QME COMPREHENSIVE PRACTICE EXAM
BEST ANSWER. RATIONALES ARE PROVIDED
TO EXPLAIN THE REASONING BEHIND,
REFERENCING THE CALIFORNIA CODE OF
REGULATIONS (CCR), LABOR CODE (LC), AMA
GUIDES, AND RELEVANT CASE LAW.
Section 1: Ethics and General Duties (Questions 1-15)
1. A treating physician refers a patient to you for a QME evaluation. During the evaluation, the patient
states they were told by the referring doctor to "make sure you get a high impairment rating." What is
the QME’s BEST course of action?
a) Note the statement but proceed with the evaluation as planned.
b) Contact the referring physician to discuss the inappropriate coaching.
c) Terminate the evaluation immediately and report the treating physician to the Medical Board.
d) Document the statement in the report, address its impact on reliability, and proceed objectively.
Correct Answer: d) Document the statement in the report, address its impact on reliability,
and proceed objectively.
Rationale: The QME’s duty is to be impartial. While coaching is inappropriate, the QME must document
the history as provided, note any potential impact on credibility, and continue the evaluation based on
objective findings. Terminating the evaluation prematurely (c) is not the first step.
2. According to 8 CCR § 39.5, a QME must provide a complete and impartial evaluation. Which of the
following constitutes a violation of impartiality?
a) Accepting a cancellation fee from the claims administrator.
b) Having a previous doctor-patient relationship with the injured worker 10 years ago for an unrelated
,condition.
c) Basing the impairment rating solely on the AMA Guides.
d) Using a telephonic interpreter provided by the claims administrator.
Correct Answer: a) Accepting a cancellation fee from the claims administrator.
Rationale: 8 CCR § 39.5 prohibits a QME from charging a cancellation fee to the claims administrator if
the injured worker cancels. Fees are regulated by the DWC. Option (b) requires disclosure but is not
automatically a violation if it doesn’t affect impartiality.
3. You are conducting a QME evaluation. The injured worker brings their attorney to the evaluation.
The attorney insists on remaining in the examination room during the physical examination. What
should you do?
a) Allow the attorney to stay to avoid delaying the process.
b) Proceed only if the attorney signs a confidentiality agreement.
c) Refuse to proceed unless the attorney leaves, citing the right to a private examination.
d) Reschedule the evaluation to a date when the attorney is unavailable.
Correct Answer: c) Refuse to proceed unless the attorney leaves, citing the right to a private
examination.
Rationale: The QME has the right to conduct a private physical examination. The presence of a third
party (other than a necessary interpreter or chaperone) can compromise the validity of the exam. The
evaluator may suspend the exam until the third party leaves.
4. Under California Labor Code § 139.2, what is the maximum penalty for a QME who is found to have
committed a material misrepresentation or fraud?
a) Suspension from the QME panel for 1 year.
b) A fine of $10,000.
c) Permanent removal from the QME panel and referral to the Medical Board.
d) Mandatory continuing education on ethics.
Correct Answer: c) Permanent removal from the QME panel and referral to the Medical Board.
Rationale: Material misrepresentation or fraud is grounds for permanent removal from the QME panel,
in addition to potential disciplinary action by the Medical Board of California.
5. A QME is reviewing records and finds a report from a previous QME that contains a significant
mathematical error in calculating the Whole Person Impairment (WPI). What is the QME’s
responsibility?
a) Ignore the error; it is not your report.
b) Note the error in your report and state why your calculation is correct.
c) Contact the previous QME to inform them of their mistake.
d) Use the previous QME’s WPI to maintain consistency.
, Correct Answer: b) Note the error in your report and state why your calculation is correct.
Rationale: The QME’s duty is to provide an accurate and independent evaluation. If a discrepancy exists,
the QME must address it, show their work, and explain why their conclusion differs from prior
evaluations.
6. An injured worker speaks limited English. The claims administrator sends a certified interpreter.
However, the injured worker insists their 10-year-old child can interpret. What is the proper
procedure?
a) Allow the child to interpret to build rapport with the patient.
b) Proceed only with the certified interpreter provided, as per regulations.
c) Cancel the appointment and require a written request for an interpreter.
d) Use the child but document the objection.
Correct Answer: b) Proceed only with the certified interpreter provided, as per regulations.
Rationale: Regulations require the use of qualified/certified interpreters. Using a minor child is
inappropriate due to issues of accuracy, confidentiality, and potential undue influence on the child.
7. According to the AMA Guides (5th Ed.), which of the following is a key principle for rating
impairment?
a) Impairment is synonymous with disability.
b) Ratings should be based on the maximum medical improvement (MMI) standard.
c) Pain alone is a valid basis for a significant impairment rating.
d) The diagnosis is the sole determinant of the impairment rating.
Correct Answer: b) Ratings should be based on the maximum medical improvement (MMI)
standard.
Rationale: The AMA Guides emphasize that impairment ratings are to be given when the condition is
stable and at MMI. Impairment is not disability (a), pain alone is not ratable without objective findings
(c), and diagnosis informs but does not solely determine rating (d).
8. The "15% cap" under LC § 4660.1(c) applies to which type of impairment?
a) Orthopedic impairment for a knee injury.
b) Psychiatric impairment resulting from a physical injury.
c) Sleep impairment.
d) Impairment from a hernia.
Correct Answer: b) Psychiatric impairment resulting from a physical injury.
Rationale: Labor Code § 4660.1(c) states that for psychiatric injuries (excluding those arising from a
violent act), the PD award for the psychiatric component shall not exceed 15% unless there is a
"catastrophic" physical injury.
BEST ANSWER. RATIONALES ARE PROVIDED
TO EXPLAIN THE REASONING BEHIND,
REFERENCING THE CALIFORNIA CODE OF
REGULATIONS (CCR), LABOR CODE (LC), AMA
GUIDES, AND RELEVANT CASE LAW.
Section 1: Ethics and General Duties (Questions 1-15)
1. A treating physician refers a patient to you for a QME evaluation. During the evaluation, the patient
states they were told by the referring doctor to "make sure you get a high impairment rating." What is
the QME’s BEST course of action?
a) Note the statement but proceed with the evaluation as planned.
b) Contact the referring physician to discuss the inappropriate coaching.
c) Terminate the evaluation immediately and report the treating physician to the Medical Board.
d) Document the statement in the report, address its impact on reliability, and proceed objectively.
Correct Answer: d) Document the statement in the report, address its impact on reliability,
and proceed objectively.
Rationale: The QME’s duty is to be impartial. While coaching is inappropriate, the QME must document
the history as provided, note any potential impact on credibility, and continue the evaluation based on
objective findings. Terminating the evaluation prematurely (c) is not the first step.
2. According to 8 CCR § 39.5, a QME must provide a complete and impartial evaluation. Which of the
following constitutes a violation of impartiality?
a) Accepting a cancellation fee from the claims administrator.
b) Having a previous doctor-patient relationship with the injured worker 10 years ago for an unrelated
,condition.
c) Basing the impairment rating solely on the AMA Guides.
d) Using a telephonic interpreter provided by the claims administrator.
Correct Answer: a) Accepting a cancellation fee from the claims administrator.
Rationale: 8 CCR § 39.5 prohibits a QME from charging a cancellation fee to the claims administrator if
the injured worker cancels. Fees are regulated by the DWC. Option (b) requires disclosure but is not
automatically a violation if it doesn’t affect impartiality.
3. You are conducting a QME evaluation. The injured worker brings their attorney to the evaluation.
The attorney insists on remaining in the examination room during the physical examination. What
should you do?
a) Allow the attorney to stay to avoid delaying the process.
b) Proceed only if the attorney signs a confidentiality agreement.
c) Refuse to proceed unless the attorney leaves, citing the right to a private examination.
d) Reschedule the evaluation to a date when the attorney is unavailable.
Correct Answer: c) Refuse to proceed unless the attorney leaves, citing the right to a private
examination.
Rationale: The QME has the right to conduct a private physical examination. The presence of a third
party (other than a necessary interpreter or chaperone) can compromise the validity of the exam. The
evaluator may suspend the exam until the third party leaves.
4. Under California Labor Code § 139.2, what is the maximum penalty for a QME who is found to have
committed a material misrepresentation or fraud?
a) Suspension from the QME panel for 1 year.
b) A fine of $10,000.
c) Permanent removal from the QME panel and referral to the Medical Board.
d) Mandatory continuing education on ethics.
Correct Answer: c) Permanent removal from the QME panel and referral to the Medical Board.
Rationale: Material misrepresentation or fraud is grounds for permanent removal from the QME panel,
in addition to potential disciplinary action by the Medical Board of California.
5. A QME is reviewing records and finds a report from a previous QME that contains a significant
mathematical error in calculating the Whole Person Impairment (WPI). What is the QME’s
responsibility?
a) Ignore the error; it is not your report.
b) Note the error in your report and state why your calculation is correct.
c) Contact the previous QME to inform them of their mistake.
d) Use the previous QME’s WPI to maintain consistency.
, Correct Answer: b) Note the error in your report and state why your calculation is correct.
Rationale: The QME’s duty is to provide an accurate and independent evaluation. If a discrepancy exists,
the QME must address it, show their work, and explain why their conclusion differs from prior
evaluations.
6. An injured worker speaks limited English. The claims administrator sends a certified interpreter.
However, the injured worker insists their 10-year-old child can interpret. What is the proper
procedure?
a) Allow the child to interpret to build rapport with the patient.
b) Proceed only with the certified interpreter provided, as per regulations.
c) Cancel the appointment and require a written request for an interpreter.
d) Use the child but document the objection.
Correct Answer: b) Proceed only with the certified interpreter provided, as per regulations.
Rationale: Regulations require the use of qualified/certified interpreters. Using a minor child is
inappropriate due to issues of accuracy, confidentiality, and potential undue influence on the child.
7. According to the AMA Guides (5th Ed.), which of the following is a key principle for rating
impairment?
a) Impairment is synonymous with disability.
b) Ratings should be based on the maximum medical improvement (MMI) standard.
c) Pain alone is a valid basis for a significant impairment rating.
d) The diagnosis is the sole determinant of the impairment rating.
Correct Answer: b) Ratings should be based on the maximum medical improvement (MMI)
standard.
Rationale: The AMA Guides emphasize that impairment ratings are to be given when the condition is
stable and at MMI. Impairment is not disability (a), pain alone is not ratable without objective findings
(c), and diagnosis informs but does not solely determine rating (d).
8. The "15% cap" under LC § 4660.1(c) applies to which type of impairment?
a) Orthopedic impairment for a knee injury.
b) Psychiatric impairment resulting from a physical injury.
c) Sleep impairment.
d) Impairment from a hernia.
Correct Answer: b) Psychiatric impairment resulting from a physical injury.
Rationale: Labor Code § 4660.1(c) states that for psychiatric injuries (excluding those arising from a
violent act), the PD award for the psychiatric component shall not exceed 15% unless there is a
"catastrophic" physical injury.
