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QME EXAM 2026/2027 Complete Qualified
Medical Evaluator Examination | Actual
Questions & Verified Answers | California
Workers' Compensation Certification Prep
Section 1: Workers' Compensation Laws & Regulations
Q1: The exclusive-remedy provision in California workers’ compensation law means that:
A. Employees may sue their employer in civil court for any workplace injury.
B. The workers’ compensation system is the sole remedy for covered injuries.
C. Employers may opt out of providing workers’ compensation coverage.
D. Injured workers must exhaust unemployment benefits before filing a claim.
**Answer: B
Verified Rationale: The exclusive-remedy doctrine bars employees from suing employers in civil
court for covered injuries once workers’ compensation benefits are provided.
Q2: Which of the following injuries is most likely to be excluded from coverage under the
“coming and going” rule?
A. Low-back strain while lifting a box in the employer’s warehouse.
B. Knee injury while walking from the parking lot reserved for employees only.
C. Whiplash sustained in a car accident during the ordinary commute from home.
D. Wrist fracture from slipping on a wet floor in the company cafeteria.
**Answer: C
Verified Rationale: Ordinary travel to and from work is generally outside the course of
employment unless a special hazard or employer-controlled route exists.
Q3: Under California Labor Code §3600(a)(9), an injury is compensable only if the employee’s
intoxication was:
A. The sole cause of the injury.
B. A substantial contributing factor.
C. Not causally related to the injury.
D. Documented by a blood alcohol level above 0.08 %.
**Answer: C
Verified Rationale: The statute denies compensation when intoxication is the proximate cause, so
absence of causal relation preserves compensability.
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Q4: The statute of limitations for filing a workers’ compensation claim in California for an injury
occurring on or after 1/1/2025 is:
A. 30 days from the date of injury.
B. One year from the date of injury.
C. One year from the date the employee knew or should have known the injury was work-
related.
D. Five years from the date of last provision of benefits.
**Answer: C
Verified Rationale: Labor Code §5405 provides a one-year limitations period that begins when
the employee has actual or constructive knowledge of work-relatedness.
Q5: Which entity has final authority to resolve disputes over medical treatment in California
workers’ compensation?
A. Division of Workers’ Compensation (DWC) Administrative Director.
B. Workers’ Compensation Appeals Board (WCAB).
C. Division of Occupational Safety and Health (Cal/OSHA).
D. Qualified Medical Evaluator selected by the applicant.
**Answer: B
Verified Rationale: WCAB is the ultimate adjudicatory body for all disputes, including medical
treatment disputes, under Labor Code §5309.
Q6: An employer’s failure to secure workers’ compensation insurance as required by Labor Code
§3700 exposes the employer to:
A. A civil penalty of up to $10,000 per employee and possible criminal charges.
B. Loss of the exclusive-remedy defense only.
C. A stop-work order but no monetary penalties.
D. Mandatory participation in the state insurance fund for one year.
**Answer: A
Verified Rationale: Uninsured employers face penalties up to $10,000 per employee and
misdemeanor prosecution under §3700.5.
Q7: The “AOE/COE” standard refers to:
A. Arising out of employment and occurring in the course of employment.
B. Assessment of occupational exposure and cumulative trauma evidence.
C. Applicant’s overall earnings and cost of evaluation.
D. Authorization of expert opinion and clinical observation evidence.
**Answer: A
Verified Rationale: AOE/COE is the fundamental test for compensability, requiring both causal
relation to work and timing within employment.
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Q8: Which of the following best describes the “major contributing cause” standard used in
apportionment?
A. The work factor must be at least 51 % responsible for the disability.
B. Any industrial contribution, no matter how slight, is sufficient.
C. The employer must prove the injury is 100 % work-related.
D. The standard applies only to psychiatric injuries.
**Answer: A
Verified Rationale: Labor Code §4663 requires the work factor to be the predominant (≥51 %)
cause of permanent disability.
Q9: A psychiatric injury is compensable under California law only if the employee has been
employed for at least:
A. 30 days.
B. 3 months.
C. 6 months.
D. 12 months.
**Answer: C
Verified Rationale: Labor Code §3208.3(d) imposes a six-month minimum employment
requirement for psychiatric injuries.
Q10: The “presumption” for certain injuries under Labor Code §3212 (e.g., heart trouble in
firefighters) can be rebutted only by:
A. A preponderance of the evidence.
B. Clear and convincing evidence.
C. Substantial medical evidence.
D. The employer’s mere denial.
**Answer: B
Verified Rationale: Statutory presumptions are rebuttable only by clear and convincing evidence,
a higher evidentiary standard.
Section 2: Impairment Rating Using AMA Guides (6th Ed.)
Q11: According to the AMA Guides, 6th ed., whole-person impairment (WPI) is defined as:
A. The percentage loss of earning capacity.
B. The percentage loss of function of the whole person.
C. The percentage of disability under state law.
D. The percentage of pain reported by the claimant.
**Answer: B
Verified Rationale: WPI quantifies the functional loss relative to the total normal function of an
unimpaired person.
QME EXAM 2026/2027 Complete Qualified
Medical Evaluator Examination | Actual
Questions & Verified Answers | California
Workers' Compensation Certification Prep
Section 1: Workers' Compensation Laws & Regulations
Q1: The exclusive-remedy provision in California workers’ compensation law means that:
A. Employees may sue their employer in civil court for any workplace injury.
B. The workers’ compensation system is the sole remedy for covered injuries.
C. Employers may opt out of providing workers’ compensation coverage.
D. Injured workers must exhaust unemployment benefits before filing a claim.
**Answer: B
Verified Rationale: The exclusive-remedy doctrine bars employees from suing employers in civil
court for covered injuries once workers’ compensation benefits are provided.
Q2: Which of the following injuries is most likely to be excluded from coverage under the
“coming and going” rule?
A. Low-back strain while lifting a box in the employer’s warehouse.
B. Knee injury while walking from the parking lot reserved for employees only.
C. Whiplash sustained in a car accident during the ordinary commute from home.
D. Wrist fracture from slipping on a wet floor in the company cafeteria.
**Answer: C
Verified Rationale: Ordinary travel to and from work is generally outside the course of
employment unless a special hazard or employer-controlled route exists.
Q3: Under California Labor Code §3600(a)(9), an injury is compensable only if the employee’s
intoxication was:
A. The sole cause of the injury.
B. A substantial contributing factor.
C. Not causally related to the injury.
D. Documented by a blood alcohol level above 0.08 %.
**Answer: C
Verified Rationale: The statute denies compensation when intoxication is the proximate cause, so
absence of causal relation preserves compensability.
,2
Q4: The statute of limitations for filing a workers’ compensation claim in California for an injury
occurring on or after 1/1/2025 is:
A. 30 days from the date of injury.
B. One year from the date of injury.
C. One year from the date the employee knew or should have known the injury was work-
related.
D. Five years from the date of last provision of benefits.
**Answer: C
Verified Rationale: Labor Code §5405 provides a one-year limitations period that begins when
the employee has actual or constructive knowledge of work-relatedness.
Q5: Which entity has final authority to resolve disputes over medical treatment in California
workers’ compensation?
A. Division of Workers’ Compensation (DWC) Administrative Director.
B. Workers’ Compensation Appeals Board (WCAB).
C. Division of Occupational Safety and Health (Cal/OSHA).
D. Qualified Medical Evaluator selected by the applicant.
**Answer: B
Verified Rationale: WCAB is the ultimate adjudicatory body for all disputes, including medical
treatment disputes, under Labor Code §5309.
Q6: An employer’s failure to secure workers’ compensation insurance as required by Labor Code
§3700 exposes the employer to:
A. A civil penalty of up to $10,000 per employee and possible criminal charges.
B. Loss of the exclusive-remedy defense only.
C. A stop-work order but no monetary penalties.
D. Mandatory participation in the state insurance fund for one year.
**Answer: A
Verified Rationale: Uninsured employers face penalties up to $10,000 per employee and
misdemeanor prosecution under §3700.5.
Q7: The “AOE/COE” standard refers to:
A. Arising out of employment and occurring in the course of employment.
B. Assessment of occupational exposure and cumulative trauma evidence.
C. Applicant’s overall earnings and cost of evaluation.
D. Authorization of expert opinion and clinical observation evidence.
**Answer: A
Verified Rationale: AOE/COE is the fundamental test for compensability, requiring both causal
relation to work and timing within employment.
, 3
Q8: Which of the following best describes the “major contributing cause” standard used in
apportionment?
A. The work factor must be at least 51 % responsible for the disability.
B. Any industrial contribution, no matter how slight, is sufficient.
C. The employer must prove the injury is 100 % work-related.
D. The standard applies only to psychiatric injuries.
**Answer: A
Verified Rationale: Labor Code §4663 requires the work factor to be the predominant (≥51 %)
cause of permanent disability.
Q9: A psychiatric injury is compensable under California law only if the employee has been
employed for at least:
A. 30 days.
B. 3 months.
C. 6 months.
D. 12 months.
**Answer: C
Verified Rationale: Labor Code §3208.3(d) imposes a six-month minimum employment
requirement for psychiatric injuries.
Q10: The “presumption” for certain injuries under Labor Code §3212 (e.g., heart trouble in
firefighters) can be rebutted only by:
A. A preponderance of the evidence.
B. Clear and convincing evidence.
C. Substantial medical evidence.
D. The employer’s mere denial.
**Answer: B
Verified Rationale: Statutory presumptions are rebuttable only by clear and convincing evidence,
a higher evidentiary standard.
Section 2: Impairment Rating Using AMA Guides (6th Ed.)
Q11: According to the AMA Guides, 6th ed., whole-person impairment (WPI) is defined as:
A. The percentage loss of earning capacity.
B. The percentage loss of function of the whole person.
C. The percentage of disability under state law.
D. The percentage of pain reported by the claimant.
**Answer: B
Verified Rationale: WPI quantifies the functional loss relative to the total normal function of an
unimpaired person.
