Vermont Adjuster's Examination for Workers Compensation Insurance Series 14-34

Dependent children of an employee who died as a result of a work related accident or disease will receive benefits until the age of:

18

An insurance carrier who does not intend to renew a policy of workers compensation insurance covering the liability of an employer in Vermont must notify the commissioner and the employer at least prior to the expiration of such policy.

45 days

A full time firefighter is injured in Vermont. When will the injuries be considered compensable?

72 hours

An insurance binder is best described as

A temporary, short-term evidence of coverage.

In property and casualty insurance, when must a person absolutely have an insurable interest?

At the time of the loss

An employee suffered a severe injury while operating a piece of machinery known to be in need of repair. Unfamiliar with the workers compensation law, the spouse sued the employer, claiming loss of consortium. What coverage if any in a standard workers compensation policy would respond to this lawsuit?

Employers liability coverage

An employer may deduct what portion of the premium for workers compensation coverage from employees' wages?

Employers may not deduct any portion of the cost from employees.

What are used to add, delete, or change any of the policy parts?

Endorsements

In the promulgation of workers compensation rates, which of the following is a factor in the calculation of the rates? (select the best answer) A: Experience Mod B: The largest loss C: Loss Severity D: Loss Frequency

Experience Mod

The premium adjustment made for the current year of workers compensation coverage is sometimes based on prior years' loss experience. This is called:

Experience Mod Rating

Who is covered under the Federal Employees Compensation Act?

Federal employees exempt under state workers compensation laws.

An applicant may qualify for a nonresident adjuster license in Vermont only if he or she:

Holds a resident license in his or her home state

The Vermont Insurance Commissioner may suspend, revoke, or refuse to continue or renew any license for which of the following reasons?

I. The licensee has had his or her license suspended or revoked in any other state II. The licensee has knowingly accepted insurance business from a person who is not properly licensed Ill. The licensee has failed to comply with a court order imposing a child support obligation IV. The licensee has failed to pay state income tax

Which worker would be covered under Longshoreman's coverage

Injury to a worker loading a ship at the dock

The purpose of the declarations section of an insurance policy is to list the:

Name and address of the insured, name of the insurer, policy premium, type of coverage

In most states, workers compensation coverage is available through

Private insurers or self-insurance

If a contractor hires a sub contractor who allows their workers compensation coverage to expire, what are the consequences?

The contactor can be held liable.

For an agreement to be considered a contract, it must contain all of the following, EXCEPT: A: The contract must be carefully considered by both parties B: One party must accept an offer that is made by the other party. C: Both parties must be legally competent at the time of making the agreement. D: The parties must exchange money, services, work, products, or other valuable consideration.

The contract must be carefully considered by both parties

Each of the following is true about work-related injury cases which fall outside the scope of the workers compensation law, EXCEPT: A: Common law defenses are retained by the employer B: Damages may be paid if negligence or legal liability is established C: Pain and suffering damages may be awarded in a court of law D: The employer cannot be held liable for such injuries

The employer cannot be held liable for such injuries

An employee in Vermont has contracted a disease as a result of employment. A claim must be brought for workers compensation benefits within:

Two years of the discovery of the disease

A(n) is a statement that is considered to be guaranteed

Warranty

Each adjuster, workers compensation adjuster, public adjuster or appraiser must keep at the address shown on the license a record of all transactions under the license for a period of:

at least 3 years

Employer's liability coverage under the workers compensation policy could cover the legal liability of an employer in which of the following situations? A: Exempt employments B: Illegal employment C: Non-compensable injuries D:All of the answers are correct

All of the answers are correct

Which of the following is not considered in workers compensation experience modification calculations? A: An accounting of the insured's actual losses. B: Amount of employee payroll C: A credibility factor based on premiums paid by the insured D: The amount of losses expected for the same work classifications.

Amount of employee payroll

Workers compensation will not be allowed for an injury caused by:

An employee's willful intention to injure himself or another, an employee's intoxication, an employee's failure to use a safety appliance provided for his use.

When do benefits under Vermont's workers compensation law begin for a temporary partial disability?

Benefits begin after the third day

A person who willfully makes a false statement or representation for the purpose of obtaining any workers compensation benefit or payment either for her or himself or another shall be assessed a penalty of:

$1,000

An employer which refuses to submit a First Report of Injury within 72 hours of learning of an alleged injury, shall be assessed a penalty of for each violation.

$50

An employer who fails to provide workers compensation insurance shall be assessed a penalty of how much per day for every day that the employer neglected to insure workers compensation liability prior to receiving notice from the commissioner, but not to exceed how much?

$50 / $5,000

In the case of a death of a covered employee as a result of a work related accident or disease, what is benefit for burial and funeral expenses?

$5500

Which of the following statements about workers compensation laws is correct? A: The scope of coverage is identical in all states B: Every state provides "extraterritorial" coverage for residents working in another state C: Limited benefits are provided for non-economic damages such as pain and suffering D: The benefits provided under the law are typically the exclusive remedy for injured employees

D: The benefits provided under the law are typically the exclusive remedy for injured employees

Before interviewing the injured worker, what should the adjuster do? A: Determine if WC coverage is in effect B: Determine if the employee is represented by an attorney C: Verify the injury with the employer D: Speak with the attending physician

Determine if the employee is represented by an attorney

In Vermont, the employer/insurer has how many days from receiving notice of a claim to determine whether any compensation is due an injured employee?

21 Days

In Vermont, the employer/insurer has_ from receiving notice or knowledge of an injury within which to determine whether workers compensation benefits are payable.

21 days

An applicant must submit an application to the commissioner within how long of licensing examination?

24 months

If a worker is injured in a job related accident and the employer has failed to provide the proper workers compensation coverage, the worker must commence a civil action against the employer within years.

3 years

Any licensee who ceases to maintain his or her residency in Vermont must deliver his or her license to the commissioner by personal delivery or by mail within how many days?

30 Days

In the event the commissioner does not renew a license or denies an application for a license, the applicant or licensee may make written demand upon the commissioner for a hearing to determine the reasonableness of the commissioner's action. The hearing must be held within how long from receipt of the written demand.

30 days

If a worker, covered under workers compensation coverage in Vermont, sustains a work related fatality, what will the death and survivor benefit be for the employee's surviving spouse and two or more children?

76 2/3% of the employee's average weekly income **Spouse and 1 dependent is 71 2/3% Spouse and 0 dependent is 66 2/3%

Under Vermont's workers compensation laws, which of the following injuries would not qualify for permanent total disability benefits?

A severely broken arm that can heal.

Each adjuster, workers compensation adjuster, public adjuster or appraiser must keep at the address shown on his or her license a record of all transactions under the license. The records must include:

A: A copy of all investigations or adjustments undertaken. B: A copy of all investigations or adjustments consummated. C: A statement of any fee, commission or other compensation received or to be received.

All of the following must be covered for workers compensation coverage in Vermont except? A: Maritime workers B: Stockbrokers C: Public employees D: Road contractor's employees

A: Maritime workers

In Vermont, an employee must give an employer notice of an injury, a recurrence or aggravation:

ASAP

The adjuster is a fiduciary agent. As a fiduciary agent of the principal (the insurer), the adjuster should:

Act with a high degree of fidelity and loyalty to the interests of the principal

Which of the following best exemplifies the fundamental tradeoff in workers compensation laws?

Employees are provided no-fault benefits for most work-related injuries in exchange for the loss of the right to sue the employer for damages.

Which of the following are covered by the Federal Employers' Liability Act {FELA)?

Employees of interstate railroads

What is Part II of the standard workers compensation policy form?

Employers Liability Insurance

To determine coverage and compensability in workers compensation claims involving lost time from work, an effective investigation should include evidence derived from:

I. Statements from the injured worker, the employer, and any witnesses II. A visit to the accident location; Ill. Information about prior injuries and accidents; IV. Investigation of the worker's post-accident activities

A workers compensation claim may be denied for all of the following except?

Injured while being trained for a hazardous job

All of the following are factors affecting claim reserves, EXCEPT: A: Attorney involvement B: Injured worker's age C: Injured worker's sex D:Amount of AWW

Injured worker's sex

Which of the following is not a factor in determining the reserves of a claim? A: Marital status B: Attorney Involvement C: Injured workers age D: Motivation of injured worker

Marital status

In every state some classes of employment are exempt from workers compensation laws. Benefits for exempt employees:

May be voluntarily provided by the employer

All states' workers compensation laws provide which benefits in the case of worker injury?

Medical expenses without limits Disability/loss of wages

The insured maintains a business where workers compensation coverage can be written by private insurance companies. If he has employees going to a state that is monopolistic for this coverage, what must he do to cover his employees for workers compensation coverage?

Purchase coverage for the employees from the state

Which of the following workers are covered by the FELA Act of 1908?

Railroad employees

The amounts shown as liabilities on an insurer's financial statements that represent how much is expected to be paid on all existing but not yet settled claims are known as:

Reserves

Which of the following statements about risk is the most accurate? A: Risk can be retained, shared, transferred, avoided, or reduced. B: Risk is most properly assumed when loss potential is catastrophic. C: Risk is any characteristic or condition that increases the chance of loss. D: Total risk is reduced by the use of deductibles and insurance.

Risk can be retained, shared, transferred, avoided, or reduced.

Who does the Jones Act pertain to?

Seaman

Which of the following is the least desired in regards to vocational rehabilitation? A: Self-employment B: Job modification C: Retraining D: Transferring skills

Self-employment

Under a self-insured workers compensation plan, what coverage should be purchased to cover a claim that is more than the per occurrence limit?

Specific excess coverage

Which of the following is not covered by employers liability coverage? A: Statutory workers compensation benefits B: Loss of consortium claims C: Failure to provide workers compensation benefits claims D: Dual capacity claims

Statutory workers compensation benefits

Which of the following can be categorized as liability doctrines?

Strict, Vicarious, Res lpsa Loquitur

If a large employer has a current workers compensation policy with an experience modification factor above 1.00, which of the following is the most accurate statement? A: The employer has recently modified its products and services B: The employer has experienced a reduction in total payroll during the last year C:The employer has had better- than-expected claims experience during the last few years D: The employer has had worse-than-expected claims experience during the last few years

The employer has had worse-than-expected claims experience during the last few years

Under workers compensation insurance, the insurance company is considered to have notice of an accident when:

The employer has notice.

If an employer fails to provide the required workers compensation coverage for employees in Vermont, the employer cannot plead as a defense any of the following except: A: The injury was caused by the negligence of a fellow employee B: The defense was provided under contributory negligence C: The injury was proved to not be work related. D: The employee assumed any risk in the employment

The injury was proved to not be work related.

Which of the following is the most correct concerning premiums in a standard workers compensation policy?

The insurer has three years after policy expiration to audit the insured's payroll records in order to determine the final premium.

What would most likely be the effect of an insured's breach of warranty?

The insurer might void the entire policy

Part One (Workers Compensation Insurance) of the Workers Compensation Employer Liability Insurance Policy describes:

The insurer's duty to pay promptly, when due, the benefits required of the employer by the workers compensation statute.

The manual premiums for workers compensation are based on:

The job description of the employees (the work they perform).

In a contract of adhesion, how are disputes between the parties generally resolved in court?

Unclear provisions in the contract will be resolved in favor of the non-writing party's reasonable interpretation of those provisions.

Dependent children of a worker killed on the job will receive income benefits:

Until age 18 or longer if still in an accredited school

In the event that a workers compensation policy contains provisions contrary to Vermont's workers compensation laws, which of the following is true? A: The policy provisions will always prevail B: The claim is sent to arbitration C: Vermont law will prevail D: If the policy provides broader coverage, the policy will prevail

Vermont law will prevail

A Vermont employee is working out of state for his employer and is injured in a work related incident. Coverage and benefits can be claimed:

Vermont workers compensation coverage would apply

To be covered under a standard workers compensation policy, the last exposure to the conditions causing bodily injury by disease must occur:

Within the policy period

Which of the following policies would cover a contractor's own employees for injuries sustained on the job? A: Owners and Contractors Protective B: Contractual Liability C: Workers Compensation D: Commercial General Liability

Workers Compensation

Which one of the following statements about workers compensation is correct? A: Workers compensation is identical in all states B: Every state provides extraterritorial coverage. C: Workers compensation pays for incurred pain and suffering. D: Workers compensation is an exclusive remedy.

Workers compensation is an exclusive remedy.

An insurance carrier who does not intend to renew a policy of workers compensation insurance covering the liability of an employer in Vermont must notify the commissioner and the employer at least how long prior to the expiration of such policy?

45 days

The workers compensation definition of the "minimum average weekly" wage?

50% of the average compensation, rounded to the next dollar

Every employer liable to pay workers compensation benefits must keep a record of all injuries and must report such an injury causing an absence of one day or more, or necessitating medical attendance, to the commissioner in writing within:

72 hours

In an attempt to settle a medical dispute in a workers compensation claim, the commissioner may appoint an independent medical examiner whenever a dispute exists in all of the following, EXCEPT: A: A dispute regarding the reasonableness and necessity of treatment for an injury. B: A dispute regarding the claimant's ability to perform suitable work. C: A dispute regarding the percentage of average weekly wage the claimant should receive. D: A dispute regarding the claimant's ability to perform light duty work.

A dispute regarding the percentage of average weekly wage the claimant should receive.

The employer has asked one on the employees to organize a company baseball game. The purpose is to boost morale amongst the employees. The company closes the business for one day and everyone is expected to participate that physically can or desires to play. The game is held off the work premises. One of the employees suffers a permanent eye injury. In Vermont workers compensation the claim may not be considered an injury that has occurred during the course of employment unless:

A: The employer derived substantial benefit from the activity, beyond that of attracting labor or improving employee health and morale. B: The activity was reasonably part of the employee's regular duties or undertaken to meet the expectations of the employer. C: The activity was undertaken at the request of the employer.

What is a method of settling disputes involving a claim?

Arbitration

Which of the following do not have to be covered for workers compensation in Vermont? A: A bank employee B: An auto mechanic C: A ranch employee whose payroll is less than $10K per year D: An insurance adjuster for an insurance company

C: A ranch employee whose payroll is less than $10K per year

Which of the following is not a common-law defense for an employer in a workplace injury lawsuit? A: Contributory Negligence B: Fellow-Servant C: Proximate Cause D: Assumption of Risk

C: Proximate Cause

Part II - employers liability coverage, provides which of the following workers compensation coverages?

Claims that are not subject to WC laws

What should be the central goal of the claims adjuster?

Comply with the provisions of the insurance contract

If you are the sole proprietor or partner of a business in Vermont, which of the following applies as regards workers compensation coverage?

Coverage can be elected

If you are the sole proprietor or partner of a business in Vermont, which of the following applies as regards workers compensation coverage? A: Coverage is required B: Coverage can be elected C: A modified plan can be purchased. D: They must provide only health insurance on themselves.

Coverage can be elected

A contractor applying for workers compensation insurance has traditionally worked in only one state, but is now bidding for work in several surrounding states. What provisions of the standard policy addresses this contractor's loss exposures that might develop during the policy period in these new states?

Other States Insurance

The premium charged for a standard workers compensation policy is based primarily on a company's:

Payroll

Which of the following is NOT used to determine wages? A: The total household income B: Bonuses C: Paid vacation D: Average of last 12 weeks of wages

A: The total household income

In Vermont, which of the following criteria might determine that the person or persons performing work might be considered an employee versus an independent contractor? A: The employer has the right to control the way the work is done B: The employer supplies the tools and equipment for the work C: The employer directs the scheduling of the work D: All of the responses are correct

All of the responses are correct

Estoppel is best exemplified by which of the following? A: An insured is prohibited from suing its insurer if the policy was cancelled for non-payment of premium. B: An insurance producer is prohibited from selling insurance with unauthorized insurers. C: An insurer is prohibited from appointing persons without a valid producer's license. D: An insurer is prohibited from denying a claim that its appointed producer told the insured was covered.

An insurer is prohibited from denying a claim that its appointed producer told the insured was covered.

In every state, some employees or employments are exempt from workers compensation laws. Which of the following is most true about workers compensation benefits to these employees? A: They are prohibited B: They are provided by state workers compensation funds C: Individual, "at-work" coverage may purchased by employees D: Coverage may be made available voluntarily by the employer

Coverage may be made available voluntarily by the employer

Which of the following is not a violation of the "Unfair Trade Practices Act"? A: Not attempting in good faith to settle claims when it could and should have done so B: Denying an uncovered claim C: Failing to promptly settle non-liability claims under one portion of coverage, where the obligation has become reasonably clear, in order to influence settlements under other portions of coverage D: Making claim payments to insureds and not setting forth the coverage under which payment is being made

Denying an uncovered claim

How are workers compensation benefits for permanent partial disabilities determined?

Employee receives 66 2/3% of his or her average weekly wage for a period of time determined by multiplying the percentage of impairment by 330 weeks.

The medical investigation of a workers compensation claim can begin upon receipt of a signed medical authorization from the injured worker. The authorization should contain language stating that it complies with the requirements of:

HIPPA

Which of the following is true about the Jones Act?

I. It allows injured crew members to sue the employer for negligence II. It allows the personal representative of a deceased crew member to sue the employer

Which of the following is not allowed in a formal hearing regarding a workers compensation claim? A: Hearsay that has been reviewed and agreed to by both parties B: Medical testimony C: Eye witnesses to the accident D: Irrelevant material

Irrelevant material

What workers compensation law extends to land-based employees who load and unload seagoing vessels?

Longshore and Harbor Workers Compensation Act