Deck 9: Medical Utilization Issues in Workers Compensation

Question 1

What are preemployment screenings?

Answer 1

The purpose of this testing is to ensure that the worker can perform the routine tasks associated with the job, as well as determine individuals who are at risk for potential workers' compensation claims.

Question 2

What types of sanctions can be brought against employers or insurance carriers for wrongfully denying benefits?

Answer 2

Some states are allowed to assess a 10% of the total medical costs as a penalty, even for a relatively minor violation.

Question 3

What are generic drugs?

Answer 3

Generic drugs are medical compounds that have the same molecular structure as brand name drugs, but are significantly cheaper.

Question 4

What limitation did the judge place on the utilization review requests?

Question 5

Why did the workers' compensation judge determine that chiropractic treatment in this case was necessary and related to the work injury received by the employee?

Question 6

Why is it important to track medical costs in workers' compensation cases?

Question 7

What are some of the proposals to streamline the workers' compensation process?

Question 8

What did the petitioner argue about the utilization review and how it should be limited?

Question 9

List and explain various proposals to change the workers' compensation system.

Question 10

What determination did the expert witness in this case make about the
114 office visits for chiropractic care?

Question 11

Should employers be forced to institute policies such as mandatory child day care or emotional counseling, instead of allowing individual employers to decide if they should implement such programs?

Question 12

What is the medical utilization issue in this case?

Question 13

What is evidence-based medicine?

Question 14

Does your state's Workers' Compensation Board have medical utilization as part of its claims process?

Question 15

What is medical utilization?

Question 16

Why is it important to update fee schedules?

Question 17

Based on what you have read in this chapter, which of the proposals to change the workers' compensation system make the most sense to you?

Question 18

How could better training of claims handlers help improve the efficiency of the workers' compensation system?

Question 19

Why is fraud such a big concern in workers' compensation cases?

Question 20

Explain the issues surrounding training physicians in disability ratings.

Question 21

Medical utilization has become an important aspect of all workers' compensation cases.

Question 22

Many prospective employees are now routinely asked to provide their height and weight in addition to other medical information.

Question 23

What can be said about the training that physicians receive in assessing disability ratings in workers' compensation cases?

A)Physicians receive extensive training in disability ratings.
B)Physicians receive some training in disability ratings.
C)Physicians receive virtually no training in disability ratings.
D)Physicians are not authorized to give disability ratings.

Question 24

Many employers now use preemployment screening to discover potential physical problems in employees before they are officially hired.

Question 25

All states have increased their fraud detection practices in workers' compensation cases.

Question 26

The review of medical procedures to ensure that they are effective both for medical purposes and for overall cost reduction.

A)Medical utilization
B)Cost-benefit analysis
C)Customer review
D)Peer review

Question 27

Testing and evaluation of an applicant's physical abilities to ensure that he or she can perform the work duties assigned to reduce potential workers' compensation claims.

A)Controversy requirement
B)Preemployment screening
C)Unconstitutional data collection
D)Post-claim review

Question 28

Studies have shown that workers with higher incomes generally receive poorer medical care than workers with lower incomes.

Question 29

Employers have begun to see the advantages of creating better and safer environment for their employees, not only as a way
to reduce claims, but also to improve working conditions.

Question 30

The amount that medical costs have increased in workers' compensation cases between 1997 and 2002.

A)25 percent
B)50 percent
C)100 percent
D)125 percent

Question 31

Each of the following is a proposal to change the workers' compensation except one.Identify the proposal that has not become part of the national discussion on workers' compensation.

A)Establish fee schedules for all medical services
B)Evidence-based medicine
C)Train physicians in disability ratings
D)Remove significant numbers of workers from the system

Question 32

Most doctors are never trained in how to arrive at a disability rating in a workers' compensation case.

Question 33

These are reports that detail an accident that almost occurred, but did not.

A)Almost reports
B)Variance reports
C)Near miss reports
D)All of the above

Question 34

A schedule or code of all possible treatments, therapies, and medical services provided along with a maximum payment authorized for each.

A)Injury fee system
B)Medical cost charge sheet
C)Medical fee schedule
D)None of the above

Question 35

Evidence-based medicine has already made big advances in medical treatment.

Question 36

Most states have resisted calls to create some form of generic drug program.

Question 37

An approach to medical treatment that focuses on proven data collec- tion, peer review, and scientific analysis.

A)Scientific analysis
B)Regressive studies
C)Point of purchase analysis
D)Evidence-based medicine

Question 38

Medical compounds that have the same molecular structure as brand name drugs, but are significantly cheaper

A)Syntax drugs
B)Generic drugs
C)Similar drugs
D)Responding drugs

Question 39

A near miss report is used to describe an accident that almost happened, but did not.

Question 40

What have studies shown about the kind of care received by high-income workers when compared to low-income workers?

A)That high income workers receive better care.
B)That high-income workers receive worse care.
C)That high-income and-low income workers receive the same care.
D)No such studies have been conducted.

Question 41

What is the purpose of a preemployment screening, and how can it reduce workers' compensation claims.

Question 42

A determination by a medical provider of the percentage of an injured worker's temporary or permanent impairment due to a work-related injury or illness:
.

Question 43

The review of medical procedures to ensure that they are effective both for medical purposes and for overall cost reduction: .

Question 44

A term for law offices that take on questionable cases at best and outright fraudulent cases at worst, all with an eye toward moving as many cases toward settlement as possible and thus increasing the fees paid to the law office:
.

Question 45

What is evidence-based medicine?

Question 46

Explain medical utilization initiatives, and how they relate to effective use of current medical treatments and tracking medical costs.

Question 47

A chemical and molecular duplicate of a drug that has an expired patent:
.

Question 48

Explain the various initiatives to investigate fraudulent practices by employers, employees, and medical providers.
Accompany Test Bank for Workers' Compensation Law

Question 49

An approach to medical treatment that focuses on proven data collection, peer review, and scientific analysis: .

Question 50

Explain the initiatives used by employers to reduce the total number of workers' compensation injury claims per year.