# BAS 07 Workers Comp
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| If the patient has a non-work condition, the doctors first report must include that with the diagnosis. | False.
The doctors first report and all subsequent progress reports are based only upon the work related illness.
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| If the patient is treated for a non-work injury while being examined for a work-related injury, the doctor can charge workers compensation for both conditions. | False.
The Dr. can charge workers compensation only for work related illness. Any exam or treatment of nonwork related illness must be charged to the patient.
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| A lien is a claim for payment that requires a legal filing. | True.
If the Dr. does not file a lien there will be no claim for payment when the workers compensation case is settled. The Dr. may lose any claim to payment for services.
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| Who are the beneficiaries for workers comp claims. | 1. The injured patient
2. Spouse and Dependents of the injured worker.
3. Spouse and dependents of a worker who died on the job.
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| Workers compensation is regulated by state laws that will pay medical expenses and partial loss of wages for workers who become ill or injured on the job. | True.
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| A typical temporary disability Worker's Comp. chart would have what documents. | 1. employers 1st report
2. doctor's 1st report
3. doctor's lien
4. progress reports
5. Doctor's final report
6. employees eligibility DWC-1 form
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| All employers must pay for the Worker's Compensation insurance. | False.
There are some employees exempt based upon the nature of the job when the number of individuals.
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| All workers are covered by workers compensation in the state of California. | False.
Temporary employees, volunteers, domestic help, are all exempt from workers compensation benefits.
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| Federal workers have something similar to a workers compensation through special federal programs. | FECA, FELA, Merchant Marine Act, Longshore and Harbor Workers, and Black Lung Benefits Act
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| What does worker compensation pay for? | 1. Medical Expense
2. Disability pay while out of work
3. Vocational Rehabilitation
4. Death Benefits
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| The "going and coming rule" in Workers Compensation states that an emjployee is covered when traveling to work and traveling to home from work. | False.
Workers compensation does not cover travel to and from work.
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| No travel is covered in Workers Compensation. | False.
Any job that requires travel as part of the job function is covered.
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| A State ombudsman can help employees if the employee feels wrongly denied. | Yes. Most States have an ombudsman but even if there is no State Ombudsman employees may appeal a denial.
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| A doctor is limited to the State fee schedule when charging for medical treatment. | True.
You must know the State Fee Schdule before billing.
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| Time limits for reporting illness or injury are limits defined by the State, but, there is no definite time limit for: | Delayed illnesses.
These illnesses can have an extended time limit that extens to the date of first symptoms. This could be years after the first exposure.
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| The Doctor's First Report of Illness or Injkury is important in determining the potential for temporary or permanent loss. | True.
If the insurance company should disagree there may be another physician called in to do a separate first report.
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| What does the first day of injury report used to establsih? | Is the injury caused by the job.
Is the condition permanent or temporary
Can the emmployee return to work with some type of accomodation (special chair, no lifting.
Will the employee require future medical treatment.
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| What are the disability classifications | TD - Temporary disability (partial or total)
PD - Permanent disability (partial or total)
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| When is vocational rehabilitation required | When the injury or illness prevents the employee from returning to the same job.
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| Doctors can bill a patient even though it is still pending. | No. They cannot bill patients when the claim is pending. The only alternative is to ask a patient to make payments. If the patient agrees there is no need to bill the patient.
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| If a claim is denied, the doctor can bill the patient, but is limited to the State fee schedule for workers comp | NO. The doctor can charge the normal fee.
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| HIPAA applies to worker compensation cases. | False.
HIPAA does not apply. WC cases will end up in court and that makes them a matter of public record.
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