38 terms

Ch.16 review questions

Health insurance that provides monthly or weekly income when an individual is unable to work because of a nonindustrial illness or injury is called:
Disability income insurance
Some insurance contracts that pay twice the face amount of the policy if accidental death occurs may have a provision titled:
double indemnity
When an individual who is insured under a disability income insurance policy cannot perform one or more of his or her regular job duties, this is known as:
Residual disability or partial disability
When an individual becomes permanently disabled and cannot pay the insurance premium, a desirable provision in an insurance contract is:
Waiver of premium
Ezra Jackson has disability income insurance under a group policy paid for his employer. Ezra makes no contribution toward the policy premiums. One evening he goes inline skating and suffers a complex fracture of the patella, which necessitates several months off from work. Are his monthly disability benefits taxable?
Yes because he has not made any contribution toward the premium
Two federal programs for individuals younger than 65 years of age who have a severe disability are:
1. SSDI: Social Security Disability Insurance-program
2. SSI: Supplemental Security Income
The Social Security Administration may hire a physician to evaluate an applicant's disability. A physician's role may be one of the following:
1. Physician treating the patient
2. Consultative Examiner (CE)
3. Full-or-part-time medical or psychologic consultant
Jamie Woods, a navy petty officer, suffers an accident aboard the USS Denebola just before his honorable discharge. To receive veteran;s benefits for this injury, the time limit in which a claim must be filed is:
Within 1 year from date of sustaining the injury.
Name the states and the territory that have nonindustrial state disability programs.
1. California- California unemployment insurance code
2. Hawaii-Temporary Disability Insurance Law
3. New Jersey-Temporary Disability Benefits Law
4. New York-Disability Benefits Law
5. Puerto Rico-Disability Benefits Act
6. Rhode Island-Temporary Disability Insurance Act
Temporary Disability insurance claims must be filed within how many days in your state?
49 Days
How long can a person continue to draw state disability insurance benefits?
52 Weeks
1. After a claim begins, when do basic state disability benefits become payable if the patient is confined to his or her home?
2. If the patient is hospitalized?
1. After the 7th day of disability
2. First day of hospital confinement only in Hawaii and Puerto Rico
Nick Tyson has recovered since a previous illness ended and becomes ill again with the same ailment. Is he entitled to state disability benefits?
Yes,if 15 days have elapsed
John S. Thatcher stubbed his toe as he was leaving work. Because the injury was only slightly uncomfortable, he thought no more about it. The next morning he found that his foot was too swollen to fit in his shoe, so he stayed home. When the swelling did not subside after 3 days, john went to the doctor. Radiographs showed a broken toe, which kept John home for 2 weeks. After 1 week he applied for temporary state disability benefits. Will he be paid? why or why not?
Yes, Benefits become payable after 7th day of disability.
Peggy Jonson has an ectopic pregnancy and is unable to work because of complications of this condition. Can she receive state temporary disability benefits?
Four states that allow for maternity benefits in normal pregnancy are:
1. California
2. Hawaii
3. New Jersey
4. Rhode Island
Betty T. Kraft had to stay home from her job because her 10 years old daughter had measles. She applied for temporary state disability benefits. Will she be paid?
No, because Betty herself must be ill or injured to collect, benefits.
Vincent P. Michael was ill with a bad cold for 1 week. Will he receive temporary state disability benefits? Why or why not?
No, He must be ill more than 1 week to collect state disability benefits
Betsy C. Palm works in Hawaii and had an emergency appendectomy. She was hospitalized for 3 days. Will she receive state disability benefits? Why or why not?
No, she will only receive benefits if disabled more than 7 days
Frank E. Thomson is a box boy at a supermaket on Saturdays and Sunday while a full time student at college. He broke his leg while skiing and cannot work at the market, but he is able to attend classes with his leg in a cast. Can he collect state disability benefits for his part time job? Why or why not?
Yes, As long as he can met the quarterly amount that is required to be put into the fund in the state, he is eligible
Jerry L. Slate is out of a job and is receiving unemployment insurance benefits. He is now suffering from severe intestinal flu. The employment office calls him to interview for a job, but he is too ill to go. Can he collect temporary state disability benefits for this illness when he might have been given a job? Why or why not?
Yes, because at the time he gets the flu, he can go on state disability, since he is not able to go for a job interview
While walking the picket line with other employees on strike, Gene J Berry came down with pneumonia and was ill for 2 weeks. Can he collect temporary state disability benefits? Why or why not?
Yes, because he might have become ill rather the strike was on or not
Gene went back to work for 3 weeks and then developed a slight cold and cough, which again was diagnosed as pneumonia. The doctor told him to stay home from work. Would he able to collect temporary disability benefits again? Why or why not?
Yes, because more than 15 days had elapsed between his return work at the recurrence of illness
A month after he retired, Roger Regan had a gallbladder operation. Can he receive temporary state disability benefits? Why or why not?
No, because he is retired and has no state disability insurance
Jane M. Lambert fell in the back yard of her home and fractured her left ankle. She had a nonunion fracture and could not work for 28 weeks. For how long will she collect temporary state disability benefits?
Dr. Kay examines Ben Yates and completes a disability income claim form because of a prolonged illness. On receiving the information, the insurance adjuster notices some conflicting data. Name other documents that may be requested to justify payment of benefits.
1. Employer's records
2. Employee's rage statements and/or tax forms
3.Medical records of attending physician
Trent Walters, a permanently disabled individual, applies for federal disability benefits. To establish eligibility for benefits under this program, data allowed must be ___________ year/years old.
no more than 1
A Veterans Affairs patient is seen on an emergency basis by Dr, Onion. Name the two methods or options for billing this case.
1.Physician may bill Veterans Affair (VA) outpatient clinic
2. Patient may pay physician and get reimbursed by the VA by following the instructions on the VA out patient clinic card.
Another Disability income insurance term for benefits is:
When the purchase of insurance is investigated, the word/words to look for in the insurance contract that mean the premium cannot be increased at renewal time is/are:
Noncancelable clause
Provision that limit the scope if insurance coverage are known as:
A Social Security Administration division that determines and individual's eligibility to be placed under the federal disability program is called:
Disability Determination Services
The time period from the begining of disability to receiving the first payment of benefits is called a/an:
Waiting period
True or False

When a person insured under a disability income insurance policy cannot, for limited period of time, perform all functions of his or her regular job duties, this is known as permanent disability.
True or False

To be eligible to apply for disability benefits under Social Security, an individual must be unable to perform any type of work for a period of not less than 12 months.
True or False

Hospital benefits may be paid for nonoccupational illness or injury under Hawaii and Puerto Rico's temporary disability benefits prepaid health care program.
True or False

If a women has an abnormal condition that arises from her pregnancy (e.g, diabetes or varicose veins) and is unable to work because of the condition, she may not receive state disability benefits.
True or False

When a claim form is submitted for a patient applying for state disability benefits, the most important item required on the claimant's Social Security number.