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MED112 CODE/BILL
MED112 CH 12 WORKER'S COMP & DISABILITY/AUTO INSURANCE SB
| Question | Answer |
|---|---|
| MED112 CH 12 SB | |
| Which entity administers programs to cover work-related illnesses or injuries suffered by civilian employees of federal agencies? A. OWCP B. FECA C. FICA D. OWCP | D. OWCP |
| State workers' compensation programs are administered and governed by ________. A. OWCP B. the federal government C. OSHA D. each state | D. each state |
| Companies that are required to carry workers' compensation insurance but fail to do so are subject to ________. A. increased taxes B. legal penalties C. withdrawn federal loans and incentives D. imprisonment | B. legal penalties |
| Which of the following are benefits paid under workers' compensation? (MAY BE MORE THAN ONE) A. Death benefits B. Medical benefits C. Wage-loss benefits D. Healthy benefits | A. Death benefits B. Medical benefits C. Wage-loss benefits |
| What organization was created to protect workers from health and safety risks on the job? A. SSDI B. OSHA C. COBRA D. FERPA | B. OSHA |
| Generally, an injury is covered if it meets which of the following criteria? (MAY BE MORE THAN ONE) A. It is intentionally inflicted. B. It results in a personal injury or death. C. It arises during a paid break or vacation off site. D. It arises from employment. E. It occurs by accident. | B. It results in a personal injury or death. D. It arises from employment. E. It occurs by accident. |
| Individuals employed by the federal government are provided workers' compensation under ________. A. OWCP B. SSDI C. OSHA D. FECA | D. FECA |
| Which of the following are sources from which employers can obtain workers' compensation insurance? (MAY BE MORE THAN ONE) A. Directly through FECA B. Directly with a self-insured fund C. State workers' compensation fund D. Private plan | B. Directly with a self-insured fund C. State workers' compensation fund D. Private plan |
| Which of the following categories of employees are generally not covered by state workers' compensation insurance? (MAY BE MORE THAN ONE) A. Self-employed individuals B. Railroad employees C. Federal employees D. Part-time employees | A. Self-employed individuals B. Railroad employees C. Federal employees |
| Occupational diseases or illnesses develop as a result of ________. A. using proper ergonomics B. common workplace standards C. following OSHA guidelines D. workplace conditions | D. workplace conditions |
| What classification of injury applies in the case of a worker who is injured while on the job and requires medical treatment but returns to work within two days? A. Highly severe temporary disability B. Injury requiring vocational rehabilitation C. Very mild permanent disability D. Injury without disability | D. Injury without disability |
| Which of the following is not a condition of a covered accident or injury under workers' compensation? A. It arises during the course of employment. B. It is an unexpected event. C. It occurs on any location. D. It is an accidental event. | C. It occurs on any location. |
| Pain that requires activity limits that lead to pain is classified under workers' compensation as ________. A. severe B. slight C. moderate D. intolerable | A. severe |
| Which of the following PHI disclosures are permitted under the HIPAA Privacy Rule for workers' compensation purposes? (MAY BE MORE THAN ONE) A. Covered entities are permitted to reasonably assure that the information requested is the minimum necessary for the intended purpose. B. Insurers can access to the worker's compensation file. C. Disclosure of information about a previous condition that is not related to the claim. D. Disclosure for any judicial proceeding without patient's authorization. | A. Covered entities are permitted to reasonably assure that the information requested is the minimum necessary for the intended purpose. D. Disclosure for any judicial proceeding without patient's authorization. |
| Which of the following statements are true about workers' compensation plans? (MAY BE MORE THAN ONE) A. Each state administers its own program. B. Workers' compensation insurance is only offered by the state workers' compensation fund. C. All states provide coverage for medical expenses and wage compensation. D. Workers' compensation plans vary from state to state. | A. Each state administers its own program. C. All states provide coverage for medical expenses and wage compensation. D. Workers' compensation plans vary from state to state. |
| Which of the following is not true about the workers' compensation claims process? A. An employee must report the injury if the employer views it as work-related. B. The employer is given a medical service order. C. An employee must notify the employer in writing about the injury. D. An employee has an unlimited time period to report the injury. | D. An employee has an unlimited time period to report the injury. |
| The physician of record is responsible for which of the following? (MAY BE MORE THAN ONE) A. Deciding on the return-to-work date. B. Determining the percentage of disability. C. Testifying on behalf of the employee. D. Treating the patient's condition. | A. Deciding on the return-to-work date. B. Determining the percentage of disability. D. Treating the patient's condition. |
| A worker who is injured on the job and requires treatment but is able to resume working within several days is eligible for workers' compensation under the ________ classification. A. injury requiring vocational rehabilitation B. injury with permanent disability C. injury resulting in death D. injury without disability | D. injury without disability |
| Which of the following is not a classification of pain under workers' compensation? A. Intolerable pain B. Moderate pain C. Slight pain D. Minimal pain | A. intolerable pain |
| Which of the following are true about compensation for lost wages? (MAY BE MORE THAN ONE) A. Checks must be sent to the employer before being redirected to the employee. B. Federal income taxes are withheld from payments. C. Checks are sent directly to the employee. D. No income taxes are withheld from payments. | C. Checks are sent directly to the employee. D. No income taxes are withheld from payments. |
| Cases are among the few situations in which a healthcare provider may disclose a patient's PHI to an employer without the patient's authorization. A. Trust pay liability B. Motor vehicle accident C. Malpractice D. Workers' compensation | D. Workers' compensation |
| Which entities are typical payers that are involved in a private accident? (MAY BE MORE THAN ONE) A. Employer B. Insurance carrier C. Judicial proceeding D. Patient | A. Employer B. Insurance carrier |
| Which of the following is not true about the workers' compensation claims process? A. Payment is made directly to the healthcare provider. B. Patients may select the employee that served the accident fee. C. Providers submit their charges to the workers' compensation insurance carrier. D. Charges are made to an established fee schedule. | B. Patients may select the employee that served the accident fee. |
| What classification of injury applies in the case of a worker who is injured while on the job and requires medical treatment but returns to work within two days? A. Injury with permanent disability B. Injury without disability C. Injury requiring vocational rehabilitation D. Injury with temporary disability | B. injury without disability |
| What is the first step in the appeal process for a workers' compensation claim denial? A. Arbitration B. Mediation C. Jury trial D. Litigation | B. mediation |
| Who is responsible for a worker's injury under an Admission of Liability? A. Employee B. No one C. Insurance carrier D. Employer | D. employer |
| Which of the following are true about the billing and claims management for workers' compensation? (MAY BE MORE THAN ONE) A. Most practice management programs (PMS) do not capture workers' compensation and injury-related information, and a manual process must be implemented. B. Providers must accept payment from the insurance carrier as payment in full. C. The medical insurance specialist contacts the workers' compensation carrier for authorization to treat the patient before the initial visit. | B. Providers must accept payment from the insurance carrier as payment in full. C. The medical insurance specialist contacts the workers' compensation carrier for authorization to treat the patient before the initial visit. |
| In disability cases, inaccurate or incomplete medical records may result in ________. A. patient's dismissal from a medical practice B. denial of disability benefits C. termination from employment D. approval of disability benefits | B. denial of disability benefits |
| Which of the following may occur, causing temporary partial and temporary total disability benefits to cease? (MAY BE MORE THAN ONE) A. The employee has exhausted the maximum workers' compensation benefits for the injury or illness. B. The employee is offered the same job as they had before the injury. C. The employee is given a physician's release authorizing a return to their regular job. D. The employee does not cooperate with the request for a medical examination. | A. The employee has exhausted the maximum workers' compensation benefits for the injury or illness. C. The employee is given a physician's release authorizing a return to their regular job. D. The employee does not cooperate with the request for a medical examination. |
| A governmental disability insurance ________. A. TRICARE B. Medicaid C. SSDI D. Medicare | C. SSDI |
| The physician who first treats the injured or ill employee is known as the ________. A. returning physician B. physician of record C. consulting physician D. primary care physician | B. physician of record |
| How is the SSDI program funded? A. By workers' payroll deductions and matching employer contributions B. By employer contributions only C. By workers' payroll deductions and matching federal and state funds D. By workers' payroll deductions only | A. By workers' payroll deductions and matching employer contributions |
| During the first step of the appeals process for workers' compensation, a ________ works with both parties to obtain a satisfactory resolution. A. lawyer B. mediator C. physician D. judge | B. mediator |
| Which of the following must be included on the report for a disability claim? (MAY BE MORE THAN ONE) A. Medical history B. Diagnosis C. Diagnostic test results D. Cognitive function tests | A. Medical history B. Diagnosis C. Diagnostic test results |
| If the patient being treated for a work-related injury or illness is already an established patient of the practice, the patient has ________ medical records. A. one inclusive B. two separate C. only one D. none | B. two separate |
| A contract between an insurance company and an individual for which the individual pays a premium in exchange for coverage of specified motor vehicle-related medical costs is called ________. A. automobile insurance policy B. supplemental insurance policy C. workers' compensation D. assignment of benefits | A. automobile insurance policy |
| A plan that provides partial reimbursement for lost income when a disability prevents an individual from working is called a(n) ________. A. adoption benefit B. tertiary program C. disability compensation program D. supplemental insurance | C. disability compensation program |
| The action by a payer to recoup expenses for a claim it paid when another party should have been responsible for paying is called ________. A. subrogation B. coordination of benefits C. assignment of benefits D. adjudication | A. subrogation |
| SSDI provides compensation for ________. A. medical expenses due to disability B. lost wages due to disability C. lost wages due to unemployment D. lost wages and medical expenses due to a work-related injury or illness | B. lost wages due to disability |
| Which of the following cases may be subject to subrogation? (MAY BE MORE THAN ONE) A. Social Security Disability B. Liability insurance C. No-fault insurance D. Workers' compensation | B. Liability insurance C. No-fault insurance D. Workers' compensation |
| How is the SSDI program funded? A. By workers' payroll deductions and matching employer contributions B. By employer contributions only C. By workers' payroll deductions and matching federal and state funds D. By workers' payroll deductions only | A. By workers' payroll deductions and matching employer contributions |
| An employee who believes the work environment to be dangerous may file a complaint with the A. local Social Security office. B. Workers’ Compensation Board in the state in which the company is headquartered. C. Occupational Safety and Health Administration. D. Office of Workers’ Compensation Programs. | C. Occupational Safety and Health Administration. |
| For a widow or widower age fifty years or older who is disabled to qualify for Social Security Disability Insurance (SSDI), his or her spouse must have paid into Social Security for at least A. ten years. B. one year. C. five years. D. six months. | A. ten years. |
| A disability that limits a worker to jobs that are performed in an upright or walking position and that require no more than minimal effort is classified as A. precluding heavy lifting, repeated bending, and stooping. B. limitation to semisedentary work. C. precluding very heavy work. D. limitation to light work. | D. limitation to light work. |
| Vocational rehabilitation programs provide ______ for individuals with job-related disabilities. A. physical therapy B. training in a different job C. payment for medical expenses D. compensation for lost wages | B. training in a different job |
| The classifications of pain used in workers’ compensation claims are A. minimal, slight, major, severe. B. minimal, moderate, severe. C. slight, moderate, major, severe. D. minimal, slight, moderate, severe. | D. minimal, slight, moderate, severe. |
| Which of the following provides workers’ compensation insurance coverage to employees of the federal government? A. Office of Workers’ Compensation Programs (OWCP) B. Federal Insurance Contribution Act (FICA) C. Federal Employees’ Compensation Act (FECA) D. Supplemental Security Income (SSI) | C. Federal Employees’ Compensation Act (FECA) |
| Before an injured employee can return to work, a physician must write A. a final report of injury. B. a final report. C. a progress report. D. an admission of liability report. | B. a final report. |
| An individual with a disability described as precluding heavy work has lost _____ of the capacity to push, pull, bend, stoop, and climb. A. 90 percent B. 25 percent C. 20 percent D. 50 percent | D. 50 percent |
| A _____ is a denial of employer liability issued by the workers’ compensation insurance carrier. A. Denial of Finding B. No-Fault Notice C. First Report of Liability D. Notice of Contest | D. Notice of Contest |
| Once an application for Social Security Disability Insurance (SSDI) is filed, there is a _____ waiting period before benefits begin. A. thirty day B. five month C. fourteen day D. one month | B. five month |
| Employee payroll deductions that are used to partially fund Social Security Disability Insurance (SSDI) | Federal Insurance Contribution Act (FICA) |
| A notification of a determination that the employer is not liable for the worker's injury or illness | Notice of Contest |
| Illnesses that develop as a result of workplace conditions or activities | Occupational diseases or illnesses |
| The government agency that administers workers' compensation programs for civilian employees of federal agencies | Office of Workers' Compensation Programs (OWCP) |
| Program funded by workers' payroll deductions and matching employer contributions that provides compensation for lost wages due to disability | Social Security Disability Insurance (SSDI) |
| A document indicating that an individual is fit to return to work and resume normal job activities | Final report |
| Legislation that provides workers' compensation benefits to individuals employed by the federal government | Federal Employees' Compensation Act (FECA) |
| Provides workers’ compensation benefits to individuals employed by the federal government under the Federal Employees’ Compensation Act (FECA) | Federal Employees’ Compensation Program |
| Provides benefits to individuals working in coal mines under the Black Lung Benefits Act | Federal Black Lung Program |
| Provides benefits to workers who have developed cancer and other serious diseases because of exposure to radiation, beryllium, or silica at atomic weapons facilities or at certain federally owned facilities in which radioactive materials were used | Energy Employees Occupational Illness Compensation Program |
| Provides coverage for individuals employed in the maritime field under the Longshore and Harbor Workers’ Compensation Act and for certain other classes of workers covered by extensions of the act | Longshore and Harbor Workers’ Compensation Program |
| Insurance coverage for medical expenses and other expenses related to a motor vehicle accident | personal injury protection (PIP) |
| A document that contains information about the patient, the employer, and the injury or illness that must be filed by the employer, often within twenty-four hours of the incident | first report of injury |
| Determination that the employer is responsible for the worker’s injury or illness | Admission of Liability |
| A welfare program that provides financial assistance to individuals in need, including those who are aged, blind, and disabled | Supplemental Security Income (SSI) Correct |
| Programs that provide reimbursement for lost income that occurs due to a disability that prevents the individual from working, whether the injury is work-related or not | disability compensation programs |
| The physician who first assesses and treats an injured or ill employee | physician of record |
| Documents filed with the insurance carrier when there is a substantial change in the patient’s condition that affects the status of an occupational illness | progress reports |
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