31 terms

Insurance Handbook

Chapter 15 Workers Compensation 1-34
Name two kinds of statues under workers' compensation
a. Ferderal compensation laws
b. State compensation laws
An unexpected, unintended event that occurs at a particular time and place, causeing injury to an individual not of his or her own making, is called a/an
Maria Cardoza works in a plastics manufacturing company and inhales some fumes that cause bronchitis. Because this condition is associate withher employment, it is called a/an
industrial or workers compensation illness
Name the ferderal workers' compensation acts that cover workers.
a.Workmens Compensation Law of the District Columbia
b. Ferderal Coal Mine Health and Safty Act
c Ferderal Employee Compesation Act
d. Longshoremens and Harbor Workers Compensation act
State compensation laws that require each employer to accept its provisions and provide for speacialized benefite for employees who are injured at work are called
Compulsory Laws
Satate compensation laws that may be accepted or rejeceted by the employer are known as
elective laws
State fivemethods used for funding workers' compensation
a. monopolistic state or provinical fund
b. qualifcation of employers as self-insurers
c.territoral fund
d. competitive state fund
e. private insurance companies
Who pays the workers' compensation insurance premiums
When an employee withpreexsting condtion is injured at work and the injury produces a disabilty greater that would have been caused by the secound injury alone the benefits are derived form a/an
subsequent or second injury fund
Name jobs that may be covered by workers' compensation insurance
a. domestic or casuel employees
b. laborers
c. babysitter
d. charity workers
e. gardners
f. newspaper venders or distributors
List five types of workers' compensation benefits
a. medical treament
b. temoray disability inenmity
c. permament disabilty indenmity
d. Death benefits
e. rehabilitation benefits
Who can treat an industrial injury
Medical doctors, osteopath, dentist, or chiroprator
What are three types of workers' compensation claims and the differences among them?
a. Nondisabilty claim: Person is injured or ill, is treated, and goes back to work. No disabilty form his or her job.
b. Temporary disabilty claim: Person is injured or ill and cannot work at his/her job is off work for periodof time.
c. Permanet disability claim: Person is injured or ill and cannot work, and the problem results in permament injury or illness
Weekly temporary disability payments are based on
A perecntage of the employee earrings at the time of the injury or illness.
After suffering an industrial injury, mr. Field is in a treatment program in which he is givien real work tasks for building strength and endurance. This form of therapy is called
work hardening
When an industral case reaches the time for rating the disability , this accomplished by what state agency
The state indusrial accident commission or workers compensation board.
May an injured person appel his or her case if he or she is not satisfied with rating YES If so to whom does he or she appeal
Workers compensation Appeals board or Industrial accident commission
When fraud or abuse is susspected in a workers' compensation case the physician should report the situation to
The insurance carrier
Explain third-party subroggation
Responsible for the injury (person is injured by an outside party)
When an individual suffers a work-related injury or illness, the employer must complete and send a form called
Employer Report of Occupational Injury or Illness
Employers are required to meet health and sftey satnders for their employees under federal and state statutes known as
a. Occupational Safety and Health Administration (OSHA) Act of 1970
The process of carrying on lawsuit is called
b. Litigation
A proceeding during which an attorney question a witness who answerunder oath but not in open court is called a/an
d. deposition
The legal promise of a patient to satisty a debt the the physician form proceeds received form a litigated case is termed a/an
c. lien
When a physician treats an industrail he or she must complete a first Treatment Medical Report or Doctor's First Report of Occupational Inury or Illness and send it to the following
d. All of the above
The first thing an employee should do after he or she is injured on the job is notfify his or her emplyer or immendiate supervior.
A roofer takes his girlfriend to a roofing job and she is injured. She is cover by workers' compesation
A stamped physicians signutre is acceptable on the Doctor's First report of occcupational injury or illness form
In a workers' compensation case bills should be submetted monthly or at time of termination of treatment ans a claim becomes delinquent after a time fram od 45days
If an individual seeks medical care for a workers' compenseation injury form another state the states regulation are followed in which the injured person's claim was originally filed.
When a patient arrives at a medical office and says he or she was hurt at work you should verify insurance information with the beneifte with benefitecoordinator for the emloyer.