Insurance Handbook - Ch. 15 Worker's Compensation

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What are the 2 kinds of statues under worker's compensation?

1) Federal Compensation Laws
2) State Compensation Laws

What is the 1st reason worker's compensation laws were developed?

to provide the best available medical care necessary to ensure a prompt return to work of any injured or ill employee (as well as to achieve the maximum recovery).

What is the 2nd reason worker's compensation laws were developed?

to provide income to the injured or ill worker (or to his/her dependents) regardless of fault.

What is the 6st reason worker's compensation laws were developed?

to encourage maximum employer interest in safety and rehabilitation through an appropriate experience-rating mechanism.

Who is eligible/entitled to worker's compensation insurance coverage?

Private business employees, state employees, and federal employees (ex. postal workers, IRS employees, coal miners, and maritime workers).

What is occupational illness or disease?

is any abnormal condition or disorder caused by exposure to environmental factors associated with employment (includes chronic illnesses or diseases).

What can cause occupational illnesses or diseases?

Inhalation, absorption, ingestion, or direct contact.

Are minors covered by worker's compensation?

Yes. In some states, double compensation or added penalties are provided.

What occupations have state exemptions?

Domestic or Casual Employees. (ex. laborers, babysitters, newspaper vendors or distributors, charity workers, and gardeners).

Name 4 types of state compensation benefits

(1) Medical Treatment
(2) Chiropractor
(3) Permanent Disability Indemnity
(4) Death benefits for survivors

What is work hardening?

a type of therapy where an individualized program uses stimulated or real work tasks.

Why use work hardening?

it is used to build up strength and improve the worker's endurance toward a full day's work.

What words must be included in a physician's final report for Permanent Disability claims?

permanent and stationary (P and S)

Define "P and S"

this phrase means that damage from the injury is permanent (the patient has recovered to the fullest extent possible). The physician cannot do anything more. The patient will be hampered by the disability to some extent for the rest of his/her life.

What does OSHA stand for?

Occupational Safety and Health Administration

What is a disposition?

a proceeding in which an attorney asks a witness questions about a case, the witness answers under oath but NOT in open court.

What is a medical service order?

it is the authorization for a physician to treat an injured employee.

How must authorizations be obtained?

over the telephone.

What must the physician do after seeing an injured person?

send either a medical report (detailing injury) with a CMS 1500 claim form or a Doctor's First Report of Occupational Injury or Illness form as soon as possible.

What must be done with a medical report because it is a medical document?

each copy must be signed in ink by the physician.

When should subsequent progress or supplemental reports be sent to the insurance carrier?

after each hospitalization and office visits to update the progress of each case.

In a worker's compensation case, the financial responsibility exists between who?

the physician and insurance company or state program.

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