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Module 8 Chap 16
Disability Ins
Question | Answer |
---|---|
Health insurance that provides monthly or weekly income when an individual is unable to work because of a nonindustrial illness or injury is called what? | disability income insurance |
Some insurance contracts that pay twice the face amount of the policy if accidental death occurs may have a provision called what? | double indemnity |
When an individual who is insured under a disability income insurance policy cannot perform one or more of his/her regular job duties, this is known as what type of disability? | residual or partial |
When an individual becomes permanently disabled and cannot pay the insurance premium, a desirable provision in an insurance contract is what? | waiver of premium |
EE has disability income insurance in a group policy; EE makes no contribution to policy premiums. EE incurs injury needing several months off work. Are his monthly disability taxable? Why or why not? | Yes because the EE is not making any contributions towards the premiums |
Two federal programs for individuals younger than 65 years of age who have a sever disability are what? | SSDI and SSI |
The SSA may hire a physician to evaluate an applicant's disability. A physicians role may be any one of the following: | 1. treating source - provides evidence on behalf of pt. 2. consultative examiner - paid a fee & examines, tests pt. 3. full or part-time medical or psychological consultant reviewing claims for a state regional office |
Navel officer suffers an accident about navel ship just before his honorable discharge. To receive veteran's benefits for this injury, the time limit in which ta claim must be filed is what? | within 1 year from the date of the injury |
Name the states and the territory that have nonindustrial state disability programs | 1. CA 2. Hawaii 3. New Jersey 4. New York 5. Rhode Island 6. Puerto Rico |
Temporary disability insurance claims must be filed within how many days in CA? | 49 |
How long can a person continue to draw state disability insurance benefits in CA? | 52 weeks |
After a claim begins, when do basic state disability benefits become payable if the patient is confined to his or her home? | after the 7th day of disability |
After a claim begins, when do basic state disability benefits become payable if the patient is hospitalized? | HI and Puerto Rico - after the 1st day; other states after the 7th day |
Patient who recovered since a previous illness ended and become ill again with the same illness - is he entitled to SDI? | Yes |
EE stubs toe leaving works, area swells next day & could not put shoe on so stayed home. EE saw doctor 3 days later and off work for two weeks. After 1 week EE applied for temporary SDI. Will he be paid and why? | Yes - because he is out of work due to the injury over the waiting period. |
Patient with ectopic pregnancy unable to work due to complications of this condition. Can she get SDI? | Yes - complications of pregnancy covered |
Name 4 states that allow for maternity benefits in normal pregnancy. | 1. CA 2. Hawaii 3. New Jersey 4 Rhode Island |
EE had to stay hone from job due to daugther with measles. Can she apply for temporary SDI? | No - she has to be the one ill |
EE ill with bad cold for 1 week. Will he get temporary SDI? | No - period he is out will be the wait period |
EE has emergency appendectomy & hospitalized for 3 days. Will she get SDI? | Yes - get immediately in Hawaii after the first day hospitalized |
Can a part-time worker get SDI? | Yes, reduced benefits |
Person unemployed and getting UI suffer flu, EDD calls him to interview for a job but too ill to go - can he collect temporary SDI for this illness when he might have been given a job? | Yes one must either be employed full or part-time OR actively looking for work |
EE walking picket line uring strick and gets pneumonia & ill for 2 weeks. Can he get temporary SDI? | Yes may have become ill while working whether on strike or not |
EE RTW for 3 weeks then develops cold and cough and dx'd again with pneumonia. Can he collect temp SDI? | Yes entitled to benefits 15 days after recovery from a previous disability or illness |
Month after retireing EE has GB surgery. Can EE get temp SDI? | No once retired no longer eligible |
If an insurance adjuster notices some conflicting data on a disability income claim forms, what other documents may be requested to justify payment of benefits? | employer records wage statements or tax forms medical records |
Permanently disabled person applies for federal disability benefits. To establish eligibility for benefits under this program, data allowed must be how old? | no more than 1 year old |
Name the two methods or options for billing on a Veterans Affairs patient seen on an emergency basis. | 1. bill the VA monthly 2. patient pays physician and then gets reimbursed by the VA |
Another disability income insurance term for benefits is called what? | indemnity |
When the purchase of insurance is investigated, the wor/words to look for in the insurance contract that mean the premium cannot be increased at renewal time is/are | noncancelable clause |
Provisions that limit the scope of insurance coverage are known as what? | exclusions |
The time period from the beginning of disability to receiving the first payment of benefits is called what? | waiting period |
True or false: when a person insured under a disability policy cannot, for a limited period of time, perform all functions of her/her work, this is known as permanent disability. | False |
True or false: to be eligible to apply for disability benefits under Social Security, an individual myst be unable to perform any type of work for a period of not less than 12 months | True |
True or false: hospital benefits may be paid for nonoccupational illness or injury under Hawaii and Puerto Rico's temporary disability benefits prepaid health care programs | True |
True or false: if a woman has an abnormal condition that arises from her pregnancy and is unable to work because of the condition, she may not receive state disability benefits | False |
True or false: when a claim form is submitted for a patient applying for state disability benefits, the most important item required on the form is the claimant's social security number | True |
NP | new patient |
LBP | low blood pressure |
lt | left |
reg | regular |
SLR | slight leg raises |
WNL | within normal limits |
MRI | magnetic resonance imaging |
imp | impression |
c/o | complains of |
pt | patient |
wk | week |
exam | examination |
rt | right |
STAT | immediately |
RTO | return to office |
retn | return |