QME CERTIFICATION EXAM 2026 COMPLETE
QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ 3 types of substantive medical disputes resolved by QMEs.
Answer: (1) Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and
further disabilities after permanent disability (detereoration of
original injury), compensability of new body part added to claim)
◉ Definition of *injury* in compensability claims. Answer: (1) An
injury or disease arising out of employment;
(2) A *derivative* injury caused by treatment of an injury arising out
of employment;
(3) Any reaction to or side effect from preventative health care the
employer provides to health care workers
◉ *Specific injury*. Answer: Occurs as the result of a single incident
or exposure
◉ *Cumulative injury*. Answer: Results from repetitive trauma
(mental or physical) over a period of time
,◉ 2 requirements for a condition to be considered an injury.
Answer: (1) Cause disability; or
(2) Result in a need for medical treatment
◉ Occupational disease. Answer: Disease that in whole or part is
caused by work
◉ 7 types of excluded injuries. Answer: (1) Caused by employee's
use of alcohol or illegal controlled substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured employee is the
*initial physical aggressor*;
(5) Resulting from the employee's commission of a felony, for which
the employee has been convicted (including "wobbly felonies,"
which are crimes that may be prosecuted as misdemeanors or
felonies)
(6) Resulting from off-duty recreational activities, in which
participation in the activities does not constitute part of the
employee's work-related duties and the activity is not an expressed
or implicit condition of employment;
(7) Psychiatric injuries claimed after notice of termination/layoff
unless certain conditions exist
, ◉ 4 basic conditions to establish a workers' compensation claim.
Answer: (1) *Injury* (physiological or psychological harm);
(2) Employment relationship;
(3) Injury caused by the employment (This is also referred to as
arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
◉ Aggravation of a pre-existing, non-industrial condition. Answer:
(1) Causes a temporary or permanent increase in disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
◉ Symptoms that don't constitute a new injury. Answer: *Flare-ups*
or *recurrence* of a previous industrial injury or illness; not been
caused by the current employment
◉ Date of injury (DOI)-specific injury. Answer: Date on which the
incident or exposure occurred
◉ Date of injury (DOI)-cumulative injury. Answer: Date when the
employee first suffered disability from the exposure, and either
knew, or should have known, that the disability was caused by
present or previous employment
QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ 3 types of substantive medical disputes resolved by QMEs.
Answer: (1) Compensability of the claim;
(2) Permanent disability;
(3) "Catch-all" (temporary disability, work restrictions, new and
further disabilities after permanent disability (detereoration of
original injury), compensability of new body part added to claim)
◉ Definition of *injury* in compensability claims. Answer: (1) An
injury or disease arising out of employment;
(2) A *derivative* injury caused by treatment of an injury arising out
of employment;
(3) Any reaction to or side effect from preventative health care the
employer provides to health care workers
◉ *Specific injury*. Answer: Occurs as the result of a single incident
or exposure
◉ *Cumulative injury*. Answer: Results from repetitive trauma
(mental or physical) over a period of time
,◉ 2 requirements for a condition to be considered an injury.
Answer: (1) Cause disability; or
(2) Result in a need for medical treatment
◉ Occupational disease. Answer: Disease that in whole or part is
caused by work
◉ 7 types of excluded injuries. Answer: (1) Caused by employee's
use of alcohol or illegal controlled substances;
(2) Intentionally self-inflicted injuries;
(3) Suicide;
(4) Resulting from altercations, in which the injured employee is the
*initial physical aggressor*;
(5) Resulting from the employee's commission of a felony, for which
the employee has been convicted (including "wobbly felonies,"
which are crimes that may be prosecuted as misdemeanors or
felonies)
(6) Resulting from off-duty recreational activities, in which
participation in the activities does not constitute part of the
employee's work-related duties and the activity is not an expressed
or implicit condition of employment;
(7) Psychiatric injuries claimed after notice of termination/layoff
unless certain conditions exist
, ◉ 4 basic conditions to establish a workers' compensation claim.
Answer: (1) *Injury* (physiological or psychological harm);
(2) Employment relationship;
(3) Injury caused by the employment (This is also referred to as
arising out of employment [AOE].);
(4) Occurred in the course of the employment (COE)
◉ Aggravation of a pre-existing, non-industrial condition. Answer:
(1) Causes a temporary or permanent increase in disability;
(2) Creates a new need for medical treatment; or
(3) Requires a change in the existing course of treatment
◉ Symptoms that don't constitute a new injury. Answer: *Flare-ups*
or *recurrence* of a previous industrial injury or illness; not been
caused by the current employment
◉ Date of injury (DOI)-specific injury. Answer: Date on which the
incident or exposure occurred
◉ Date of injury (DOI)-cumulative injury. Answer: Date when the
employee first suffered disability from the exposure, and either
knew, or should have known, that the disability was caused by
present or previous employment
