Podcast
Questions and Answers
Workers' compensation got its start in the 1800s in?
Workers' compensation got its start in the 1800s in?
Germany
In workers' compensation insurance, the premiums are paid by?
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?
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?
The federal program that establishes workers' compensation for railroad workers engaged in interstate commerce is known by the acronym?
An individual responsible for investigating and resolving workers' complaints against the employer or insurance company is called?
An individual responsible for investigating and resolving workers' complaints against the employer or insurance company is called?
The time limit for filing a workers' compensation claim is established by?
The time limit for filing a workers' compensation claim is established by?
An injury or illness that is job-related typically must be reported to the employer within?
An injury or illness that is job-related typically must be reported to the employer within?
A patient's inability to perform normal job duties as a result of being absent is called?
A patient's inability to perform normal job duties as a result of being absent is called?
Periodic updates provided to the employer/insurance after the initial attending physician report are called?
Periodic updates provided to the employer/insurance after the initial attending physician report are called?
The type of insurance that replaces earned income when unable to work due to non-job-related injury or illness is called?
The type of insurance that replaces earned income when unable to work due to non-job-related injury or illness is called?
The maximum amount of benefits that can be received in a specific time period is called?
The maximum amount of benefits that can be received in a specific time period is called?
The federal act established in 1990 that protects the civil rights of individuals with disabilities is called?
The federal act established in 1990 that protects the civil rights of individuals with disabilities is called?
The examining body that determines if an applicant qualifies for SSDI is the?
The examining body that determines if an applicant qualifies for SSDI is the?
The method of determining eligibility for SSI benefits is through a?
The method of determining eligibility for SSI benefits is through a?
The program that provides greater choice in selecting providers and rehabilitation services for disabled individuals is called?
The program that provides greater choice in selecting providers and rehabilitation services for disabled individuals is called?
All employers must purchase workers' compensation policies from the state in which their business operates.
All employers must purchase workers' compensation policies from the state in which their business operates.
In the United States, any employee injured on the job is likely eligible for workers' compensation benefits.
In the United States, any employee injured on the job is likely eligible for workers' compensation benefits.
If an employee is injured on the job, the employer can be penalized if the cause was due to their negligence.
If an employee is injured on the job, the employer can be penalized if the cause was due to their negligence.
Most state workers' compensation laws include coverage for injuries sustained during commuting.
Most state workers' compensation laws include coverage for injuries sustained during commuting.
If a workers' compensation claim is denied, the worker can file a claim with their health insurance after exhausting appeals.
If a workers' compensation claim is denied, the worker can file a claim with their health insurance after exhausting appeals.
The first thing an injured employee must do is call their family physician.
The first thing an injured employee must do is call their family physician.
Workers' compensation claims must be submitted on the universal CMS-1500 claim form.
Workers' compensation claims must be submitted on the universal CMS-1500 claim form.
As long as a workers' compensation claim is pending, the provider cannot bill the patient.
As long as a workers' compensation claim is pending, the provider cannot bill the patient.
Workers' compensation patients are not required to sign a release of information form for a claim to be filed.
Workers' compensation patients are not required to sign a release of information form for a claim to be filed.
An individual may receive benefits from multiple federal disability programs even if they meet the eligibility requirements for several.
An individual may receive benefits from multiple federal disability programs even if they meet the eligibility requirements for several.
The SSI program provides monthly cash payments to low-income aged, blind, and disabled individuals.
The SSI program provides monthly cash payments to low-income aged, blind, and disabled individuals.
The CDC Disability and Health team's focus is promoting safe workplace procedures.
The CDC Disability and Health team's focus is promoting safe workplace procedures.
The SSDI and SSI programs share various concepts, but there are many important differences in rules affecting eligibility and benefit payments.
The SSDI and SSI programs share various concepts, but there are many important differences in rules affecting eligibility and benefit payments.
The HIPAA Privacy Rule does not permit covered entities to disclose PHI to workers' compensation insurers without patient consent.
The HIPAA Privacy Rule does not permit covered entities to disclose PHI to workers' compensation insurers without patient consent.
The premium cost of a managed care option cannot be less than a fee-for-service option for workers' compensation insurance.
The premium cost of a managed care option cannot be less than a fee-for-service option for workers' compensation insurance.
List four work-related incidents in which injury occurs that would be exceptions to the employee drawing workers' compensation benefits.
List four work-related incidents in which injury occurs that would be exceptions to the employee drawing workers' compensation benefits.
List five classifications of businesses that do not provide workers' compensation for their employees.
List five classifications of businesses that do not provide workers' compensation for their employees.
Workers' compensation insurance is no-fault insurance. Explain what this means.
Workers' compensation insurance is no-fault insurance. Explain what this means.
List the four major benefit compensations of workers' compensation.
List the four major benefit compensations of workers' compensation.
List the physician's two distinct roles in workers' compensation claims.
List the physician's two distinct roles in workers' compensation claims.
List and explain the various classifications of workers' compensation disability cases, as mandated by federal law.
List and explain the various classifications of workers' compensation disability cases, as mandated by federal law.
List five pertinent items the attending physician's statement must include when filing a disability claim.
List five pertinent items the attending physician's statement must include when filing a disability claim.
List the nine federal disability programs.
List the nine federal disability programs.
Define 'Disability'.
Define 'Disability'.
Name at least four of the commonly used factors federal programs consider in assessing disability.
Name at least four of the commonly used factors federal programs consider in assessing disability.
Name the two criteria an individual must meet to become eligible for SSDI.
Name the two criteria an individual must meet to become eligible for SSDI.
List three ways disabled individuals can receive SSDI.
List three ways disabled individuals can receive SSDI.
Discuss the health insurance professional's role in the disability claim process.
Discuss the health insurance professional's role in the disability claim process.
List at least three differences between SSDI and SSI.
List at least three differences between SSDI and SSI.
Flashcards
Workers' Compensation
Workers' Compensation
System providing benefits to employees for work-related injuries or illnesses.
Who pays for Workers' Comp?
Who pays for Workers' Comp?
Premiums are paid entirely by the employer.
FECA
FECA
Provides workers' compensation to non-military federal employees.
FELA
FELA
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Ombudsman Role
Ombudsman Role
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Reporting Time Limits
Reporting Time Limits
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Job Deconditioning
Job Deconditioning
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Progress/Supplemental Reports
Progress/Supplemental Reports
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Disability Insurance
Disability Insurance
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Benefit Cap
Benefit Cap
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ADA (1990)
ADA (1990)
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State Disability Determination Unit
State Disability Determination Unit
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Financial Means Test
Financial Means Test
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Ticket to Work Program
Ticket to Work Program
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No-Fault Insurance
No-Fault Insurance
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Commute Coverage
Commute Coverage
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Health Insurance Usage
Health Insurance Usage
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Billing Restrictions
Billing Restrictions
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Excluded Injuries
Excluded Injuries
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WC Exceptions
WC Exceptions
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SSDI vs. SSI
SSDI vs. SSI
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SSDI Eligibility
SSDI Eligibility
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Definition of Disability
Definition of Disability
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Federal Disability Programs
Federal Disability Programs
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Medical Professionals' Role
Medical Professionals' Role
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HIPAA Exception
HIPAA Exception
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Managed Care Option
Managed Care Option
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Non-work activities.
Non-work activities.
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Workers Compensation Appeals Process
Workers Compensation Appeals Process
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Return-to-Work Programs
Return-to-Work Programs
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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.
Legal Framework
- 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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Description
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.
