Deck 18: Workers Compensation

Question 1

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.

Answer 1

impairment rating.

Question 2

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 2

spouse and dependent children.

Question 3

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.

Answer 3

without disability.

Question 4

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 5

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

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

Question 6

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 7

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 8

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 9

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 10

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 11

Employers that are regulated by OSHA include:

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

Question 12

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 13

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.

Question 14

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 15

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.

Question 16

All states provide workers' compensation coverage for:

A)medical expenses only.
B)lost wages only.
C)medical expenses and lost wages.
D)death benefits only.

Question 17

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 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

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 20

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 21

In the event that a worker and insurance company decide to engage a different designated doctor than the one named by the state WC Department, they must agree to select the new doctor within:

A)5 business days of the date of the state's notice.
B)1 week of the date of the state's notice.
C)10 days of the date of the state's notice.
D)30 days of the date of the state's notice.

Question 22

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 23

All of the following are types of income benefits EXCEPT:

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

Question 24

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 25

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 26

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 27

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 28

Maximum medical improvement is the earliest point in time that a worker's injury or illness has improved as much as it is likely to improve or:

A)52 weeks from the date the worker became eligible to receive income benefits.
B)60 weeks from the date the worker became eligible to receive income benefits.
C)90 weeks from the date the worker became eligible to receive income benefits.
D)104 weeks from the date the worker became eligible to receive income benefits.

Question 29

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

A)obtain a full-time job.
B)reach age 18.
C)reach age 18, or 25 if enrolled as a full-time college student.
D)reach age 21.

Question 30

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 31

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 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

To be eligible to receive temporary income benefits, an injured worker must have lost some or all income for more than:

A)3 days.
B)7 days.
C)2 weeks.
D)30 days.

Question 34

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

A)for life regardless of whether or not the spouse remarries.
B)until the spouse remarries.
C)until the spouse remarries plus a lump sum payment of 1 year.
D)until the spouse remarries plus a lump sum payment of 2 years.

Question 35

An individual who becomes disabled due to a non-work-related injury may be eligible for which type of benefits paid by a private plan or government program?

A)Medical and income benefits
B)Medical benefits
C)Income benefits
D)Income and death benefits

Question 36

If an injured worker has an impairment rating of 8%, the worker would receive impairment income benefits for:

A)8 weeks.
B)16 weeks.
C)24 weeks.
D)52 weeks.

Question 37

Supplemental income benefits are paid for a maximum of:

A)52 weeks.
B)104 weeks.
C)208 weeks.
D)401 weeks.

Question 38

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 39

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 40

The injured worker or the insurance company must dispute an impairment rating or maximum medical improvement date within:

A)30 days from the date of notice.
B)45 days from the date of notice.
C)90 days from the date of notice.
D)120 days from the date of notice.

Question 41

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 42

A provider in a managed care network who does NOT provide a sufficient level of treatment to patients because of a capitation agreement is committing which type of fraud?

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

Question 43

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

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

Question 44

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

Question 45

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

Question 46

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

Question 47

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

Question 48

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

Question 49

Workers' compensation claims must be submitted to the insurance carrier within:

A)30 days of the date of service.
B)45 days of the date of service.
C)95 days of the date of service.
D)120 days of the date of service.

Question 50

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 51

The 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 52

If a workers' compensation claim is denied, the 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 53

To qualify for Social Security Disability Insurance (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 54

A workers' compensation insurance carrier must pay, reduce, deny, or determine to audit a claim no later than the:

A)30th day after receipt of the claim.
B)45th day after receipt of the claim.
C)95th day after receipt of the claim.
D)120th day after receipt of the claim.

Question 55

An injured worker who disagrees with the maximum medical improvement date or the impairment rating assigned by a physician must dispute the rating within 90 days.

Question 56

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

Question 57

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 58

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 59

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

Question 60

Workers' compensation fraud can be punishable by:

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

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

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

Question 63

The workers' compensation insurance carrier must pay for services if an independent review organization decides that the care was medically necessary.

Question 64

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

Question 65

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

Question 66

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

Question 67

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

Question 68

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

Question 69

Medical benefits for a workers' compensation claim begin __________ .

Question 70

Temporary income benefits are paid if the injury or illness causes the worker to lose income for more than 7 days.

Question 71

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

Question 72

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

Question 73

What is occupational disease?

Question 74

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.

Question 75

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

Question 76

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

Question 77

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

Question 78

Up to $6,000 of a deceased worker's funeral expenses can be paid as __________ benefits.

Question 79

Eligibility to receive supplemental income benefits ends 365 days from the date of injury.

Question 80

Match the following:

A) Law that provides the government with the authority to set and enforce safety and health standards for employers
B) Law that provides workers' compensation benefits to employees of the United States government
C) Government program that provides income benefits to people who cannot work because of a medical condition lasting 1 year or more
D) Billing by a provider for a more expensive service than the one performed
E) Illegal incentives paid for patient referrals
F) A sign that suggests that some type of illegal behavior may be occurring; triggers a closer review of a claim or situation
G) Physician orders unnecessary treatments or tests to enable billing for higher fees
H) Providers collude with the insurance company to defraud the employer
I) Physician does NOT provide a sufficient level of treatment because of a fixed capitation payment arrangement
J) Physician performs a single service but bills it as a series of separate procedures


Occupational Safety and Health Act
Federal Employees' Compensation Act
Social Security Disability Insurance
upcoding
kickbacks
fraud indicator
overutilization
internal fraud
underutilization
unbundling