QME EXAM COMPLETE QUESTIONS AND ANSWERS
BASED ON THE MOST RECENT EXAM FORMAT
214 QUESTIONS AND ANSWERS
1. Q: What is the primary purpose of the workers' compensation system?
A: To provide medical treatment and compensation for work-related injuries
and illnesses while protecting employers from civil lawsuits.
2. Q: What are the four basic benefits available under workers'
compensation? A: Medical treatment, temporary disability, permanent
disability, and vocational rehabilitation.
3. Q: What does "AOE/COE" stand for? A: Arising Out of
Employment/Course of Employment - the legal standard for determining if an
injury is work-related.
4. Q: What is the role of a Qualified Medical Examiner (QME)? A: To
provide independent medical evaluations and opinions on disputed medical
issues in workers' compensation cases.
5. Q: What is the difference between a QME and an AME? A: QME is
appointed by the state for disputed cases; AME (Agreed Medical Examiner) is
selected by agreement between parties.
6. Q: What is Maximum Medical Improvement (MMI)? A: The point when
an injured worker's condition has stabilized and no further improvement is
expected with or without treatment.
7. Q: What is Permanent and Stationary (P&S) status? A: California's term
equivalent to MMI, indicating the condition has reached maximum
improvement.
8. Q: What is the purpose of the AMA Guides to the Evaluation of
Permanent Impairment? A: To provide standardized methods for evaluating
and rating permanent impairment resulting from injuries or illnesses.
9. Q: What is apportionment in workers' compensation? A: The allocation
of permanent disability between work-related and non-work-related causes.
,10. Q: What is causation in workers' compensation context? A: The
relationship between workplace factors and an injury or illness, determining
compensability.
11. Q: What is the difference between temporary total disability (TTD) and
temporary partial disability (TPD)? A: TTD applies when unable to work at
all; TPD when able to work with restrictions or reduced capacity.
12. Q: What is the Labor Code section that governs QME appointments?
A: Labor Code Section 4062 et seq.
13. Q: What is the standard of proof required in workers' compensation
cases? A: Preponderance of evidence (more likely than not, >50%).
14. Q: What is industrial causation? A: Work-related factors that contribute
to or cause an injury or illness.
15. Q: What is the definition of "injury" under workers' compensation
law? A: Any injury or disease arising out of and in the course of employment.
16. Q: What is the statute of limitations for filing a workers' compensation
claim in California? A: Generally one year from date of injury or knowledge
of injury and its work-relatedness.
17. Q: What is a Subsequent Injuries Benefits Trust Fund (SIBTF) case? A:
Cases involving workers with pre-existing disabilities who suffer additional
work-related injuries.
18. Q: What is the presumption doctrine in workers' compensation? A:
Legal presumptions that certain conditions in specific occupations are work-
related unless proven otherwise.
19. Q: What is the role of the Workers' Compensation Appeals Board
(WCAB)? A: The judicial body that hears and decides disputed workers'
compensation cases.
20. Q: What is a Declaration of Readiness to Proceed (DOR)? A: A
document filed to request a hearing before the WCAB.
21. Q: What is the difference between medical treatment and medical-legal
evaluation? A: Treatment aims to cure/relieve; medical-legal evaluations
provide opinions on disputed medical issues.
22. Q: What is the Utilization Review (UR) process? A: The system to review
and approve or deny medical treatment requests for appropriateness and
necessity.
, 23. Q: What is Independent Medical Review (IMR)? A: The external review
process for disputed UR decisions.
24. Q: What is the Official Medical Fee Schedule (OMFS)? A: The fee
schedule that governs reimbursement for medical services in workers'
compensation.
25. Q: What is return to work in workers' compensation? A: The process of
getting injured workers back to employment, either with the same or different
employer.
26. Q: What is the definition of "permanent disability"? A: Lasting
impairment or loss of function that persists after maximum medical
improvement.
27. Q: What is the role of the Disability Evaluation Unit (DEU)? A: A state
agency that provides disability ratings and medical evaluations.
28. Q: What is the difference between Schedule Loss of Use and whole
person impairment? A: Schedule Loss relates to specific body parts; whole
person considers overall functional impact.
29. Q: What is the concept of "substantial medical evidence"? A: Medical
evidence of sufficient scope and quality to support a conclusion or opinion.
30. Q: What is the reporting requirement for QMEs regarding their
evaluations? A: QMEs must provide comprehensive written reports addressing
all disputed medical issues.
31. Q: What is the time frame for completing a QME evaluation? A:
Generally 30 days from the examination date to issue the report.
32. Q: What is the fee structure for QME evaluations? A: Set by regulation,
typically based on complexity levels (ML-101, ML-102, ML-103, ML-104).
33. Q: What is the requirement for QME continuing education? A: QMEs
must complete continuing education requirements to maintain their certification.
34. Q: What is the process for becoming a QME? A: Application,
examination, background check, and meeting specialty requirements.
35. Q: What is the disciplinary process for QMEs? A: Investigation and
potential sanctions by the Administrative Director for violations.
36. Q: What is the definition of "good cause" for QME replacement? A:
Legitimate reasons such as bias, conflict of interest, or failure to complete
evaluation.
BASED ON THE MOST RECENT EXAM FORMAT
214 QUESTIONS AND ANSWERS
1. Q: What is the primary purpose of the workers' compensation system?
A: To provide medical treatment and compensation for work-related injuries
and illnesses while protecting employers from civil lawsuits.
2. Q: What are the four basic benefits available under workers'
compensation? A: Medical treatment, temporary disability, permanent
disability, and vocational rehabilitation.
3. Q: What does "AOE/COE" stand for? A: Arising Out of
Employment/Course of Employment - the legal standard for determining if an
injury is work-related.
4. Q: What is the role of a Qualified Medical Examiner (QME)? A: To
provide independent medical evaluations and opinions on disputed medical
issues in workers' compensation cases.
5. Q: What is the difference between a QME and an AME? A: QME is
appointed by the state for disputed cases; AME (Agreed Medical Examiner) is
selected by agreement between parties.
6. Q: What is Maximum Medical Improvement (MMI)? A: The point when
an injured worker's condition has stabilized and no further improvement is
expected with or without treatment.
7. Q: What is Permanent and Stationary (P&S) status? A: California's term
equivalent to MMI, indicating the condition has reached maximum
improvement.
8. Q: What is the purpose of the AMA Guides to the Evaluation of
Permanent Impairment? A: To provide standardized methods for evaluating
and rating permanent impairment resulting from injuries or illnesses.
9. Q: What is apportionment in workers' compensation? A: The allocation
of permanent disability between work-related and non-work-related causes.
,10. Q: What is causation in workers' compensation context? A: The
relationship between workplace factors and an injury or illness, determining
compensability.
11. Q: What is the difference between temporary total disability (TTD) and
temporary partial disability (TPD)? A: TTD applies when unable to work at
all; TPD when able to work with restrictions or reduced capacity.
12. Q: What is the Labor Code section that governs QME appointments?
A: Labor Code Section 4062 et seq.
13. Q: What is the standard of proof required in workers' compensation
cases? A: Preponderance of evidence (more likely than not, >50%).
14. Q: What is industrial causation? A: Work-related factors that contribute
to or cause an injury or illness.
15. Q: What is the definition of "injury" under workers' compensation
law? A: Any injury or disease arising out of and in the course of employment.
16. Q: What is the statute of limitations for filing a workers' compensation
claim in California? A: Generally one year from date of injury or knowledge
of injury and its work-relatedness.
17. Q: What is a Subsequent Injuries Benefits Trust Fund (SIBTF) case? A:
Cases involving workers with pre-existing disabilities who suffer additional
work-related injuries.
18. Q: What is the presumption doctrine in workers' compensation? A:
Legal presumptions that certain conditions in specific occupations are work-
related unless proven otherwise.
19. Q: What is the role of the Workers' Compensation Appeals Board
(WCAB)? A: The judicial body that hears and decides disputed workers'
compensation cases.
20. Q: What is a Declaration of Readiness to Proceed (DOR)? A: A
document filed to request a hearing before the WCAB.
21. Q: What is the difference between medical treatment and medical-legal
evaluation? A: Treatment aims to cure/relieve; medical-legal evaluations
provide opinions on disputed medical issues.
22. Q: What is the Utilization Review (UR) process? A: The system to review
and approve or deny medical treatment requests for appropriateness and
necessity.
, 23. Q: What is Independent Medical Review (IMR)? A: The external review
process for disputed UR decisions.
24. Q: What is the Official Medical Fee Schedule (OMFS)? A: The fee
schedule that governs reimbursement for medical services in workers'
compensation.
25. Q: What is return to work in workers' compensation? A: The process of
getting injured workers back to employment, either with the same or different
employer.
26. Q: What is the definition of "permanent disability"? A: Lasting
impairment or loss of function that persists after maximum medical
improvement.
27. Q: What is the role of the Disability Evaluation Unit (DEU)? A: A state
agency that provides disability ratings and medical evaluations.
28. Q: What is the difference between Schedule Loss of Use and whole
person impairment? A: Schedule Loss relates to specific body parts; whole
person considers overall functional impact.
29. Q: What is the concept of "substantial medical evidence"? A: Medical
evidence of sufficient scope and quality to support a conclusion or opinion.
30. Q: What is the reporting requirement for QMEs regarding their
evaluations? A: QMEs must provide comprehensive written reports addressing
all disputed medical issues.
31. Q: What is the time frame for completing a QME evaluation? A:
Generally 30 days from the examination date to issue the report.
32. Q: What is the fee structure for QME evaluations? A: Set by regulation,
typically based on complexity levels (ML-101, ML-102, ML-103, ML-104).
33. Q: What is the requirement for QME continuing education? A: QMEs
must complete continuing education requirements to maintain their certification.
34. Q: What is the process for becoming a QME? A: Application,
examination, background check, and meeting specialty requirements.
35. Q: What is the disciplinary process for QMEs? A: Investigation and
potential sanctions by the Administrative Director for violations.
36. Q: What is the definition of "good cause" for QME replacement? A:
Legitimate reasons such as bias, conflict of interest, or failure to complete
evaluation.
