QME ACTUAL EXAM LATEST 2024/2025 QUESTIONS AND
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
A request for extension of time to serve a report must be filed
A. At least 20 days prior to the due date.
B. At least 15 days prior to the due date.
C. At least 5 days prior to the due date.
D. Only if the evaluator does not have once square of their schedule to spare within a
14-day span. - ANSWER C. At least 5 days prior to the due date.
The required Labor Code §4628 disclosure at the end of every report:
A. Is made under penalty of perjury.
B. Can be signed by the clerical staff of an evaluator.
C. Is not required to be made under penalty of perjury.
D.Includes an clause not to violate EMTALA laws. - ANSWER A. Is made under
penalty of perjury.
How is the disability rating made? - ANSWER QMEs rate the impairment (NOT
DISABILITY), and then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of
permanent impairment? - ANSWER Psych cases and cases prior to 1/1/2005 (the
latter use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time
devoted to direct clinical practice? - ANSWER 1) if the QME has been an AME at least
8 times in the past year
2) if the QME is retired or a teaching physician
Can acupuncturists issue opinions on permanent disability? - ANSWER No
What are the limitations to apportionment? - ANSWER 1) Apportionment applies only
to permanent disability and is based on causation
2) only permanent disability is apportioned, never treatment, work restrictions, etc.
What is the signing date for QME reports? - ANSWER the date the report is
completed, not the evaluation date. include the county of the report
What are the five major categories of QME disciplinary action? - ANSWER 1)
consistent late reports
,1. lack of availability
2) ex parte communications
3) self-referral
4) reports do not meet DWC minimum standards
What must be included with the HPI? - ANSWER A discussion of the mechanism of
injury
What are the 5 main types of workers comp benefits? - ANSWER 1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? - ANSWER Requires CA employees to have
worker's comp insurance
what is the definition of a medical-legal report? - ANSWER to prove or disprove an
aspect of a contested claim
What is the impairment rating? - ANSWER Rates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? - ANSWER AOE: arising out of employment
COE: through the course of employment
What is ex parte communication? - ANSWER Occurs when a party to a case
communicates with one side only. a QME CANNOT do this (but can speak with the
treating MD if questions arise)
What is the difference between exacerbation and aggravation? - ANSWER
Exacerbation: temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. - ANSWER
Permanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury? - ANSWER No
,Define apportionment - ANSWER Estimate of the % of permanent disability was
caused by work-related injury
What are temporary disability payments? - ANSWER 2/3 of average weekly pay,
limited to 104 weeks (2 years)
when are supplemental job displacement benefits offered? - ANSWER if the employer
doesn't offer a RTW (return to work), a voucher can be offered to the IW, but must be
used within 2 years of offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? - ANSWER Non-psych: if 1% or
more of the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? - ANSWER 1) Firefighters &
peace officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues
if >5 years work
What are the medical treatment utilization schedule (MTUS) guidelines? - ANSWER
ODG: chronic pain / post-surgical
ACOEM: everything else
When did SB899 go into effect, so we use the AMA guides to the eval of permanent
impairment 5th edition now? - ANSWER Jan 1, 2005
When are reports due? - ANSWER 30 days from evaluation
When are supplemental reports due? - ANSWER 60 days
For how long must reports be kept? - ANSWER 5 years
What is the timeframe for appointment scheduling?
What is the timeframe for form 110 (appt notification)? - ANSWER Appt must be made
within 60 days from the date of the call.
Form 110 (appt notification) sent within 5 days of making the appt.
What is the timeframe for disclosing a conflict of interest? - ANSWER 5 days from
learning of the conflict, in writing to all parties involved
What are the two conditions and timelines for a medical eval extension? - ANSWER 1)
30 days if waiting for test results
2) 15 days for all else ("with good cause")
, What is the minimal required FaceTime for neuromusculoskeletal vs psych vs all else? -
ANSWER Neuromusculoskeletal: 20 min
Psych: 60 min
All else: 30 min
When did SB 863 (restricted ability for IW to get impairment fro psych / sexual / sleep
d/o) go into effect? - ANSWER Jan 1 2013
What is the time frame for a QME to notify, via form 109, of unavailability? - ANSWER
at least 30 days prior for a 14-90 day absence
What is the limitation re time for cancelling / rescheduling an appointment? How far out
can rescheduling happen? - ANSWER Cannot cancel within 6 days of the appt unless
there is "good cause," and must reschedule for within 30 days of the cancellation date
(and 60 days of the date of the initial call to schedule)
What is the timeframe for deposition scheduling? - ANSWER within 120 days of notice
What is the time in which a carrier can accept for deny a claim? - ANSWER 90 days,
otherwise its considered compensable
How long does a first treating MD have to complete a "Doctors First Report of
Occupational Injury of Illness?" - ANSWER 5 days of the worker's first visit
Form 100 - ANSWER Employee's Disability Questionnaire (include for unrepresented
workers for permanent disability or apportionment)
Form 101 - ANSWER Request for Summary Rating Determination (include for
unrepresented workers for permanent disability or apportionment)
Form 109 - ANSWER Notice of Unavailability Form
Form 110 - ANSWER Appointment Notification Form (QME must send to all parties
within 5 days of the appt being made)
Form 111 - ANSWER QME Findings Summaary
Form 112 - ANSWER QME Report Time Frame Extension Request (has to be filed at
least 5 days before report deadline; there is a 15 day good cause extension and 30 day
extension for pending test results)
Form 122 - ANSWER Medical Legal Declaration of Service Form (must be included
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
A request for extension of time to serve a report must be filed
A. At least 20 days prior to the due date.
B. At least 15 days prior to the due date.
C. At least 5 days prior to the due date.
D. Only if the evaluator does not have once square of their schedule to spare within a
14-day span. - ANSWER C. At least 5 days prior to the due date.
The required Labor Code §4628 disclosure at the end of every report:
A. Is made under penalty of perjury.
B. Can be signed by the clerical staff of an evaluator.
C. Is not required to be made under penalty of perjury.
D.Includes an clause not to violate EMTALA laws. - ANSWER A. Is made under
penalty of perjury.
How is the disability rating made? - ANSWER QMEs rate the impairment (NOT
DISABILITY), and then raters use the impairment rating to make a disability rating
What are the two exceptions to using the AMA guides 5th ed. to the evaluation of
permanent impairment? - ANSWER Psych cases and cases prior to 1/1/2005 (the
latter use the 1997 PDRS)
What are the two exceptions to the requirement that QMEs have 1/3 of their time
devoted to direct clinical practice? - ANSWER 1) if the QME has been an AME at least
8 times in the past year
2) if the QME is retired or a teaching physician
Can acupuncturists issue opinions on permanent disability? - ANSWER No
What are the limitations to apportionment? - ANSWER 1) Apportionment applies only
to permanent disability and is based on causation
2) only permanent disability is apportioned, never treatment, work restrictions, etc.
What is the signing date for QME reports? - ANSWER the date the report is
completed, not the evaluation date. include the county of the report
What are the five major categories of QME disciplinary action? - ANSWER 1)
consistent late reports
,1. lack of availability
2) ex parte communications
3) self-referral
4) reports do not meet DWC minimum standards
What must be included with the HPI? - ANSWER A discussion of the mechanism of
injury
What are the 5 main types of workers comp benefits? - ANSWER 1) Medical treatment
2) temporary disability benefits
3) permanent disability benefits
4) death benefits
5) supplemental job displacement benefits (SJDB)
What is the Boynton Act of 1913? - ANSWER Requires CA employees to have
worker's comp insurance
what is the definition of a medical-legal report? - ANSWER to prove or disprove an
aspect of a contested claim
What is the impairment rating? - ANSWER Rates the degree to which the impairment
decreases a person's ability to perform ADLs, excluding work
What are AOE and COE? - ANSWER AOE: arising out of employment
COE: through the course of employment
What is ex parte communication? - ANSWER Occurs when a party to a case
communicates with one side only. a QME CANNOT do this (but can speak with the
treating MD if questions arise)
What is the difference between exacerbation and aggravation? - ANSWER
Exacerbation: temporary worsening
Aggravation: permanent worsening (new injury)
Define permanent, temporary partial and temporary total disability. - ANSWER
Permanent: irreversible residual of an injury
Temp partial: can work, but earn less than previously
Temp total: cannot work at all
Do psych injuries after termination count as injury? - ANSWER No
,Define apportionment - ANSWER Estimate of the % of permanent disability was
caused by work-related injury
What are temporary disability payments? - ANSWER 2/3 of average weekly pay,
limited to 104 weeks (2 years)
when are supplemental job displacement benefits offered? - ANSWER if the employer
doesn't offer a RTW (return to work), a voucher can be offered to the IW, but must be
used within 2 years of offer or 5 years from date of injury (DOI)
When are non-psych vs psych injuries compensable? - ANSWER Non-psych: if 1% or
more of the injury is industrial
Psych: if >50% is industrial (some exceptions)
What are the known presumptions for worker's comp? - ANSWER 1) Firefighters &
peace officers cancer, if known exposures
2) Peace officers with heart trouble, PNA, hernia, infectious diseases, lower back issues
if >5 years work
What are the medical treatment utilization schedule (MTUS) guidelines? - ANSWER
ODG: chronic pain / post-surgical
ACOEM: everything else
When did SB899 go into effect, so we use the AMA guides to the eval of permanent
impairment 5th edition now? - ANSWER Jan 1, 2005
When are reports due? - ANSWER 30 days from evaluation
When are supplemental reports due? - ANSWER 60 days
For how long must reports be kept? - ANSWER 5 years
What is the timeframe for appointment scheduling?
What is the timeframe for form 110 (appt notification)? - ANSWER Appt must be made
within 60 days from the date of the call.
Form 110 (appt notification) sent within 5 days of making the appt.
What is the timeframe for disclosing a conflict of interest? - ANSWER 5 days from
learning of the conflict, in writing to all parties involved
What are the two conditions and timelines for a medical eval extension? - ANSWER 1)
30 days if waiting for test results
2) 15 days for all else ("with good cause")
, What is the minimal required FaceTime for neuromusculoskeletal vs psych vs all else? -
ANSWER Neuromusculoskeletal: 20 min
Psych: 60 min
All else: 30 min
When did SB 863 (restricted ability for IW to get impairment fro psych / sexual / sleep
d/o) go into effect? - ANSWER Jan 1 2013
What is the time frame for a QME to notify, via form 109, of unavailability? - ANSWER
at least 30 days prior for a 14-90 day absence
What is the limitation re time for cancelling / rescheduling an appointment? How far out
can rescheduling happen? - ANSWER Cannot cancel within 6 days of the appt unless
there is "good cause," and must reschedule for within 30 days of the cancellation date
(and 60 days of the date of the initial call to schedule)
What is the timeframe for deposition scheduling? - ANSWER within 120 days of notice
What is the time in which a carrier can accept for deny a claim? - ANSWER 90 days,
otherwise its considered compensable
How long does a first treating MD have to complete a "Doctors First Report of
Occupational Injury of Illness?" - ANSWER 5 days of the worker's first visit
Form 100 - ANSWER Employee's Disability Questionnaire (include for unrepresented
workers for permanent disability or apportionment)
Form 101 - ANSWER Request for Summary Rating Determination (include for
unrepresented workers for permanent disability or apportionment)
Form 109 - ANSWER Notice of Unavailability Form
Form 110 - ANSWER Appointment Notification Form (QME must send to all parties
within 5 days of the appt being made)
Form 111 - ANSWER QME Findings Summaary
Form 112 - ANSWER QME Report Time Frame Extension Request (has to be filed at
least 5 days before report deadline; there is a 15 day good cause extension and 30 day
extension for pending test results)
Form 122 - ANSWER Medical Legal Declaration of Service Form (must be included
