QME Exam Newest Actual Exam Complete Questions and
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California Workers' Compensation Law and Regulations
Q1: An injured worker in California sustains a back injury at work. Under the California Labor
Code, what is the primary presumption regarding injuries that occur during the course of
employment?
A. The injury is presumed non-compensable until proven otherwise.
B. The injury is presumed to be work-related and compensable. [CORRECT]
C. The injury is only compensable if reported within 24 hours.
D. The injury is presumed to be a pre-existing condition.
Correct Answer: B
Rationale: The best answer is B because California Labor Code Section 3212 et seq.
establishes a presumption that injuries arising in the course of employment are work-
related and compensable.
Q2: A claims administrator denies a worker’s claim, stating the worker voluntarily quit
before the injury occurred. What is the worker’s primary recourse under California workers'
compensation law?
A. File a civil lawsuit in superior court immediately.
B. Request a hearing before the Workers' Compensation Appeals Board (WCAB). [CORRECT]
C. Appeal directly to the California Supreme Court.
D. Accept the denial as final under the exclusive remedy provision.
Correct Answer: B
Rationale: This choice is correct because the WCAB has exclusive jurisdiction over disputes
regarding compensability and benefits in California workers' compensation cases.
Q3: Which of the following best describes the "exclusive remedy" provision in California
workers' compensation law?
A. It allows workers to sue their employer for pain and suffering in civil court.
B. It prevents an employee from suing their employer in civil court for a work-related injury.
[CORRECT]
C. It requires the employer to provide unlimited medical care regardless of causation.
D. It allows the employee to choose any physician without restriction.
Correct Answer: B
Rationale: This aligns with the fundamental principle that workers' compensation is the sole
remedy for an employee against their employer for work-related injuries, barring specific
exceptions like fraud or dual capacity.
,Q4: An employee suffers a cumulative trauma injury. What is the statute of limitations for
filing an application for adjudication of claim in California?
A. One year from the date of the last injurious exposure or last provision of benefits.
[CORRECT]
B. Two years from the date of the first symptom.
C. Six months from the date of termination.
D. Three years from the date of the injury.
Correct Answer: A
Rationale: The best answer is A because California Labor Code Section 5405 sets a one-year
statute of limitations from the date of last injurious exposure or last provision of workers'
compensation benefits.
Q5: A worker is offered light-duty work by their employer after a back injury. The worker
refuses without good cause. What is the likely impact on their temporary disability benefits?
A. Benefits will increase to compensate for the refusal.
B. Benefits will be suspended or terminated. [CORRECT]
C. Benefits will continue unchanged until maximum medical improvement.
D. Benefits will be converted to a permanent disability advance.
Correct Answer: B
Rationale: This choice is correct because unjustified refusal of suitable light-duty work can
lead to the suspension or termination of temporary disability benefits under California law.
Q6: Under California law, who is primarily responsible for providing medical treatment to an
injured worker during the first 30 days after a claim is filed?
A. The worker’s personal health insurance.
B. The employer or their claims administrator. [CORRECT]
C. The state workers' compensation fund.
D. The treating physician of the worker's choice, regardless of MPN.
Correct Answer: B
Rationale: This matches the principle that the employer/claims administrator controls
medical treatment for the first 30 days after a claim is filed, unless the employee
predesignated a physician.
Q7: An injured worker wishes to change their treating physician within the employer’s
Medical Provider Network (MPN). What is the general rule?
A. The worker must wait until permanent and stationary status is reached.
B. The worker may request a change of physician within the MPN at any time. [CORRECT]
C. The worker can only change physicians if the current one retires.
D. The worker must file a Declaration of Readiness to Proceed first.
Correct Answer: B
Rationale: The best answer is B because injured workers have the right to request a change
of treating physician within the MPN, and the MPN must accommodate this request.
Q8: What is the maximum duration for Temporary Total Disability (TTD) benefits for most
injuries in California, as per statutory limits?
A. 104 weeks within 5 years from the date of injury. [CORRECT]
B. 240 weeks for all injuries regardless of severity.
, C. 52 weeks with no extensions allowed.
D. Unlimited weeks until the worker returns to work.
Correct Answer: A
Rationale: This choice is correct because California Labor Code Section 4656 generally limits
TTD benefits to 104 weeks within 5 years from the date of injury, with specific exceptions
for certain severe injuries.
Q9: A worker sustains a serious facial disfigurement at work. Under California workers'
compensation law, this may be evaluated as:
A. A non-compensable cosmetic issue.
B. A permanent disability under the schedule for disfigurement. [CORRECT]
C. A temporary disability only.
D. A claim exclusively handled by civil court.
Correct Answer: B
Rationale: This aligns with the principle that serious disfigurement, particularly to the head,
face, neck, or chest, can be rated as a permanent disability under California workers'
compensation guidelines.
Q10: Which document is used by a claims administrator to formally deny a workers'
compensation claim in California?
A. Notice of Potential Claim (DWC 1)
B. Notice of Denial of Claim (DWC 12) [CORRECT]
C. Request for Authorization (DWC Form RFA)
D. Medical Legal Report (MLR)
Correct Answer: B
Rationale: The best answer is B because the DWC Form 12 is the official document used to
notify the injured worker and the DWC that a claim is being denied.
Q11: An employer fails to secure workers' compensation insurance. What is the
consequence under California law?
A. The employer is immune from all liability.
B. The employer may face civil penalties and lose the exclusive remedy protection.
[CORRECT]
C. The state automatically pays all benefits without seeking reimbursement.
D. The employee must wait two years to file a claim.
Correct Answer: B
Rationale: This choice is correct because uninsured employers in California face significant
penalties and may be subject to civil lawsuits by the injured worker, losing the exclusive
remedy shield.
Q12: What is the purpose of the Supplemental Job Displacement Benefit (SJDB) voucher in
California?
A. To pay for the worker's daily living expenses indefinitely.
B. To provide retraining or skill enhancement if the employer does not offer modified or
alternative work. [CORRECT]
C. To cover the cost of the QME evaluation.
D. To reimburse the employer for lost productivity.
Correct Detailed Answers Verified Answers Already
Graded A+ Brand New Version Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
California Workers' Compensation Law and Regulations
Q1: An injured worker in California sustains a back injury at work. Under the California Labor
Code, what is the primary presumption regarding injuries that occur during the course of
employment?
A. The injury is presumed non-compensable until proven otherwise.
B. The injury is presumed to be work-related and compensable. [CORRECT]
C. The injury is only compensable if reported within 24 hours.
D. The injury is presumed to be a pre-existing condition.
Correct Answer: B
Rationale: The best answer is B because California Labor Code Section 3212 et seq.
establishes a presumption that injuries arising in the course of employment are work-
related and compensable.
Q2: A claims administrator denies a worker’s claim, stating the worker voluntarily quit
before the injury occurred. What is the worker’s primary recourse under California workers'
compensation law?
A. File a civil lawsuit in superior court immediately.
B. Request a hearing before the Workers' Compensation Appeals Board (WCAB). [CORRECT]
C. Appeal directly to the California Supreme Court.
D. Accept the denial as final under the exclusive remedy provision.
Correct Answer: B
Rationale: This choice is correct because the WCAB has exclusive jurisdiction over disputes
regarding compensability and benefits in California workers' compensation cases.
Q3: Which of the following best describes the "exclusive remedy" provision in California
workers' compensation law?
A. It allows workers to sue their employer for pain and suffering in civil court.
B. It prevents an employee from suing their employer in civil court for a work-related injury.
[CORRECT]
C. It requires the employer to provide unlimited medical care regardless of causation.
D. It allows the employee to choose any physician without restriction.
Correct Answer: B
Rationale: This aligns with the fundamental principle that workers' compensation is the sole
remedy for an employee against their employer for work-related injuries, barring specific
exceptions like fraud or dual capacity.
,Q4: An employee suffers a cumulative trauma injury. What is the statute of limitations for
filing an application for adjudication of claim in California?
A. One year from the date of the last injurious exposure or last provision of benefits.
[CORRECT]
B. Two years from the date of the first symptom.
C. Six months from the date of termination.
D. Three years from the date of the injury.
Correct Answer: A
Rationale: The best answer is A because California Labor Code Section 5405 sets a one-year
statute of limitations from the date of last injurious exposure or last provision of workers'
compensation benefits.
Q5: A worker is offered light-duty work by their employer after a back injury. The worker
refuses without good cause. What is the likely impact on their temporary disability benefits?
A. Benefits will increase to compensate for the refusal.
B. Benefits will be suspended or terminated. [CORRECT]
C. Benefits will continue unchanged until maximum medical improvement.
D. Benefits will be converted to a permanent disability advance.
Correct Answer: B
Rationale: This choice is correct because unjustified refusal of suitable light-duty work can
lead to the suspension or termination of temporary disability benefits under California law.
Q6: Under California law, who is primarily responsible for providing medical treatment to an
injured worker during the first 30 days after a claim is filed?
A. The worker’s personal health insurance.
B. The employer or their claims administrator. [CORRECT]
C. The state workers' compensation fund.
D. The treating physician of the worker's choice, regardless of MPN.
Correct Answer: B
Rationale: This matches the principle that the employer/claims administrator controls
medical treatment for the first 30 days after a claim is filed, unless the employee
predesignated a physician.
Q7: An injured worker wishes to change their treating physician within the employer’s
Medical Provider Network (MPN). What is the general rule?
A. The worker must wait until permanent and stationary status is reached.
B. The worker may request a change of physician within the MPN at any time. [CORRECT]
C. The worker can only change physicians if the current one retires.
D. The worker must file a Declaration of Readiness to Proceed first.
Correct Answer: B
Rationale: The best answer is B because injured workers have the right to request a change
of treating physician within the MPN, and the MPN must accommodate this request.
Q8: What is the maximum duration for Temporary Total Disability (TTD) benefits for most
injuries in California, as per statutory limits?
A. 104 weeks within 5 years from the date of injury. [CORRECT]
B. 240 weeks for all injuries regardless of severity.
, C. 52 weeks with no extensions allowed.
D. Unlimited weeks until the worker returns to work.
Correct Answer: A
Rationale: This choice is correct because California Labor Code Section 4656 generally limits
TTD benefits to 104 weeks within 5 years from the date of injury, with specific exceptions
for certain severe injuries.
Q9: A worker sustains a serious facial disfigurement at work. Under California workers'
compensation law, this may be evaluated as:
A. A non-compensable cosmetic issue.
B. A permanent disability under the schedule for disfigurement. [CORRECT]
C. A temporary disability only.
D. A claim exclusively handled by civil court.
Correct Answer: B
Rationale: This aligns with the principle that serious disfigurement, particularly to the head,
face, neck, or chest, can be rated as a permanent disability under California workers'
compensation guidelines.
Q10: Which document is used by a claims administrator to formally deny a workers'
compensation claim in California?
A. Notice of Potential Claim (DWC 1)
B. Notice of Denial of Claim (DWC 12) [CORRECT]
C. Request for Authorization (DWC Form RFA)
D. Medical Legal Report (MLR)
Correct Answer: B
Rationale: The best answer is B because the DWC Form 12 is the official document used to
notify the injured worker and the DWC that a claim is being denied.
Q11: An employer fails to secure workers' compensation insurance. What is the
consequence under California law?
A. The employer is immune from all liability.
B. The employer may face civil penalties and lose the exclusive remedy protection.
[CORRECT]
C. The state automatically pays all benefits without seeking reimbursement.
D. The employee must wait two years to file a claim.
Correct Answer: B
Rationale: This choice is correct because uninsured employers in California face significant
penalties and may be subject to civil lawsuits by the injured worker, losing the exclusive
remedy shield.
Q12: What is the purpose of the Supplemental Job Displacement Benefit (SJDB) voucher in
California?
A. To pay for the worker's daily living expenses indefinitely.
B. To provide retraining or skill enhancement if the employer does not offer modified or
alternative work. [CORRECT]
C. To cover the cost of the QME evaluation.
D. To reimburse the employer for lost productivity.
