QME (Qualified Medical Evaluator) — Workers’ Compensation
Disability Rating & AMA Guides Exam Test Right Answers
Comprehensive Resource To Help You Ace 2026-2027
Includes Frequently Tested Questions With ELABORATED
100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!! Current Update!!
1. "When can you close a claims file?
A. When the last payment of PD has been made.
B. When all benefits that are due and payable have been paid.
C. When the employee has returned to work.
D. When TD has ended. - Correct Answer: B. When all benefits that are due
and payable have been paid.
2. As a self-insured administrator how long do you have to maintain the claims
file?
A. 5 years from the DOI and 1 year thereafter.
B. 5 years from the DOI and 1 year from date of last payment of benefits.
C. 5 years from the DOI or the date on which the last provision of compensation
benefits occurred, whichever is later.
d. 2 years from the date of the last payment of compensation. " - Correct
Answer: C. 5 years from the DOI or the date on which the last provision of
compensation benefits ocurred, whichever is later.
,3. "When a self-insured certificate has been revoked, the Director retains
jurisdiction for what period of time:
a. 5 years until the next audit cycle.
B. Until it has been determined no additional claims are forthcoming.
C. Until claim liability has been exhausted pursuant to the law.
d. Until claim liability has been exhausted pursuant to the administrator's
determination. - Correct Answer: C. Until claim liability has been exhausted
pursuant to the law.
4. "The employer has an aggregate stop loss excess insurance policy. It is:
a. Not legal in CA
b. legal but the ER receives no credit against the security deposit
c. legal and the excess policy reduces the amt of the security deposit
d. Not required that the ER include it on the Annual Report - Correct Answer:
b. legal but the ER receives no credit against the security deposit
5. "As an out-of-state self-insurer where must the claims files be kept and
maintained?
A. In CA
b. In the state where the self-insured is located
c. In CA unless the Manager has given written approval to administer from a
location outside CA
d. In the state where the TPA is located. - Correct Answer: c. In CA unless the
Manager has given written approval to administer from a location outside CA
,6. "You are applying for a master certificate after July 1, 1994. what is the amount
of net worth and net income needed to qualify for self-insurance
a. $2,220,000 net worth and $220,000 earnings in past year.
B. $5,000,000 net worth and $500,000 earnings in past year.
c. $5,000,000 net worth and average net income for the past 5 years of at least
$500,000
d. $7,500,000 net worth and $700.000 net income past year" - Correct
Answer: c. $5,000,000 net worth and average net income for the past 5 years of at
least $500,000
7. "A self-insured employer has denied a claim but the file does not properly
document the reason for the denial. What is the amount of the penalty?
A. $500
b. $1000
c. $5000
d. $10,000" - Correct Answer: c. $5000
8. "You have assumed the responsibilities of another TPA. While auditing the files
you discover that there are missing indemnity files. You should:
a. Contact Self Insurance Plans and ask for assistance.
B. Contact the prior administrator and inform the ER.
c. contact teheAdministrative Director and request an audit
d. Contact the I&A office and ask for assistance - Correct Answer: B. Contact
the prior administrator and inform the ER.
, 9. "When is a proof of service necessary?
A. For a Notice of Delay only
b. For a Notice Denying Liability only
c. both
D. Neither - Correct Answer: b. For a Notice Denying Liability only
10. "For an injury in 2013, resulting in death, reasonable expenses of the ER's
burial are allowed up to:
a. $2000
b. $5000
c. $10,000
d. 12,000 - Correct Answer: c. $10,000
11. When can the ER request a 2nd opinion under LC 4062(b)?
A. Where there is a dispute about the need for spinal surgery
b. Where the EE has lost an eye
c. Where there is an issue about AOE/COE
d. Where there is a dispute about the need for medical treatment - Correct
Answer: A. Where there is a dispute about the need for spinal surgery
12. The calcis is the:
A. elbow
B. heel bone.
C. A calcium deposit in the bone.
Disability Rating & AMA Guides Exam Test Right Answers
Comprehensive Resource To Help You Ace 2026-2027
Includes Frequently Tested Questions With ELABORATED
100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!! Current Update!!
1. "When can you close a claims file?
A. When the last payment of PD has been made.
B. When all benefits that are due and payable have been paid.
C. When the employee has returned to work.
D. When TD has ended. - Correct Answer: B. When all benefits that are due
and payable have been paid.
2. As a self-insured administrator how long do you have to maintain the claims
file?
A. 5 years from the DOI and 1 year thereafter.
B. 5 years from the DOI and 1 year from date of last payment of benefits.
C. 5 years from the DOI or the date on which the last provision of compensation
benefits occurred, whichever is later.
d. 2 years from the date of the last payment of compensation. " - Correct
Answer: C. 5 years from the DOI or the date on which the last provision of
compensation benefits ocurred, whichever is later.
,3. "When a self-insured certificate has been revoked, the Director retains
jurisdiction for what period of time:
a. 5 years until the next audit cycle.
B. Until it has been determined no additional claims are forthcoming.
C. Until claim liability has been exhausted pursuant to the law.
d. Until claim liability has been exhausted pursuant to the administrator's
determination. - Correct Answer: C. Until claim liability has been exhausted
pursuant to the law.
4. "The employer has an aggregate stop loss excess insurance policy. It is:
a. Not legal in CA
b. legal but the ER receives no credit against the security deposit
c. legal and the excess policy reduces the amt of the security deposit
d. Not required that the ER include it on the Annual Report - Correct Answer:
b. legal but the ER receives no credit against the security deposit
5. "As an out-of-state self-insurer where must the claims files be kept and
maintained?
A. In CA
b. In the state where the self-insured is located
c. In CA unless the Manager has given written approval to administer from a
location outside CA
d. In the state where the TPA is located. - Correct Answer: c. In CA unless the
Manager has given written approval to administer from a location outside CA
,6. "You are applying for a master certificate after July 1, 1994. what is the amount
of net worth and net income needed to qualify for self-insurance
a. $2,220,000 net worth and $220,000 earnings in past year.
B. $5,000,000 net worth and $500,000 earnings in past year.
c. $5,000,000 net worth and average net income for the past 5 years of at least
$500,000
d. $7,500,000 net worth and $700.000 net income past year" - Correct
Answer: c. $5,000,000 net worth and average net income for the past 5 years of at
least $500,000
7. "A self-insured employer has denied a claim but the file does not properly
document the reason for the denial. What is the amount of the penalty?
A. $500
b. $1000
c. $5000
d. $10,000" - Correct Answer: c. $5000
8. "You have assumed the responsibilities of another TPA. While auditing the files
you discover that there are missing indemnity files. You should:
a. Contact Self Insurance Plans and ask for assistance.
B. Contact the prior administrator and inform the ER.
c. contact teheAdministrative Director and request an audit
d. Contact the I&A office and ask for assistance - Correct Answer: B. Contact
the prior administrator and inform the ER.
, 9. "When is a proof of service necessary?
A. For a Notice of Delay only
b. For a Notice Denying Liability only
c. both
D. Neither - Correct Answer: b. For a Notice Denying Liability only
10. "For an injury in 2013, resulting in death, reasonable expenses of the ER's
burial are allowed up to:
a. $2000
b. $5000
c. $10,000
d. 12,000 - Correct Answer: c. $10,000
11. When can the ER request a 2nd opinion under LC 4062(b)?
A. Where there is a dispute about the need for spinal surgery
b. Where the EE has lost an eye
c. Where there is an issue about AOE/COE
d. Where there is a dispute about the need for medical treatment - Correct
Answer: A. Where there is a dispute about the need for spinal surgery
12. The calcis is the:
A. elbow
B. heel bone.
C. A calcium deposit in the bone.
