QME EXAM NEWEST ACTUAL EXAM 2026
COMPLETE 350 QUESTIONS AND CORRECT
DETAILED VERIFIED ANSWERS ALREADY
GRADED ACTUAL EXAM PAPER GRADED
A+
⩥ Historic compromise. Answer: -Trade-off of rights and benefits
-Employee gives up right to sue for lots of $ and gets protection from
legal system against discrimination
-Employer provides benefits regardless of fault in exchange for
protection from lawsuits
-3 components
1. No fault
2. Exclusive remedy
3. Assured and fixed benefits
⩥ No Fault & exceptions. Answer: -Employer pays benefits no matter
who caused injury, as long as it occurred during employment
*Exceptions
-self inflicted injury
-injury from serious/willful misconduct by employee: benefits reduced
by half unless employee died or has PD of 70% or more
,-injury from failure of employer to comply with health and safety reg
-employee was under 16yo
⩥ Exclusive Remedy. Answer: Workers' compensation benefits are the
only benefits injured workers may receive to compensate for a work-
related injury. (Even if employer negligent)
-unless employer uninsured
-or third party is involved, that party can be sued
⩥ Assured & Fixed Benefits. Answer: -WC has defined benefits
employer must pay
-WC is a statutory benefit w no arbitrary limits on freq, duration, or
extent of services
⩥ Benefits provided by WC system. Answer: -Medical
-TD payments: paid while injury is being tx, before it is PD
-PD payments: determined by loss of ADLs that contribute to WPI;
compensates employee who does not fully recover
-Vocational: no longer; now provides Supp Job Displacement Benefits
(SJDB)
-Death: 1 dep: $125,000, 2 dep: 135,000, 3+ dep: 160,000
⩥ Claims adjudication Unit. Answer: WC judges and staff; first level in
determining claim
,⩥ Disability eval Unit. Answer: Disability evaluator/raters that
determine PD ratings
⩥ Info and Assistance Unit. Answer: -Assists on rights, benefits, and
obligations under CA WC laws
-Officer helps resolve misunderstandings, disputes, and complaints from
claims for compensation
⩥ Rehab Unit. Answer: Makes determinations of disputes in vocational
rehab
⩥ Audit and Enforcement Unit. Answer: Conducts audits on insurance
co., self insured employer, and 3rd party admin.; ensures benefits are
paid accurately and timely
⩥ Uninsured employer fund/Collections unit. Answer: Pays benefits to
IW w/ illegally uninsured employer & pursues recovery
⩥ Medical Unit. Answer: -Executive med director; performs services
related to delivery of med benefits
-Est. policy and guidelines for tx and eval of IW
-Appoints QMEs; investigates complaints on QMEs
-Approves/certifies and oversees MPNs and HCO
, -Helps set med fee schedule
⩥ DEU ratings. Answer: 1. Formal: done at request of WC judge
2. Consultative: done on litigated cases at request of attorney or DW info
assist officer
3. Summary: non-litigated cases at request of claims admin or IW
⩥ Workers Comp Info System (WCIS). Answer: -Uses electronic record
keeping data to collect info from claims admin to help DIR oversee WC
system
-All elements/documents of claim (reports, notices, med billing) are
required to be electronic as of 9/22/06
⩥ Subsequent injury benefits trust fund (SIBTF). Answer: -Source of
add. compensation for IW who already had disability at time of injury
-Need combined effect of at least 70%
-Employer can hire disabled workers w/o fear of liability for effects of
prev. disability
⩥ WCAB. Answer: Workers Comp Appeals Board; 7 commissioners, 5
of which are attorneys
-Independent judicial body w/in DIR
-Adopt rules of procedure
-Set policies
COMPLETE 350 QUESTIONS AND CORRECT
DETAILED VERIFIED ANSWERS ALREADY
GRADED ACTUAL EXAM PAPER GRADED
A+
⩥ Historic compromise. Answer: -Trade-off of rights and benefits
-Employee gives up right to sue for lots of $ and gets protection from
legal system against discrimination
-Employer provides benefits regardless of fault in exchange for
protection from lawsuits
-3 components
1. No fault
2. Exclusive remedy
3. Assured and fixed benefits
⩥ No Fault & exceptions. Answer: -Employer pays benefits no matter
who caused injury, as long as it occurred during employment
*Exceptions
-self inflicted injury
-injury from serious/willful misconduct by employee: benefits reduced
by half unless employee died or has PD of 70% or more
,-injury from failure of employer to comply with health and safety reg
-employee was under 16yo
⩥ Exclusive Remedy. Answer: Workers' compensation benefits are the
only benefits injured workers may receive to compensate for a work-
related injury. (Even if employer negligent)
-unless employer uninsured
-or third party is involved, that party can be sued
⩥ Assured & Fixed Benefits. Answer: -WC has defined benefits
employer must pay
-WC is a statutory benefit w no arbitrary limits on freq, duration, or
extent of services
⩥ Benefits provided by WC system. Answer: -Medical
-TD payments: paid while injury is being tx, before it is PD
-PD payments: determined by loss of ADLs that contribute to WPI;
compensates employee who does not fully recover
-Vocational: no longer; now provides Supp Job Displacement Benefits
(SJDB)
-Death: 1 dep: $125,000, 2 dep: 135,000, 3+ dep: 160,000
⩥ Claims adjudication Unit. Answer: WC judges and staff; first level in
determining claim
,⩥ Disability eval Unit. Answer: Disability evaluator/raters that
determine PD ratings
⩥ Info and Assistance Unit. Answer: -Assists on rights, benefits, and
obligations under CA WC laws
-Officer helps resolve misunderstandings, disputes, and complaints from
claims for compensation
⩥ Rehab Unit. Answer: Makes determinations of disputes in vocational
rehab
⩥ Audit and Enforcement Unit. Answer: Conducts audits on insurance
co., self insured employer, and 3rd party admin.; ensures benefits are
paid accurately and timely
⩥ Uninsured employer fund/Collections unit. Answer: Pays benefits to
IW w/ illegally uninsured employer & pursues recovery
⩥ Medical Unit. Answer: -Executive med director; performs services
related to delivery of med benefits
-Est. policy and guidelines for tx and eval of IW
-Appoints QMEs; investigates complaints on QMEs
-Approves/certifies and oversees MPNs and HCO
, -Helps set med fee schedule
⩥ DEU ratings. Answer: 1. Formal: done at request of WC judge
2. Consultative: done on litigated cases at request of attorney or DW info
assist officer
3. Summary: non-litigated cases at request of claims admin or IW
⩥ Workers Comp Info System (WCIS). Answer: -Uses electronic record
keeping data to collect info from claims admin to help DIR oversee WC
system
-All elements/documents of claim (reports, notices, med billing) are
required to be electronic as of 9/22/06
⩥ Subsequent injury benefits trust fund (SIBTF). Answer: -Source of
add. compensation for IW who already had disability at time of injury
-Need combined effect of at least 70%
-Employer can hire disabled workers w/o fear of liability for effects of
prev. disability
⩥ WCAB. Answer: Workers Comp Appeals Board; 7 commissioners, 5
of which are attorneys
-Independent judicial body w/in DIR
-Adopt rules of procedure
-Set policies
