/COE, specific/cumulative injury,
Causation and Apportionment 25% 50 aggravation, natural progression,
apportionment
QME procedures, reports, substantial
Basic Laws, Regulations and
25% 50 medical evidence, ethics, forms,
Report Writing
timelines
QUESTIONS 1-200
Q1: A QME reviews a worker's records and finds that the worker reports persistent
shoulder pain after a lifting incident. MRI findings show a chronic rotator-cuff tear, but
the records also document substantial shoulder symptoms for two years before the alleged
injury. Which approach best supports a defensible QME opinion?
A) Attribute all current impairment to the lifting incident because it was the most recent event
B) Integrate the pre-injury history, mechanism, objective findings, treatment history, and
chronology before determining causation and impairment
C) Exclude all pre-injury records because they concern a nonindustrial condition
D) Defer causation entirely to the treating physician
Correct Answer: B
Rationale: A defensible QME opinion must integrate the relevant medical history, occupational
history, records, examination, mechanism, and chronology. Preexisting findings cannot simply
,be ignored. A is overly categorical, C improperly excludes potentially material evidence, and D
improperly delegates the QME's independent medical-legal responsibility.
Q2: During an evaluation, an injured worker gives a history that materially conflicts with
contemporaneous emergency-department records. What should the QME do first?
A) Automatically conclude that the worker is malingering
B) Identify the discrepancy, review the relevant records, and explain how the conflicting
information affects the medical opinion
C) Ignore the records because the worker's current history is more recent
D) Accept the emergency-department record as conclusive proof of causation
Correct Answer: B
Rationale: The QME should identify and analyze inconsistencies rather than automatically
assigning a motive or credibility finding. The official competency material emphasizes
correlating records with reported history and stating the medical facts supporting opinions. A
and D are premature conclusions, while C improperly disregards objective historical evidence.
Q3: A worker asks the QME to recommend a particular surgical procedure because the
worker believes surgery will increase the disability rating. What is the most appropriate
response?
A) Recommend surgery because it may improve the worker's rating
B) Recommend surgery whenever the worker requests it
C) Refuse to discuss treatment under any circumstances
D) Address future medical care based on the medical evidence and applicable standards,
independent of the potential effect on a disability rating
Correct Answer: D
Rationale: The QME's medical opinion must be based on medical evidence, not on an attempt to
manipulate a compensation outcome. Treatment recommendations should address reasonable
and necessary care related to the condition. A and B improperly link treatment to compensation,
while C is too broad because future medical care may appropriately be addressed in a QME
report.
Q4: A QME is evaluating a lumbar injury and discovers that the worker previously
underwent lumbar surgery for a condition involving the same spinal level. Which
additional information is most important before forming an apportionment opinion?
A) The worker's current attorney's preferred conclusion
B) Only the most recent MRI
C) The preexisting diagnosis, prior functional status, prior treatment, prior impairment,
and subsequent course
D) The worker's current job title alone
, Correct Answer: C
Rationale: Apportionment requires a medically reasoned assessment of the factors contributing
to the current permanent disability. Prior diagnosis, treatment, functional status, impairment,
and subsequent history are therefore highly relevant. A is legally irrelevant to medical
causation, D is insufficient by itself, and B provides only one piece of the evidence.
Q5: A QME concludes that a worker has reached maximum medical improvement but the
report does not explain why no additional treatment is expected to materially change the
condition. Which revision would most improve the report?
A) Add a statement that the worker is permanently disabled
B) Explain the medical evidence supporting the MMI determination and why further
material improvement is not reasonably anticipated
C) Remove the MMI conclusion
D) Substitute the worker's subjective assessment for the medical evidence
Correct Answer: B
Rationale: MMI/P&S conclusions require medical reasoning supported by the clinical course,
examination, records, and treatment status. Merely declaring permanent disability does not
establish MMI. Removing the conclusion avoids rather than solves the problem, and subjective
preference cannot substitute for medical evidence.
Q6: A QME is asked to determine whether a worker's current symptoms are consistent
with the claimed mechanism of injury. Which sequence is most appropriate?
A) Determine the disability percentage first and then infer causation
B) Accept the claimed mechanism without clinical analysis
C) Review only the worker's current symptoms
D) Compare the reported mechanism with the anatomy, pathophysiology, objective
findings, chronology, and relevant medical literature
Correct Answer: D
Rationale: Causation requires a medically reasoned connection between the alleged exposure or
event and the diagnosed condition. Mechanism, anatomy, chronology, objective findings, and
scientific evidence all contribute. A reverses the analytical process, B lacks independent
evaluation, and C is too narrow.
Q7: A QME's physical examination demonstrates substantially reduced lumbar range of
motion, but the worker's effort varies markedly between repeated measurements without a
corresponding clinical explanation. What should the QME do?
A) Automatically assign the highest possible impairment
B) Disregard the examination entirely
