Deck 17: Workers Compensation

Question 1

Workers' compensation death benefits paid when a worker has died as a result of an on-the-job injury are paid to the employee's:

A) designated beneficiary.
B) children under age 18 only.
C) spouse only.
D) spouse and dependent children.

Answer 1

spouse and dependent children.

Question 2

The act that covers maritime workers injured or killed on or adjacent to navigable waters of the United States is known as the:

A) Federal Employees' Compensation Act.
B) District of Columbia Workers' Compensation Act.
C) Energy Employees Occupational Illness Compensation Program Act.
D) Longshore and Harbor Workers' Compensation Act.

Answer 2

Longshore and Harbor Workers' Compensation Act.

Question 3

In all categories of workers' compensation claims, the injured worker will receive compensation for:

A) medical expenses.
B) lost wages.
C) vocational rehabilitation.
D) pain and suffering.

Answer 3

medical expenses.

Question 4

A Notice of Workers' Compensation Coverage must include the:

A) workers' compensation insurance administrator's name.
B) workers' compensation insurance administrator's address.
C) Workers' compensation insurance administrator's phone number.
D) all of the above.

Question 5

Employers that are regulated by OSHA include:

A) manufacturers.
B) church organizations.
C) independent contractors.
D) federal agencies.

Question 6

An employee who is injured on the job, requires treatment, and is able to return to work after retraining is categorized as having an injury:

A) without disability.
B) with temporary disability.
C) with permanent disability.
D) requiring vocational rehabilitation.

Question 7

Examples of compensable injuries include all of the following EXCEPT:

A) falls in the company parking lot.
B) injuries incurred while working on a home improvement project using tools borrowed from work.
C) injuries that occur in a company restroom, break room, or cafeteria.
D) stress injuries caused by work conditions.

Question 8

A worker may NOT receive benefits for a generally covered injury if any of the following are true EXCEPT the:

A) injury occurred while the worker was intoxicated.
B) worker signed an acknowledgement of workplace hazards.
C) worker failed to follow safety procedures.
D) worker is also receiving Social Security disability benefits.

Question 9

The form used to report information about the employee's limitations in performing his or her job duties is the:

A) Work Capability Report.
B) Injury Status Report.
C) Work Status Report.
D) Disability Status Report.

Question 10

The 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 is the:

A) degree of injury.
B) injury rating.
C) disability rating.
D) impairment rating.

Question 11

If an employee feels that his or her work environment is unsafe, he or she may file a complaint with the:

A) American Medical Association.
B) Occupational Safety and Health Administration.
C) Department of Health and Human Services.
D) Consumer Protection Agency.

Question 12

An employee who is injured on the job, requires treatment, is NOT able to return to work, and is NOT expected to be able to perform his or her regular job in the future is categorized as having an injury:

A) without disability.
B) with temporary disability.
C) with permanent disability.
D) requiring vocational rehabilitation.

Question 13

An employee who is injured on the job and requires treatment, but is NOT able to return to work within several days, is categorized as having an injury:

A) without disability.
B) with temporary disability.
C) with permanent disability.
D) requiring vocational rehabilitation.

Question 14

An employee who is injured on the job, requires treatment, and is able to return to work within several days is categorized as having an injury:

A) without disability.
B) with temporary disability.
C) with permanent disability.
D) requiring vocational rehabilitation.

Question 15

A health problem that results from exposure to a workplace health hazard such as chemical fumes is a(n):

A) terminal disease.
B) workplace injury.
C) workers' compensation accident.
D) occupational disease.

Question 16

The category of workers' compensation benefits that will pay for medical expenses only is injury:

A) without disability.
B) with temporary disability.
C) with permanent disability.
D) requiring vocational rehabilitation.

Question 17

The only state that allows private employers to choose whether or not to provide workers' compensation (WC) is:

A) Maryland.
B) New York.
C) Texas.
D) Wisconsin.

Question 18

The programs administered by the Office of Workers' Compensation Programs include all of the following EXCEPT the:

A) Federal Employees' Compensation Act.
B) District of Columbia Workers' Compensation Act.
C) Energy Employees Occupational Illness Compensation Program Act.
D) Occupational Safety and Health for Private Employers Act.

Question 19

Employers can obtain workers' compensation insurance policies through all of the following EXCEPT:

A) federal programs.
B) state workers' compensation funds.
C) private insurance carriers.
D) self-funded plans.

Question 20

OSHA stands for the:

A) Occupational Standards for Health Administration.
B) Optional Safety and Health Act.
C) Occupational Safety and Health Administration.
D) Optional Standards for Health Act.

Question 21

To qualify for SSDI, individuals must be unable to work because of a medical condition that is expected to last at least:

A) 30 days.
B) 60 days.
C) 90 days.
D) 1 year.

Question 22

All of the following are types of income benefits EXCEPT:

A) temporary income benefits.
B) impairment income benefits.
C) surviving dependents' income benefits.
D) lifetime income benefits.

Question 23

An impartial physician who helps to resolve a workers' compensation claim dispute is known as the:

A) treating doctor.
B) designated doctor.
C) physician of record.
D) primary care physician.

Question 24

Temporary income benefits end:

A) no later than 12 months from the date of the injury. After a year.
B) once the worker reaches maximum medical improvement. Medical benefits
C) once the employee is able to return to work. Income benefits
D) within 6 months of the injury or accident. Income and death benefits

Question 25

The permanent physical damage to a worker's body from a work-related injury or illness is known as:

A) disease.
B) disability.
C) handicap.
D) impairment.

Question 26

Ombudsmen can provide all of the following services EXCEPT:

A) legal advice to the injured worker.
B) information to assist the injured worker in making decisions.
C) a presentation of facts and evidence at dispute-resolution proceedings.
D) information about how to appeal a dispute-resolution decision.

Question 27

How long does an injured employee have to choose a provider before the network assigns a treating doctor?

A) 3 days.
B) 7 days.
C) 14 days
D) 30 days.

Question 28

Which state became the first to successfully establish a workers' compensation program in 1911?

A) Texas.
B) Maryland.
C) Wisconsin.
D) Iowa.

Question 29

The earliest point in time that an injured worker's injury or illness has improved as much as it is likely to improve is called the:

A) maximum healing rating.
B) maximum medical improvement.
C) medical improvement status report.
D) medical progress report.

Question 30

An injured worker is entitled to lifetime income benefits for all of the following conditions EXCEPT:

A) loss of one foot at or above the ankle.
B) total and permanent loss of sight in both eyes.
C) a physically traumatic injury to the brain resulting in incurable insanity.
D) third-degree burns covering the majority of either both hands or one hand and the face.

Question 31

The spouse of a worker killed on the job is eligible for death benefits:

A) until the spouse dies.
B) until the spouse remarries.
C) until the spouse's children are 18.
D) until the spouse reaches retirement age.

Question 32

Social Security Disability Insurance (SSDI) is paid for by:

A) workers' payroll deductions matched by employer contributions.
B) income taxes paid by individuals.
C) taxes paid by corporations.
D) individuals who purchase SSDI policies.

Question 33

The four types of workers' compensation benefits are:

A) medical, disability, health, and death.
B) medical, income, disability, and death.
C) medical, income, death, and burial.
D) disability, suffering, death, and burial.

Question 34

Dependent children of a worker killed on the job are eligible to receive death benefits until they:

A) obtain a full-time job. (Select all that apply)
B) reach age 18.
C) reach age 25 if enrolled as a full-time college student.
D) reach age 21.

Question 35

If an individual has both an employer-sponsored disability plan and a government-sponsored plan:

A) the government plan is primary, and the employer plan would supplement the benefits.
B) the employer plan is primary, and the government plan would supplement the benefits.
C) only the employer plan would pay benefits.
D) only the government plan would pay benefits.

Question 36

After the designated doctor has examined the worker, all communication with him or her about the worker's injury or condition must be made through the:

A) injured worker.
B) employer.
C) workers' compensation office handling the claim.
D) treating doctor.

Question 37

The report that affirms that a worker has been released from medical treatment and is fit to return to work and resume normal job responsibilities is the:

A) interim report.
B) status report.
C) final report.
D) rehabilitation report.

Question 38

A benefit paid to wartime veterans with limited income who are no longer able to work is:

A) Veterans Disability Compensation.
B) Veterans Disability Pension Benefits.
C) Social Security Disability.
D) Assistance for Needy Families.

Question 39

Medical benefits for an injured worker begin:

A) immediately and end 1 year after the date of the injury.
B) immediately and have no specific time limit.
C) after a 3-day waiting period and end 1 year after the date of the injury.
D) after a 3-day waiting period and have no specific time limit.

Question 40

An independent review is not available in all the following circumstances EXCEPT:

A) The employer's WC healthcare plan refuses to pay for a service the plan does not cover.
B) The employer's healthcare plan is not subject to the law related to the independent review organization (IRO) process.
C) The plan determines that the treatment was not medically necessary after treatment was received.
D) The employer's plan or its utilization review agent (URA) determines that an ongoing treatment is medically unnecessary.

Question 41

Legislation that provides workers' compensation benefits to civilian employees of the United States government is the:

A) Federal Health and Safety Act (FHSA).
B) Federal Employees' Compensation Act (FECA).
C) Occupational Safety and Health Act (OSHA).
D) Employees Occupational Illness Compensation Program Act (EOICPA).

Question 42

In which form locator would the medical specialist enter the date of injury or occupational illness?

A) locator 1.
B) locator 4.
C) locator 10.
D) locator 14.

Question 43

Workers' compensation fraud can be punishable by:

A) fines.
B) orders for restitution.
C) imprisonment.
D) all of the above.

Question 44

All of the following are medical provider fraud schemes EXCEPT:

A) creative diagnoses.
B) upcoding.
C) unbundling.
D) product switching.

Question 45

If a worker failed to obey safety procedures and was injured on the job, he or she would be eligible for workers' compensation.

Question 46

Medical benefits replace a portion of any wages a worker loses because of a work-related injury or illness.

Question 47

The Federal Employees' Compensation Act is the act that gave the federal government the authority to set and enforce safety and health standards for most U.S. employers.

Question 48

Being injured in a car accident while on a business trip is NOT considered a covered injury under workers' compensation programs.

Question 49

The Black Lung Benefits Reform Act provides benefits to current coal mine employees as well as payments to surviving dependents of deceased workers.

Question 50

If a workers' compensation claim is denied, the injured worker or provider can request a review by:

A) the state workers' compensation insurance fund.
B) the state insurance commissioner.
C) a medical examination review committee.
D) an independent review organization.

Question 51

Ombudsmen can help present facts and evidence at dispute-resolution proceedings but cannot give legal advice in a workers' compensation case.

Question 52

Doctors receiving a fixed fee per patient but not providing a sufficient level of treatment are committing which type of fraud?

A) Underutilization
B) Overutilization
C) Internal fraud
D) Unbundling

Question 53

A worker who works full time at an unreported job while collecting workers' compensation benefits commits:

A) benefit abuse.
B) criminal abuse.
C) benefit fraud.
D) premium fraud.

Question 54

An employer who misrepresents the amount of payroll or classification of employees in order to reduce workers' compensation costs commits:

A) premium abuse.
B) premium fraud.
C) benefit abuse.
D) benefit fraud.

Question 55

Burial benefits are paid to the person who paid the deceased worker's burial expenses.

Question 56

When the workers' compensation policy is NOT a managed care plan, fees for services are based on:

A) capitation rates.
B) charge-based fees.
C) the Medicare Fee Schedule.
D) usual and customary charges.

Question 57

The concept of workers' compensation insurance dates back to the late 1800s as a way to compensate workers who are injured on the job.

Question 58

A Work Status Report must be sent in with the insurance claim each time the injured worker is seen by the treating doctor.

Question 59

The prospective approval of healthcare based solely on medical necessity is called:

A) preapproval.
B) prior approval.
C) preauthorization.
D) precertification.

Question 60

An injured worker may sue his or her employer after receiving workers' compensation benefits.

Question 61

The CMS-1500 and UB-04 universal claim forms are used to file workers' compensation claims for medical and hospital services.

Question 62

An injured worker may get impairment income benefits if the worker has a temporary impairment from a work-related injury or illness.

Question 63

Eligible children can receive death benefits until age 18, or age 25 if they are a full-time college student.

Question 64

The earliest workers' compensation programs were opposed by organized labor because they did not encourage a(n) ________ work environment.

Question 65

________ reimburse a covered individual for lost wages that occur because of a disability that prevents the individual from working.

Question 66

The healthcare plan or the URA must give the injured worker the independent review request form again after denying an appeal.

Question 67

The provider from whom an injured worker receives medical care is referred to as the ________ doctor or ________ of record.

Question 68

An injured worker may get temporary income benefits if the injury or illness causes the worker to lose some or all income.

Question 69

Vocational rehabilitation involves the ________ of an injured employee to enable him or her to return to the workforce.

Question 70

________ are Workers' Compensation Department employees who can help the worker with his or her claim once a proceeding has been scheduled.

Question 71

Medical benefits for a workers' compensation claim begin ________.

Question 72

Medical records for workers' compensation cases are to be kept separate from a patient's regular medical records.

Question 73

A spouse is eligible to receive death benefits for life unless he or she remarries.

Question 74

Each ________ regulates and administers its own workers' compensation program.

Question 75

Match the following
Law that provides benefits to eligible and former employees of the U.S. Department of Energy, its contractors and subcontractors, and/or to certain survivors of such individuals.

A) The Energy Employees Occupational Illness Compensation Program Act
B) internal fraud
C) unbundling
D) underutilization
E) fraud indicator
F) overutilization
G) Occupational Safety and Health Act
H) kickbacks
I) Social Security Disability Insurance
J) upcoding

Question 76

The ________ rating describes the degree of permanent damage done to the worker's body as a whole.

Question 77

Match the following
Law that provides the government with the authority to set and enforce safety and health standards for employers

A) The Energy Employees Occupational Illness Compensation Program Act
B) internal fraud
C) unbundling
D) underutilization
E) fraud indicator
F) overutilization
G) Occupational Safety and Health Act
H) kickbacks
I) Social Security Disability Insurance
J) upcoding

Question 78

In regard to workers' compensation cases, patient health information and claim data are subject to the same confidentiality rules as regular medical records.

Question 79

A workers' compensation claim will be paid by the carrier even if no case number is assigned.

Question 80

If the workers' compensation insurance requires preauthorization for certain services, the preauthorization must be obtained before services are rendered; this does NOT apply if the services were provided in an emergency situation.