Handbook Ch-15

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Worker's Compensation

2 kinds of statutes under worker's comp

Federal compensation laws and State compensation laws

Accident

An unexpected, unintended event that occurs at a particular time and place, causing injury to an individual not of his or her own making

Occupational illness (Industrial or worker's comp)

From working in a plastics manufacturing company and inhaling some fumes, the worker gets bronchitis. Because this condition is associated with the employment, it is called a/an

Name the federal worker's compensation acts that cover workers

Workmens compensation law of the District of Columbia, Federal Coal Mine Health and Safety Act, Federal Employee's Compensation Act and Longshoremen's and Harbor Worker's Compensation Act

Compulsory Laws

State compensation laws that requiere each employer to accept its provisions
and provide for specialized benefits for employees who are injured at work

Elective Laws

State compensation laws that may be accepted or rejected by the employer

State 5 methods used for funding worker's compensation

Monopolistic state or provincial fund, Qualification of employers as self insurers, Territorial fund, Competitive state fund, Private insurance companies

Who pays the workers' compensation insurance premiums?

Employers

Time limit in California for submitting a report on an industrial accident

Immediately

Second Injury Fund

Is what is used when an employee with a preexisting condition is injured at work and the injury produces a disability greater than what would have been caused by a second injury alone

Name jobs that may not be covered by worker's comp insurance

Domestic or casual employees, Laborers, Babysitters, Charity workers, Gardeners, Newspaper vendors or distributors

One employee

Is the minimum number of employees per business needed in California for worker's comp statutes to become effective

3 days

Is the waiting period that must elapse in your state before worker's comp payments begin

List 5 types of workers' compensation benefits

Medical treatment, Temporary disability indemnity, Permanent disability indemnity, Death benefits, Rehabilitation benefits

Who can treat an industrial injury?

A Medical Doctor, Osteopath, Dentist or Chiropractor

Mention 3 types of workers' compensation claims and the differences among them

NONDISABILITY A person is injured or ill, gets treatment and goes back to work. TEMPORARY A person is injured or ill, and cannot work and is off work for a period of time. PERMANENT A person is injured or ill, cannot work and the problem results in permanent injury or illness.

Weekly temporary disability payments are based on

A percentage of the employee's earnings at the time of the injury or illness

Work hardening therapy

Treatment program for employees in form of work tasks for building strenght and endurance

State's Industrial Accident Commision or Worker's Compensation Board

When an industrial case reaches the time for rating the disability

Worker's Compensation Appeals Board or Industrial Accident Commision

Places for a person to appeal a rating desition

The Insurance carrier

When a physician suspects fraud or abuse in a worker's comp case should report the situation to

Explain third-party subrogation

A third party is responsible for the injury (person is injured by an outside party)

Medical service order

Form a employer must complete and send to the physician in order for him to treat a pt in a work-related injury or illness

Employer's Report of Occupational Injury or Illness

Form a employer must complete and send to the insurance company and worker's comp state offices in case of a work-related injury or illness

OSHA Act of 1970 (Occupational Safety and Health Administration)

Employers are required to meet health and safety standards for their employees under federal and state statutes

LITIGATION

The process of carrying on a lawsuit

DEPOSITION

A proceeding during which an attorney questions a witness who answers under oath but not in open court

LIEN

The legal promise of a patient to satisfy a debt to the physician from proceeds received from a litigated case

State workers' comp office, Employer and Insurance carrier

Must be notified by the physician treating a employee that had an industrial injury with a First Treatment Medical Report or Occupational Injury or Illness form

TRUE

The first thing an employee should do after he or she is injured on the job is to notify his or her employer or immediate supervisor

FALSE

A roofer takes his girlfriend to a roofing job and she is injured. She is covered under worker's comp insurance

FALSE

A stamped physician's signature is acceptable on the Doctor's First Report of Occupational Injury or Illness form

TRUE

In a worker's comp case, bills should be submitted monthly or at the time of termination of treatment, and a claim becomes delinquent after a time frame of 45 days

TRUE

If an individual seeks medical care for a workers' compensation injury from another state, the state's regulations are followed in which the injured person's claim was originally filed

TRUE

When a pt arrives at a medical office and says he or she was hurt at work, you should verify insurance info with the benefits coordinator for the employer

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