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Workers' Compensation Flashcards
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Workers' Compensation Flashcards

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@ColorfulTaylor

Questions and Answers

Workers' compensation got its start in the 1800s in?

Germany

In workers' compensation insurance, the premiums are paid by?

The employer

The federal program that establishes workers' compensation for non-military federal government employees is known by the acronym?

FECA

The federal program that establishes workers' compensation for railroad workers engaged in interstate commerce is known by the acronym?

<p>FELA</p> Signup and view all the answers

An individual responsible for investigating and resolving workers' complaints against the employer or insurance company is called?

<p>Ombudsman</p> Signup and view all the answers

The time limit for filing a workers' compensation claim is established by?

<p>Individual states</p> Signup and view all the answers

An injury or illness that is job-related typically must be reported to the employer within?

<p>Time limits vary from state to state</p> Signup and view all the answers

A patient's inability to perform normal job duties as a result of being absent is called?

<p>Job deconditioning</p> Signup and view all the answers

Periodic updates provided to the employer/insurance after the initial attending physician report are called?

<p>Progress reports and supplemental reports</p> Signup and view all the answers

The type of insurance that replaces earned income when unable to work due to non-job-related injury or illness is called?

<p>Disability Insurance</p> Signup and view all the answers

The maximum amount of benefits that can be received in a specific time period is called?

<p>Benefit cap</p> Signup and view all the answers

The federal act established in 1990 that protects the civil rights of individuals with disabilities is called?

<p>Americans with Disabilities Act (ADA)</p> Signup and view all the answers

The examining body that determines if an applicant qualifies for SSDI is the?

<p>State Disability Determination Unit</p> Signup and view all the answers

The method of determining eligibility for SSI benefits is through a?

<p>Financial means test</p> Signup and view all the answers

The program that provides greater choice in selecting providers and rehabilitation services for disabled individuals is called?

<p>Ticket to Work</p> Signup and view all the answers

All employers must purchase workers' compensation policies from the state in which their business operates.

<p>False</p> Signup and view all the answers

In the United States, any employee injured on the job is likely eligible for workers' compensation benefits.

<p>True</p> Signup and view all the answers

If an employee is injured on the job, the employer can be penalized if the cause was due to their negligence.

<p>True</p> Signup and view all the answers

Most state workers' compensation laws include coverage for injuries sustained during commuting.

<p>False</p> Signup and view all the answers

If a workers' compensation claim is denied, the worker can file a claim with their health insurance after exhausting appeals.

<p>True</p> Signup and view all the answers

The first thing an injured employee must do is call their family physician.

<p>False</p> Signup and view all the answers

Workers' compensation claims must be submitted on the universal CMS-1500 claim form.

<p>False</p> Signup and view all the answers

As long as a workers' compensation claim is pending, the provider cannot bill the patient.

<p>True</p> Signup and view all the answers

Workers' compensation patients are not required to sign a release of information form for a claim to be filed.

<p>True</p> Signup and view all the answers

An individual may receive benefits from multiple federal disability programs even if they meet the eligibility requirements for several.

<p>False</p> Signup and view all the answers

The SSI program provides monthly cash payments to low-income aged, blind, and disabled individuals.

<p>True</p> Signup and view all the answers

The CDC Disability and Health team's focus is promoting safe workplace procedures.

<p>False</p> Signup and view all the answers

The SSDI and SSI programs share various concepts, but there are many important differences in rules affecting eligibility and benefit payments.

<p>True</p> Signup and view all the answers

The HIPAA Privacy Rule does not permit covered entities to disclose PHI to workers' compensation insurers without patient consent.

<p>False</p> Signup and view all the answers

The premium cost of a managed care option cannot be less than a fee-for-service option for workers' compensation insurance.

<p>False</p> Signup and view all the answers

List four work-related incidents in which injury occurs that would be exceptions to the employee drawing workers' compensation benefits.

<p>Horse playing, Drunk/Stumbling, Illegal Drugs, Self-inflicted injuries</p> Signup and view all the answers

List five classifications of businesses that do not provide workers' compensation for their employees.

<p>Employers with minimum number of full-time employees, Executive officers, Individuals who are business partners, Sole proprietors, Casual employees</p> Signup and view all the answers

Workers' compensation insurance is no-fault insurance. Explain what this means.

<p>Benefits to workers who suffer work-related injuries or illnesses</p> Signup and view all the answers

List the four major benefit compensations of workers' compensation.

<p>Medical Expenses, Disability Pay, Vocational Rehabilitation, Death Benefit</p> Signup and view all the answers

List the physician's two distinct roles in workers' compensation claims.

<p>To diagnose and treat work-related injuries and illnesses, to provide claim administrator's opinions.</p> Signup and view all the answers

List and explain the various classifications of workers' compensation disability cases, as mandated by federal law.

<p>Short Term Disability, Long Term Disability</p> Signup and view all the answers

List five pertinent items the attending physician's statement must include when filing a disability claim.

<p>Diagnosis, First day individual was able to work, Work-relatedness, Nature of treatment, Restrictions and limitations.</p> Signup and view all the answers

List the nine federal disability programs.

<p>Social Security Disability Income, Supplemental Security Income, Medicare, Medicaid, Workers' Compensation, Black Lung, Veterans Affairs Disability Compensation, VA Health Services Program, VA Pension Program.</p> Signup and view all the answers

Define 'Disability'.

<p>An individual is unable to perform the occupation or job they were doing before the disability, or any job suited by education and experience.</p> Signup and view all the answers

Name at least four of the commonly used factors federal programs consider in assessing disability.

<p>Federal Employment Compensation Act (FECA), Employment Liability Act (FELA), Marine Act (Jones Act), Shore and Harbor Workers' Compensation Act.</p> Signup and view all the answers

Name the two criteria an individual must meet to become eligible for SSDI.

<p>They must have worked enough Social Security covered work quarters, They must have a severe impairment.</p> Signup and view all the answers

List three ways disabled individuals can receive SSDI.

<p>On their own as disabled workers, As a widow or widower of insured individuals, As a child disabled while their parents receive SSDI.</p> Signup and view all the answers

Discuss the health insurance professional's role in the disability claim process.

<p>Doctors assess injuries uniformly to help patients get the right amount of compensation.</p> Signup and view all the answers

List at least three differences between SSDI and SSI.

<p>SSDI offers programs of monthly benefits, SSDI requires a certain minimum amount of work, SSI involves means testing for back benefits.</p> Signup and view all the answers

Study Notes

Workers' Compensation Overview

  • Workers' compensation originated in Germany during the 1800s.
  • Premiums for workers' compensation insurance are paid solely by employers.
  • The Federal Employees' Compensation Act (FECA) provides compensation for non-military federal staff.
  • The Federal Employers Liability Act (FELA) covers railroad workers engaged in interstate commerce.

Roles and Responsibilities

  • An ombudsman investigates and resolves complaints against employers or insurance companies regarding benefit denials.
  • Workers must report job-related injuries or illnesses to their employer within state-specific time limits.

Definitions of Key Terms

  • Job deconditioning refers to an employee's inability to perform job duties at previous skill levels due to absence from work.
  • Progress reports and supplemental reports must be submitted to employers or insurance providers after initial medical assessments.

Insurance Types and Benefits

  • Disability Insurance replaces a portion of income for individuals who cannot perform job requirements due to non-work-related injuries or illnesses.
  • A benefit cap refers to the maximum benefits available within a specified timeframe.
  • The Americans with Disabilities Act (ADA) was established in 1990 to protect civil rights for individuals with disabilities.
  • The State Disability Determination unit assesses eligibility for Social Security Disability Insurance (SSDI).
  • A financial means test determines eligibility for Supplemental Security Income (SSI).

Programs for Disabled Individuals

  • The Ticket to Work program allows individuals to choose providers and services for rehabilitation to maintain or return to work.
  • Workers' compensation insurance operates as no-fault insurance, providing benefits regardless of fault in work-related injuries or illnesses.

Claim Response and Coverage

  • Most state laws do not cover injuries sustained during commutes to and from work.
  • If a claim is denied, workers may only use health insurance after exhausting all workers' compensation appeal options.
  • Health care providers cannot bill patients while a workers' compensation claim is pending.

Types of Injuries and Exceptions

  • Workers' compensation does not cover injuries from horseplay, drug or alcohol use, self-inflicted injuries, or criminal activity.
  • Certain classifications of businesses, such as those with minimal employees or individual proprietors, may not be required to provide workers’ compensation.

Discrepancies and Definitions in Disability

  • SSDI and SSI differ in eligibility criteria, benefits, and testing processes. Both programs have distinct implications for financial assistance regarding disabilities.
  • Individuals must meet specific work history and disability criteria to qualify for SSDI.
  • Disability is defined as an inability to perform previous job duties or any suitable occupation based on education and experience.

Federal Programs and Benefits

  • Key federal disability programs include SSDI, SSI, Medicare, Medicaid, and others.
  • Medical professionals play a crucial role in assessing injuries and aiding claims, impacting compensation decisions.

Conflicts and Compliance

  • The HIPAA Privacy Rule allows sharing of Protected Health Information (PHI) with workers' compensation insurers without patient consent.
  • Managed care options for workers' compensation insurance may have varying premium costs compared to fee-for-service options.

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Test your knowledge on workers' compensation with these flashcards. From its origins in Germany to the role of employers in premium payments, each card provides key definitions and concepts. Perfect for students and professionals in the field.

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