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Module 8 Chap 15

Workers Comp

QuestionAnswer
Name the two kinds of statutes under worker's compensation 1. Federal compensation laws 2. State compensation laws
An unexpected, unintended event that occurs at a particular time and place causing injury to a person not of his/her own making is called what? accident
EE works in factory and inhales fumes that cause bronchitis. Since this condition is related to the EE's employment it is called what? industrial illness
Name the federal workers' compensation acts that cover workers 1. Workman's compensation law of D.C. 2. Federal Coal Mine Health and Safety Act - black lung act 3. Federal Employees Compensation Act (FECA) 4. Longshoreman's and Harbor WC Act
state compensation laws that require each employer to accept its provisions and provide for specialized benefits for employees who are injured at work are called what? compulsory laws
State compensation laws that may be accepted or rejected by the employer are known as what? elective laws
Name five methods used for funding workers' compensation 1. monopolistic state and provincial 2. territorial 3. self-insured 4. competitive state 5. private insurance
Who pays the workers' compensation insurance premiums? employer
What is the time limit in CA for submitting the employers' and/or physicians' report on an industrial accident? 1 day; immediately if death
When an EE with preexisting condition is injured at work and the injury produces a disability greater than what would have been caused by the second injury alone, the benefits are derived from what? second or subsequent injury fund
Name jobs that may not be covered by WC? domestic workers laborers babysitters newspaper vendors or distributors charity workers gardeners
What is the minimum number of EE's per business needed in CA for WC statutes to become effective? one
What waiting period must elapse in CA before WC payments begin? 3 days
List five types of WC benefits 1. medical treatment 2. temporary disability indemnity 3. permanent disability indemnity 4. death benefits for survivors 5. rehabilitation benefits
Who can treat an industrial injury? medical doctor osteopath dentist chiropractor
what are 3 types of WC claims and the differences among them? 1. nondisability claim -minimal injury not off work 2. temporary disability - work related injury and person unable to perform duties for certain period of time 3. permanent disability - damage due injury or illness is permanent-fullest extent recovered
Weekly temporary disability payments are based on what? a percentage of the employee's earnings
form of therapy in which patient is given real work tasks for building strength and endurance is called what? work hardening
when an industrial case reaches the time for rating the disability, this is accomplished by what state agency? states industrial accident commission or workers' compensation board
Can an injured person appeal their case if not happy with the rating? Yes
To whom does one appeal to on an industrial claim? WC Appeals Board or industrial accident commision
when fraud or abuse is suspected in a WC case, the physician should report the situation to how? insurance carrier
Explain third-party subrogation a transfer of the claims and rights from the original creditor (WC carrier) to the third-party liability carrier
when a person suffers a work-related injury or illness, the employer must complete and send what form? employers report of occupational injury or illness form
to whom does the employer send the first report? to the insurance company and WC state offices
When employee is sent to a physician's office for medical care, the employer must complete a form called what? medical service order
what does a medical service order do? authorizes a physician to treat the employee
employers are required to meet health and safety standards for their employees under federal and state statutes known as what? OSHA
The process of carrying on a lawsuit is called what? litigation
a proceeding during which an attorney questions a witness who answers under oath but not in open court is called what? deposition
the legal promise of a patient to satisfy a debt to the physician from proceeds received from a litigated case is termed what? lien
when a physician treats an industrial injury, he or she must complete a first treatment medical report or doctor's first report of occupational injury or illness and send it to who? 1. insurance carrier 2. employer 3. state workers' compensation office
true or false: the first thin an employee should do after being injured on the job is to notify the employer or immediate supervisor true
true or false: a roofer takes his girlfriend to roofing job and she is injured. She is covered under WC insurance. false
true or false: a stamped physician's signature is acceptable on the doctor's first report of occupational injury or illness form false
true or false: in a WC case, bills should be submitted monthly or at the time of termination of treatment, and a claim becomes delinquent after a time from of 45 days true
true or false: if a person seeks medical care for a WC injury from another state, the state's regulations are followed in which the injured person's claim was originally filed true
true or false: when a patient arrives at a medical office and says they were hurt at work, you should verify insurance information with the benefits coordinator for the employer true
Created by: mpeoples
 

 



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