chp 8
The physician must obtain prior authorization from the nearest VA facility in disability cases if the treatment costs more than ____________________ per month.
$40
OSHA stands for Selected Answer:c.Occupational Safety and Health Administration.
.Occupational Safety and Health Administration.
The Supplemental Security Income (SSI) program under Title XVI of the Social Security Act provides
.disability payments to needy people with limited income and few resources.
A policy that offers an insured person protection when loss of sight or loss of limb(s) occurs is called
.dismemberment benefit.
Disability income benefits vary from one plan to another, but short-term disability is usually:
13 weeks to 24 months
Which of the following would NOT be entitled to workers' compensation benefits?
An employee who is injured on his morning drive to work.
Due to widespread legal and medical corruption that had evolved throughout the workers' compensation system, reform laws have been introduced in a number of states that deal wit
D all are correct =====a. antifraud legislation. b.implementation of medical necessity requirements. c.prosecution of health care organizations, physicians, lawyers and employees who abuse the system.
A proceeding in which an attorney asks a witness questions regarding a case and the witness answers under oath but not in open court is known as a/an
DEPOSITION
A physician hired by the insurance company or appointed by the referee or appeals board to examine an injured worker and render an unbiased opinion regarding the degree of disability is referred to as a/an ____________________.
IME, AME, QME
What is the correct order in the appeals process?
Reconsideration, hearing, review by the Appeals Council, review by the federal court
In 1956, the US Congress established a program under Title II of the Social Security Act for long-term disability known as
Social Security Disability Insurance.
Final determination involving settlement of an industrial accident is known as
abjudication
A/An ____________________ is an unplanned and unexpected happening traceable to a definite time and place, causing injury (damage or loss) not due to any fault on the part of the person injured.
accident
Supplemental report(s) for patients on temporary disability should be sent to the insurance carrier
after every office visit
In most states children who are injured on the job are
are provided additional workers' compensation protection over and above the standard benefits paid to adults.
The Armed Services Disability benefits program is available to
b.members of the armed services on active duty.
In regard to disability income insurance, the _____________________ period is the maximum amount of time for which benefits will be paid to the injured or ill person for a disability.
benefit
The maximum amount of time for which benefits will be paid to the injured or ill person for a disability is called the
benefit period
When a case is rated for permanent disability and settled, this is called
compromise and release
Workers' compensation benefits include
d. all are correct. Answers:a. medical care.b. disability income.c. death benefits.
Funding for State Disability Insurance is usually a small percentage of the employee's wage that
d. all are correct. Answers:a.is deducted from employees' paychecks each month.b.the employer may elect to pay a portion of.c.the employer may elect to pay as a fringe benefit.
A ______________________________ team composed of a physician/psychologist and disability examiner makes the determination regarding disability for the SSDI and SSI programs.
dds
Coverage that provides a specific monthly or weekly income when a person is unable to work because of an illness or injury is known as
disability income insurance
In a life insurance policy, a feature that provides for twice the face amount of the policy to be paid if death results from accidental causes is called _____________________.
double indemnity
A/An ____________________ evaluation of the worksite may be performed, and modifications may be instituted to lessen the possibility of future injury.
ergonomic
Provisions written into the insurance contract denying coverage or limiting the scope of coverage are called
exclusions
If a worker's occupation takes a person into another state, most compensation laws are ____________________ and effective outside the state by either specific provisions or court decision.
extraterritorial
A disabled individual is eligible to receive benefits from the beginning of disability.
false
A medical evaluator is an employee of the federal government who examines an individual, independent from the attending physician and renders an unbiased opinion about the degree of disability of an injured worker.
false
After a state disability claim is approved, basic benefits become payable on the eighth day of disability or the third day of hospital confinement, whichever comes first.
false
An independent contractor, who is not actually an employee, is still covered by the company they are contracted with if they are injured while working for them.
false
Claims for coal miners who receive medical treatment for lung diseases related to pneumoconiosis are filed under the Coal Miners Benefit Act.
false
Disability income insurance provides benefits for work-related disability.
false
For people trying to qualify for SSDI or SSI, determination is made by the physician.
false
If a state has State Disability Insurance, all types of workers are covered.
false
No prior employment is necessary for SSDI eligibility.
false
Volunteer workers are covered under workers' compensation in most states.
false
Waiting periods affect workers' compensation medical and hospital benefits.
false
Workers' compensation benefits are subject to income tax.
false
Workers' compensation programs are included under the definition of a "health plan" under HIPAA and must comply with all HIPAA standards.
false
The statutes for workers' compensation laws fall under
federal and state compensation laws.
The number of years of service required before benefits can be paid under CSRS is ____________________.
five
When billing workers' compensation for a truck driver who was injured outside of the state they are employed in, you should
follow the rules of the state in which the claim was originally filed.
If a claimant does not agree with the determination of disability, a _____________________-level appeal process is available.
four
If the validity of a State Disability Insurance case is in question, a/an _______________________________may be asked by the insurance company to examine the disabled individual.
independent medical examiner (IME)
Private and public employees engaged in maritime work nationwide are protected under the ____ Act.
lhwca
A/An ____________________ expresses legal claim on the property of another for the payment of a debt.
lien
The form that contains authorization for the physician to treat the injured employee is the
medical service order
The simplest type of workers' compensation claim is
non disability
The three types of disability claims are ____________, ________________, and _____________.
non-disability; temporary disability; permanent disability
An abnormal condition caused by exposure to environmental factors associated with employment is termed a/an
occupational illness
Any abnormal condition or disorder caused by exposure to environmental factors associated with employment, including acute and chronic illnesses or diseases that may be caused by inhalation, absorption, ingestion, or direct contact, is referred to as a/an ____________________.
occupational illness
Residual benefits pay a
partial benefit when the insured is not totally disabled.
When an illness or injury prevents an insured person from performing one or more of the functions of his or her regular job, the disability is called
partial disability and residual disability
In a PD claim, the physician's final report must include the words
permanent and stationary
in a workers' compensation case, the contract and financial responsibility exists between the
physician and the insurance company
The term guaranteed renewable means that the insurer is
required to renew the policy as long as premium payments are made, and the premium may be increased.
State Disability Insurance benefits begin after the
seventh consecutive day of disability.
In an industrial case, if the patient is experiencing pain that can be tolerated but will cause some handicap in the performance of the activity precipitating the pain, it is classified as
slight pain
Captive insurance is a form of self-insurance designed to serve
small companies and mid size companies
Which two programs managed by the Social Security Administration pay monthly disability benefits to people younger than age 65 who cannot work for at least a year because of a severe disability?
ssdi and ssi
Videotapes made of the patient without his or her knowledge to document the extent of the patient's permanent disability are called
sub rosa films
The legal words _________________________ mean to substitute one person for another.
third-party subrogation
Authorization to treat a patient with an industrial injury may be obtained over the telephone.
true
Beginning in the 1990s, increases in fraudulent workers' compensation claims have been noted throughout many large metropolitan cities.
true
California allows for state disability benefits in a normal routine pregnancy.
true
Chiropractic care is a medical benefit offered with state workers' compensation.
true
Disability income policies do not provide medical expense benefits.
true
Disability insurance may be denied or may only provide limited coverage if the individual was injured while legally intoxicated.
true
Disabled workers younger than 65 years of age are eligible for SSDI.
true
Employers with sufficient capital can save money by self-insuring employees for work-related injuries by setting aside a state-mandated percentage of funding to cover medical expenses, wage compensation, death benefits, and other benefits related to work injuries.
true
For patients receiving VA medical care, travel expenses to and from the facility are a benefit.
true
If a patient is treated by her regular physician for a work-related injury, a separate health record and financial record should be set up for the work-related injury.
true
If an individual is asked by her employer to go to the bank to deposit company money and she is injured when another automobile rear-ended her at the drive up window. Related medical services for the injury will be covered under workers' compensation insurance.
true
Medical requirements are the same for both the SSDI and SSI programs.
true
Progress reports subsequent to the initial report for workers' compensation patients may be narrative and are not necessarily completed on the special forms available in most states.
true
Some states have adopted laws authorizing employers to contract with managed care programs to insure their workers against work-related accidents and illnesses.
true
The amount of disability benefit paid to an individual will depend upon the worker's past earning records.
true
When an employer provides disability income insurance and the employee leaves the company, the insurance terminates unless the employee is disabled.
true
Non-industrial disability insurance programs exist in only five states and Puerto Rico.
ture
Rehabilitation in the form of retraining, education, and job guidance and placement to assist an injured individual in finding work is called ____________________ rehabilitation.
vocational
People residing in states that do not provide State Disability Insurance may elect to contact a local private insurance carrier to arrange for coverage under a/an ____________________ disability insurance plan.
voluntary
For a disability income insurance case, the time period from the beginning of disability to receiving the first payment of benefits is called a/an ____________________ period.
waiting
In an insurance contract, a/an ____________________ of premiums means that while disabled the employee does not have to pay any premiums because they are paid by the policy.
waiver
An individualized program of therapy using simulated or real work tasks to build up strength and improve a worker's endurance toward a full day's work is called ____________________.
work hardening
