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week 8- workers comp

Study Guide-Lesson 3- Worker's Compensation

QuestionAnswer
What are the penalties for committing Worker's Compensation fraud?** Felony punishable by fines, orders for restitution, and imprisonment.
If WC claim is denied, who can the provider request a review from?** An independent review organization.
What is the time limit to submit a WC claim to the insurance carrier?** 95 Days of the date of service.
To qualify for Social Security Disability Insurance (SSDI), individuals must be unable to work for how long? 1 year.
Who pays for Social Security Disability Insurance (SSDI)?** Worker's payroll deductions matched by employer contributions.
What are the maximum weeks paid for Supplemental income benefits?** 401 Weeks
How many days must you have missed work to be eligible to receive temporary income benefits?** 7 Days
What are the four types of worker's compensation benefits?** Medical, income, death, and burial.
What can the Ombudsmen provide?** Information to assist the injured worker in making a decisions.
Define impairment.** A determination made by the treating doctor that describes the degree of permanent damage to a worker's body as a hole as a result of a job-related injury.
What is the final report?** The report that affirms that the worker has been released from medical treatment and is fit to return to work and resume normal job responsibilities.
Define impairment rating.** A determination made by the treating doctor that describes the degree of permanent damage done to a worker's body as a whole as the result of a job-related injury.
When a worker dies from a on-the-job injury, who are the WC death benefits paid to?** The spouse and dependent children.
What is a status report?** A form used to report information about employee's limitation in performing his/her job duties.
What is an occupational disease?** Health problems that result from exposure to a workplace health hazard.
What state is the only state that allows private employers to choose whether or not to provide Worker's Compensation?** Texas
Who should the employee file a complaint with if he/she feels that his/her work environment is unsafe?** Occupational Safety and Health Administration
List the five categories of work-related injuries.** Injury without disability Injury with temporary disability Injury with permanent disability Injury resulting in death
What are the three primary rights of a worker injured on the job or suffering from a job-related illness? The right to receive medical care necessary to treat the work-related injury or illness. The right to an initial choice of doctor.
What is the primary responsibility of an injured worker with regard to his/her employer? Has the responsibility to tell his/her employer of a work-related injury or illness within 30 days of the injury or within 30 days of realizing the injury / illness may be the result of his/her employment.
What is meant by insurance fraud? Any act committed to obtain an outcome that is favorable, but fraudulent during an insurance claim.
How is reimbursement calculated for workers compensation claims? Using the Medicare Fee Schedule (MFS).
OSHA stands for what? Occupational Safety and Health Administration
*Explain the different categories: ** what is permanent disability? . describes an employee who is injured on the job, is not able to return to work, and is not expected to be able to perform his regular job in the future.
*What is temporary disability means?** describes an employee who is injured on the job, but is not able to return to work within several days.
*What is without disability?** describes an employee who is injured on the job, and is able to return to work within several days.
Created by: Lizbeth Romo