Deck 12: Workers Compensation and Disabilityautomotive Insurance

Question 1

Which of these accidents is an example of an unexpected result over time?

A) an employee injures his/her back when lifting a heavy box
B) an employee breaks their ankle working in an office
C) an employee is injured off-site due to a fall while walking to the post office on the company's behalf
D) an employee develops a hearing disability after years in a noisy work environment

Answer 1

an employee develops a hearing disability after years in a noisy work environment

Question 2

Which of these accidents is an example of an immediate event?

A) an employee falls while walking on a catwalk
B) an employee develops a lung condition after a long career working in a factory
C) an employee suffers a repetitive stress injury that develops over several years on the job
D) an employee develops carpal tunnel syndrome over the course of years of excessive typing

Answer 2

an employee falls while walking on a catwalk

Question 3

Which of the following individuals would generally be covered by state workers' compensation insurance?

A) a part-time employee of a private food-service company
B) a volunteer at a private banking company
C) a federal employee
D) a real estate agent working on commission

Answer 3

a part-time employee of a private food-service company

Question 4

How many categories of work-related injuries are there?

A) three
B) five
C) six
D) four

Question 5

A patient presents with an injury suffered while working on an offshore fishing ship. By which OWCP program are they likely to be covered?

A) The Federal Employees' Compensation Program
B) The Federal Black Lung Program
C) The Longshore and Harbor Workers' Compensation Program
D) The Energy Employees Occupational Illness Compensation Program

Question 6

What program helps to pay living expenses for people who are blind or have disabilities and those of low-income older people?

A) SSI
B) FICA
C) FERS
D) SSDI

Question 7

When a provider initially examines a workers' compensation patient, what document must be filed with the state?

A) admission of liability
B) first report of injury
C) vocational report
D) final report

Question 8

Which of the following is an example of an injury that is generally covered?

A) an injury resulting from an employee's intoxication by alcohol
B) an injury due to heavy lifting
C) an injury resulting from an employee's failure to use safety equipment
D) an injury that was intentionally self-inflicted

Question 9

Which form should always be used in completing a workers' compensation claim form?

A) CMS-1500
B) none of these are correct; there is no universal rule
C) HIPAA 837
D) the plan's own claim form

Question 10

Which of these categories applies to a worker who is injured on the job, requires treatment, and is unable to return to work without vocational rehabilitation?

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

Question 11

Where is payment made when a federal worker injured on the job is treated by a physician authorized by the OWCP?

A) through a clearinghouse which forwards the payment
B) directly to the provider
C) directly to the patient
D) directly to Medicare

Question 12

Which of the following individuals would generally not be covered by state workers' compensation insurance?

A) a full-time employee of a public trucking company
B) a part-time employee of a private insurance company
C) a sixteen-year-old working for a private investment company
D) a self-employed individual

Question 13

What type of pain will force an employee to avoid any activities that will lead to the pain?

A) minimal pain
B) slight pain
C) moderate pain
D) severe pain

Question 14

Supplemental Security Income provides financial assistance to individuals who

A) provide reimbursement for injuries sustained on the job.
B) automatically qualify for SSDI benefits.
C) have contributed to Social Security.
D) are qualified for welfare programs.

Question 15

What determination indicates that an employer is responsible for an employee's claim under workers' compensation?

A) first report of injury
B) Admission of Liability
C) Notice of Contest
D) progress report

Question 16

What was created to protect workers from health and safety risks on the job?

A) FICA
B) OSHA
C) OWCP
D) FECA

Question 17

What type of pain will markedly limit an employee's performance but is not intolerable?

A) moderate pain
B) severe pain
C) minimal pain
D) slight pain

Question 18

What may a claimant be eligible for if a workers' compensation claim is not paid within the specified time?

A) interest only
B) a late fee only
C) interest on the payment or a late fee
D) a reversed determination

Question 19

After discharging a workers' compensation for a patient to go back to work, the provider must file

A) a first report of illness.
B) an admission of liability.
C) a first report of injury.
D) a final report.

Question 20

Which of the following authorizes payroll deductions for the Social Security Disability Program?

A) SSI
B) SSDI
C) FERS
D) FICA

Question 21

What classification of disability describes an individual who has lost 25 percent of the ability for very heavy lifting?

A) precluding very heavy lifting
B) precluding heavy work
C) limitation to light work
D) precluding heavy lifting

Question 22

For how many days of disability are cash benefits generally not paid?

A) the first ten days
B) the first three days
C) the first day
D) the first seven days

Question 23

What is the most common method states use to determine wage-loss benefits?

A) They compensate employees based on a percentage of their salary before the injury.
B) They compensate employees at the full rate of their normal salary before the injury.
C) They compensate employees at 115 percent of their normal salary before the injury.
D) They compensate employees based on a percentage of their average salary over the last five years.

Question 24

An employee suffers a bad fall in a factory and has to be trained to work in the administrative office for the company as a result of the injury. Which category describes this type of injury?

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

Question 25

Who may file the first report of injury?

A) employee and one additional staff member who witnessed the accident
B) physician or employee
C) employer or physician
D) patient

Question 26

What would most states pay when an individual is fatally injured on the job?

A) funeral expenses only
B) death benefits and funeral expenses
C) funeral expenses and one year of pay
D) death benefits to the employee's survivors only

Question 27

Which term is used to describe the physician who first treats the injured or ill employee?

A) active physician
B) physician on file
C) physician of record
D) first physician

Question 28

An incomplete or inadequate medical report often leads to

A) a change in claim determination.
B) the denial of a disability claim.
C) the termination of the employee.
D) invalid medical records.

Question 29

Subrogation refers to

A) actions a payer takes to recoup paid claim expense in certain circumstances.
B) invalid medical records.
C) the denial of a disability claim.
D) the termination of the employee.

Question 30

What is the process of retraining an employee to return to the workforce called?

A) employee retraining
B) physical therapy
C) medical treatment
D) vocational rehabilitation

Question 31

Which of the following is not a legitimate process for the completion of workers' compensation claims?

A) report code 99080
B) reporting codes 99455-99456
C) reporting 99080 with the correct E/M office visit code
D) reporting 99455 or 99456 together with 99080

Question 32

What is not covered by workers' compensation insurance?

A) occupational illnesses/diseases
B) injuries of self-employed individuals
C) work-related injuries
D) job-related deaths

Question 33

What does an insurance carrier not do after it receives the first report of injury?

A) contacts the employee for medical records
B) determines whether the claim is eligible for workers' compensation
C) assigns a claim number to the case
D) notifies the employer of its determination

Question 34

What is the purpose of an IME?

A) to provide an additional, impartial medical opinion before a final determination is made
B) none of these are correct
C) to provide an additional, impartial medical opinion after the final determination is made
D) to determine if an injury resulting in death was a result of work conditions

Question 35

What classification of disability describes an individual who has lost 50 percent of heavy lifting ability?

A) precluding heavy work
B) precluding heavy lifting
C) precluding very heavy lifting
D) limitation to light work

Question 36

Who requests an IME?

A) the insurance carrier only
B) the employer only
C) the state workers' compensation office
D) the patient only

Question 37

What type of programs provide partial reimbursement for lost income when a disability-whether work-related or not-prevents the individual from working?

A) disability compensation programs
B) rehabilitation compensation programs
C) illness compensation programs
D) injury compensation programs

Question 38

Which of the following is an example of an injury that is generally not covered?

A) an injury resulting from an employee's failure to obey safety procedures
B) an injury that occurs during personal time while on the job
C) an injury that occurs during a fall in the parking lot
D) a work injury that results in a hernia

Question 39

How is workers' compensation insurance funded under a state fund?

A) Companies pay premiums to a central state insurance fund.
B) Employees pay premiums to a federal insurance fund.
C) Companies pay premiums to a federal insurance fund.
D) Employees pay premiums to a central state insurance fund.

Question 40

An employee breaks his arm on the job and requires treatment and a rehabilitation of several weeks before he can return to work. Which category describes this type of injury?

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

Question 41

What determination denies liability for an employee's workers' compensation claim?

A) Admission of Liability
B) first report of injury
C) progress report
D) Notice of Contest

Question 42

A patient presents with a form of cancer developed from radiation exposure during their work in a federal weapons facility. By which OWCP programs are they likely to be covered?

A) The Federal Employees' Compensation Program
B) The Energy Employees Occupational Illness Compensation Program
C) The Longshore and Harbor Workers' Compensation Program
D) The Federal Black Lung Program

Question 43

What type of pain is merely annoying and does not limit an employee's ability to perform their job?

A) minimal pain
B) moderate pain
C) slight pain
D) severe pain

Question 44

What type of pain may limit an employee on some work assignments but is generally tolerable?

A) severe pain
B) slight pain
C) moderate pain
D) minimal pain

Question 45

Who is allowed unrestricted access to workers' compensation files in most states?

A) claim adjusters only
B) the patient and employers
C) employees and employer
D) employers and claim adjusters

Question 46

What type of codes must be included in ICD-10-CM coding to report the cause of an accident?

A) external causes
B) internal causes
C) CPT code
D) A codes

Question 47

What does the physician of record file with the insurance carrier every time there is a substantial change in the patient's condition that affects disability status or when required by state rules and regulations?

A) progress report
B) patient report
C) progress notice
D) official notice

Question 48

At what level are workers' compensation programs administered?

A) county
B) state
C) national
D) region

Question 49

Which of these correctly explains the key components that all states' workers' compensation programs share?

A) They compensate the employee for lost wages while he or she is unable to return to work.
B) They compensate for lost wages and pay for medical expenses.
C) They provide job placement services for employees who lose their jobs due to injury.
D) They pay the employee's medical expenses that result from a work-related injury.

Question 50

The Federal Black Lung Program provides benefits for individuals who work in

A) atomic weapons facilities.
B) the maritime field.
C) coal mines.
D) schools.

Question 51

Among the following, for whom do most states require public and private companies to provide workers' compensation coverage?

A) employees who are minors
B) full-time employees and part time employees only
C) part-time employees only
D) full time, part time, and minors, if more than three people are employed at an organization

Question 52

What can develop due to workplace conditions or activities?

A) occupational diseases and illnesses
B) occupational symptoms only
C) occupational signs and symptoms
D) occupational illnesses only

Question 53

For a company to self-insure for workers' compensation, most states require you to

A) file proof of workers' compensation insurance.
B) contract with private insurance carriers.
C) deduct premiums from employee payroll.
D) obtain authorization.

Question 54

Which of these correctly describes the process of submitting charges and receiving payment through workers' compensation insurance?

A) Providers submit their charges to the workers' compensation insurance carrier and the patients are paid directly by the carrier.
B) Patients submit charges to the workers' compensation insurance carrier and the providers are paid directly by the carrier.
C) Providers submit their charges to the workers' compensation insurance carrier and are paid directly by the carrier.
D) Patients submit their charges to the workers' compensation insurance carrier and are paid directly by the carrier.

Question 55

Identify a source from which employers cannot obtain workers' compensation insurance.

A) a private plan
B) directly from Medicare
C) directly with a self-insured fund
D) a state workers' compensation fund

Question 56

Which one of these is not a government disability program?

A) SSDI
B) FERS
C) SSI
D) PIP

Question 57

Injuries are generally covered under workers' compensation except for?

A) if an injury arises out of employment and it occurs during the course of employment
B) if an injury occurs by accident
C) if an injury was an intentional injury
D) if an injury results in personal injury or death

Question 58

When do temporary partial and temporary total disability benefits not cease?

A) the employee cooperates with request for medical examination
B) the employee has died
C) the employee cannot work due to circumstances other than the work-related injury
D) the employee has returned to work

Question 59

What classification of disability describes an individual who has lost 50 percent or more of the ability to lift, push, pull, bend, stoop, and climb?

A) precluding heavy lifting
B) limitation to light work
C) precluding very heavy lifting
D) precluding heavy work

Question 60

What provides workers' compensation benefits for civilian employees of the federal government?

A) Longshore and Harbor Workers' Compensation Act
B) Energy Employees Occupational Illness Compensation Program
C) Federal Employees' Compensation Act
D) Federal Black Lung Program

Question 61

What type of disabilities are due to lower extremity injuries?

A) limitation to sedentary and semisedentary work
B) limitation to all work
C) limitation to all walking and standing
D) limitation to light work

Question 62

What is the first step in the process of appealing workers' compensation decisions?

A) request a meeting at a workers' compensation appeals board
B) file for a redetermination
C) request a hearing
D) request mediation

Question 63

What type of workers are covered by the programs of the OWCP?

A) those who have been injured serving in the armed forces
B) those who have congenital diseases
C) those who have sustained workplace injuries
D) those who have been killed in the line of duty while serving in the military

Question 64

Various programs that are administered by the __________ cover work-related illnesses or injuries suffered by civilian employees of federal agencies, including occupational diseases they acquire.

A) FICA
B) OWCP
C) IME
D) OSHA

Question 65

What classification of disability describes an individual who may work in an upright or walking position as long as no greater than minimal effort is required?

A) precluding heavy lifting
B) precluding very heavy lifting
C) limitation to light work
D) precluding heavy work

Question 66

When an employee is injured on the job, most states require

A) a certified physician statement.
B) an interview with the employee.
C) the injury to be reported to the employer within one hour of the injury occurring.
D) notification in writing within a certain time period.

Question 67

What conditions would exclude benefits from the Veteran's Pension Program?

A) The disability must be permanent.
B) The veteran is injured while working for a private employer.
C) The disability must be total.
D) The disability must be service-related.

Question 68

Federal workers hired after 1984 are covered by

A) SSI.
B) FERS.
C) FICA.
D) SSDI.

Question 69

Which law may allow individuals the right to request that a physician restrict a disclosure of their PHI for workers' compensation purposes?

A) none of these are correct; individuals do not have this right
B) FICA
C) HIPAA Security Rule
D) HIPAA Privacy Rule

Question 70

Which types of services are offered by the programs administered by the OWCP?

A) cash benefits for lost wages only
B) vocational rehabilitation only
C) vocational rehabilitation, medical treatment, and cash benefits for lost wages
D) medical treatment only

Question 71

An employee sprains her ankle on the job, resulting in a trip to a physician, but is cleared to return to work later that week. Which of the following categories describes this type of injury?

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