MBL103 Chapter 12 Workers Compensation & Disability Automotive Insurance
The Energy Employees' Occupational Illness Compensation Program
A patient presents with a form of cancer developed from radiation exposure during their work in a federal weapons facility. By which OWCP programs are they likely to be covered?
a final report
After discharging a workers' compensation for a patient to go back to work, the provider must file _______________
full time, part time, minors
Among the following, who do most states require public and private companies to provide workers' compensation coverage for?
state
At what level are workers' compensation programs administered?
obtain authorization
For a company to self insure for workers' compensation, most states require you to ______________
the first seven days
For how many days of disability are cash benefits generally not paid?
companies' pay premiums to a central state insurance fund
How is workers' compensation insurance funded under state fund?
five
How many categories of work related injuries are there?
if an injury was an intentional injury
Injuries are generally covered under workers' compensation except for?
are qualifies for welfare programs
Supplemental Security Income provides financial assistance to individuals who _______________
coal mines
The Federal Black Lung Program provides benefits for individuals who work in ___________
limitation to light work
What classification of disability describes an individual who may work in an upright or walking position as long as no greater than minimal effort is required?
injuries of self employed individuals
What is NOT covered by workers' compensation insurance?
vocational rehabilitation
What is the process of retraining an employee to returned to the workforce called?
to provide an additional, impartial medical opinion before a final determination is made
What is the purpose of an IME?
slight pain
What type of pain may limit an employee some work assignments but is generally tolerable?
severe pain
What type of pain will force an employer to avoid any activities that will lead to pain?
those who have sustained workplace injuries
What type of workers are covered by the programs of the OWCP?
external causes
What types of codes must be included in ICD-10-CM coding to report the cause of an accident?
vocational rehabilitation, medical treatment, and cash benefits for lost wages
What types of services are offered by the programs administered by the OWCP?
OSHA
What was created to protect workers from health and safety risks on the job?
first report of injury
When a provider initially examines a workers' compensation patient, what document must be filed with the state?
notification in writing within a certain time period
When an employee is injured on the job, most states require ______________
when the employee cooperates with request for medical examination
When do temporary partial or temporary total disability benefit NOT cease?
a part time employee of a private food service company
Which of the following individuals would generally be covered by state workers' compensation insurance?
an injury resulting from and employees' failure to obey safety procedures
Which of the following is an example of an injury that is generally NOT covered?
an injury due to heavy lifting
Which of the following is an example of an injury that is generally covered?
PIP
Which of these is not a government disability program?
the state workers' compensation office
Who requests an IME?
The Longshore and Harbor Workers Compensation Program
A patient presents with an injury suffered while working on an offshore fishing ship. By which OWCP program are they likely to be covered?
injury with temporary disability
An employee breaks his arm on the job and requires treatment and a rehabilitation of several weeks before he can return to work. Which category describes this type of injury?
injury with permanent disability
An employee breaks his back on the job and is not expected to be able to return to the job in the future. Which category describes this type of injury?
injury without disability
An employee sprains her ankle on the job, resulting in a trip to the physician, but is cleared to return to work later that week. Which of the following categories describes this type of injury?
injury requiring vocational rehabilitation
An employee suffers a bad fall in a factory and has to be trained to work in the administrative office for the company as a result of the injury. Which category describes this type of injury?
the denial of a disability claim
An incomplete or inadequate medical report often leads to ___________
FERS
Federal workers hired after 1984 are covered by __________
directly from Medicare
Identify a source from which employers cannot obtain workers' compensation insurance.
actions a payer takes to recoup paid claim expense in certain circumstances
Subrogation refers to _________________
the U.S. Dept. of Labor
The OWCP is part of which branch of the federal government?
OWCP
Various programs that are administered by the __________ cover work related illnesses or injuries suffered by civilian employees of federal agencies, including occupational diseases they acquire.
FICA
What authorizes payroll deductions for the Social Security Disability Program?
occupational diseases and illnesses
What can develop due to workplace conditions or activities?
precluding very heavy lifting
What classification of disability describes an individual who has lost 25 percent of the ability for very heavy lifting?
precluding heavy lifting
What classification of disability describes an individual who has lost 50 percent of the ability for heavy lifting?
precluding heavy work
What classification of disability describes an individual who has lost 50 percent or more of the ability to lift, push, pull, bend, stoop, and climb?
the veteran is injured while working for a private employer
What conditions would exclude benefits from the Veteran's Pension Program?
Notice of Contest
What determination denies liability for an employees' workers' compensation claim?
Admission of Liability
What determination indicates that an employer is responsible for an employees' claim under workers' compensation?
contacts the employee for medical records
What does an insurance carrier not do after it receives the first report of injury?
progress report
What does the physician of record file with the insurance carrier every time there is a substantial change in the patients' condition that affects disability status or when required by state rules and regulations?
request mediation
What is the first step in the process of appealing workers' compensation decisions?
they compensate employees based on a percentage of their salary before the injury
What is the most common method states use to determine wage loss benefits?
interest on the payment or a late fee
What may a claimant be eligible for if a workers' compensation claim is not paid within the specified time?
SSI
What program helps to pay living expenses for people who are blind or have disabilities and those of low - income older people?
FECA
What provides workers' compensation benefits for civilian employees of the federal government?
death benefits and funeral expenses
What states pay when an individual is fatally injured on the job?
limitation to sedentary and semi-sedentary work
What type of disabilities are due to lower extremity injuries?
minimal pain
What type of pain is merely annoying and does not limit an employee's ability to perform their job?
moderate pain
What type of pain will markedly limit an employee's performance but is not intolerable?
disability compensation programs
What type of programs provide partial reimbursement for lost income when a disability - whether work related or not - prevents the individual from working?
directly to the provider
Where is payment made when a federal worker injured on the job is treated by a physician authorized by the OWCP?
none of these are correct; there is no universal rule
Which form should always be used in completing a workers' compensation claim form?
a self employed individual
Which of the following individuals would generally NOT be covered by state workers' compensation insurance?
reporting 99455 or 99456 together with 99080
Which of the following is not a legitimate process for the completion of workers' compensation claims?
none of these are correct; individuals do not have this right
Which of the law may allow individuals the right to request that a physician restrict a disclosure of their PHI for workers' compensation purposes?
an employee falls while walking on a catwalk
Which of these accidents is an example of an immediate event?
an employee develops a hearing disability after years in a noisy work environment
Which of these accidents is an example of an unexpected result over time?
injury with temporary disability
Which of these categories applies to a worker who is injured on the job, requires treatment, and is unable to return to work within several days?
injury requiring vocational rehabilitation
Which of these categories applies to a worker who is injured on the job, requires treatment, and is unable to return to work without vocational rehabilitation.
injury without disability
Which of these categories applies to a worker who is injured on the job, requires treatment, but is able to return to work within several days?
injury with permanent disability
Which of these categories applies to a worker who is injured on the job, requires treatment, is unable to return to work, and is not expected to be able to return to his/her regular job in the future?
they compensate for lost wages and pay medical expenses
Which of these completely explains the key components that all states' workers' compensation programs share?
providers submit their charges to the workers' compensation carrier and are paid directly by the carrier
Which of these correctly describes the process of submitting charges and receiving payment through workers' compensation insurance?
physician of record
Which term is used to describe the physician who first treats the injured or ill employee?
employers and claim adjusters
Who is allowed unrestricted access to workers' compensation files in most states?
employer or physician
Who may file the first report of injury?
