Ch14- Worker's Compensation

Question 1

Under Workers’ Compensation, when is a worker covered for an injury that occurred on-the-job?
a. Only if the employer was negligent
b. Only if the employee is not to blame
c. They are covered regardless of who is at fault
d. If there is a witness to the injury

Answer 1

c. They are covered regardless of who is at fault

Rationale: Workers’ Compensation is considered a “no fault” insurance program, meaning an injured employee will receive benefits regardless of who was at fault (the employer, the employee, a patient, etc.).

Question 2

Which program covers postal workers for employment related injuries?
a. Energy Employees Occupational Illness Compensation Program
b. Federal Employees’ Compensation Program
c. Longshore and Harbor Workers’ Compensation
d. Federal Black Lung Benefits

Answer 2

b. Federal Employees’ Compensation Program

Rationale: Compensation Act provides workers’ compensation coverage to three million federal and postal workers around the world for employment-related injuries and occupational diseases.

Question 3

Can an employer require an employee to pay a portion of the insurance premiums for the workers’ compensation coverage? Why or why not?
a. Yes, if the employee only works part-time
b. No, if the employee only works part-time
c. Yes, if the employee also pays a portion of the commercial insurance premium
d. No, the employer is required by law to pay the premiums for coverage

Answer 3

d. No, the employer is required by law to pay the premiums for coverage

Rationale: Federal and state laws require employers to maintain workers’ compensation coverage. The employer is required to pay for or provide insurance to cover the lost wages and medical expenses of an employee who is injured on the job. The employer is required to pay the premiums and any deductible for insurance coverage, not the employee.

Question 4

A patient presents to be seen with chronic beryllium disease that he incurred while under government employment. What coverage would apply to him?
a. Part B Energy Employees Occupational Illness Compensation Program
b. Federal Black Lung Benefit
c. Part E Energy Employees Occupational Illness Compensation Program
d. Longshore and Harbor Workers’ Compensation Program

Answer 4

a. Part B Energy Employees Occupational Illness Compensation Program

Rationale: To be eligible for Part B under the Energy Employees Occupational Illness Compensation Program, an employee must have sustained a radiogenic cancer, chronic silicosis, beryllium sensitivity, or chronic beryllium disease while working at a covered Department of Energy facility, atomic weapons employer, or a beryllium vendor during specified time periods.

Question 5

According to OSHA, who has the highest rate of work-related musculoskeletal disorders?
a. Movers
b. Welders
c. Nurses’ aides
d. Manufacturers

Answer 5

c. Nurses’ aides

Rationale: Nurses’ aides, orderlies, and attendants had the highest rate of musculoskeletal disorders of all occupations. The incidence rate of work-related musculoskeletal disorders in healthcare/social assistance was 166.3 per 10,000 workers, compared to 30.5 average for all other workers in 2017.

Question 6

What must be submitted to the workers’ compensation payer after an initial employee injury visit?
a. CMS-1500 claim form, office encounter note, and a letter from the provider documenting the case
b. CMS-1500 claim form and First Report of Injury form
c. First Report of Injury form and office encounter note
d. First Report of Injury form, CMS-1500 claim form, and office encounter note

Answer 6

d. First Report of Injury form, CMS-1500 claim form, and office encounter note

Rationale: The claim will be submitted to the workers’ compensation payer in paper format using a CMS-1500 claim form. A First Report of Injury form and the progress note for the encounter must also be submitted with the paper claim.

Question 7

A 70-year-old patient with complex pneumoconiosis presents after a fall. X-rays are taken and are negative for fracture. The patient gives both a Medicare card and a Federal Black Lung ID card. How should this claim be billed?
a. Federal Black Lung first, then Medicare
b. Medicare first, then Federal Black Lung
c. Medicare only
d. Federal Black Lung only

Answer 7

c. Medicare only

Rationale: Federal Black Lung only pays claims that relate to conditions from the pneumoconiosis. This patient fell and had X-rays that are not related to his lung condition. Therefore, Medicare would be the only payer billed for this visit.

Question 8

What type of state workers’ compensation coverage allows an employer to set aside money to cover medical expenses and other related benefits for its employees?
a. State insurance fund
b. Self-insurance plans
c. Commercial workers’ compensation insurance
d. Combination program

Answer 8

b. Self-insurance plans

Rationale: Self-insurance plans require the employer to set aside a state-mandated percentage of capital funds to cover medical expenses, wage compensation, and other benefits payable to employees who have an on-the-job injury and/or illness.

Question 9

What kind of workers are covered under the Longshore and Harbor Workers’ Compensation Program?
i.Shipbuilders
ii. Seamen
iii. Government worker
iv. Longshore worker
a. i, ii, iii, and iv
b. ii and iii
c. i and iv
d. i, ii, and iv

Answer 9

c. i and iv

Rationale: The LHWCA covers workers in traditional maritime occupations, such as longshore workers, shipbuilders, ship-repairers, and harbor construction workers. The LHWCA specifically excludes seamen, employees of the U.S. government or of any state or foreign government, employees whose injuries were caused solely by their intoxication, and employees whose injuries were due to their own willful intention to harm themselves or others.

Question 10

Healthcare workers must be provided specific training including the use of Standard Precautions if they might come into contact with
a. Lifting and repetitive tasks
b. Workplace violence
c. Infectious materials
d. None of the above

Answer 10

c. Infectious materials

Rationale: Specific training in the handling of infectious materials and exposure to human blood must be provided to healthcare workers who might come into contact with these to avoid contamination.

Question 11

Which of the following may be benefits included as part of workers’ compensation?
a. Wage-loss benefits
b. Medical rehabilitation
c. Career rehabilitation
d. All of the above

Answer 11

d. All of the above

Rationale: Benefits may include cash or wage-loss benefits, medical and career rehabilitation benefits, and in the case of accidental death of an employee, benefits to dependents.

Question 12

Which statement is TRUE regarding Workers’ Compensation?
a. The carrier must find fault with the employer for Workers’ Compensation to apply
b. In exchange for Worker’s Compensation benefits, employees lose the seniority they have acquired at their job
c. In exchange for Workers’ Compensation benefits, the employee cannot bring civil action against the employer for pain and suffering
d. Independent contractors are covered under Workers’ Compensation

Answer 12

c. In exchange for Workers’ Compensation benefits, the employee cannot bring civil action against the employer for pain and suffering

Rationale: Workers’ compensation is considered a “no fault” insurance program, meaning an injured employee will receive benefits regardless of who was at fault. In exchange for these benefits, the worker cannot bring a civil action against the employer for pain and suffering or other damages, except in cases of intentional acts.

Question 13

What is essential to ensure the non-work related issues are not sent to workers’ compensation?
a. Maintain separate charts
b. Have a provider that only sees workers’ compensation patients
c. Have release of information form signed
d. None of the above

Answer 13

a. Maintain separate charts

Rationale: Providers who treat their patients for a workers’ compensation injury should have a separate chart created for the injury in order for the treatment of non-work related issues to not be sent to the workers’ compensation insurance and the State Compensation Boards/Commissions.

Question 14

OSHA has developed what standards to protect against transmission of infectious agents?
a. Bloodborne Pathogens standards, Personal Protective Equipment standards, Respiratory Protection standards, TB compliance directive
b. TB compliance directive, Specimen Testing standards, Medical Record standards
c. Bloodborne Pathogens standards, Specimen Testing standards, CLIA standards
d. Respiratory Protection standards, Personal Protective Equipment standards, Coding standards

Answer 14

a. Bloodborne Pathogens standards, Personal Protective Equipment standards, Respiratory Protection standards, TB compliance directive

Rationale: OSHA has developed standards and directives to protect workers against transmission of infectious agents. These include: OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) which provides protection of workers from exposure to blood and body fluids that may contain bloodborne infectious agents; OSHA’s Personal Protective Equipment standard (29 CFR 1910.132); Respiratory Protection standard (29 CFR 1910.134) which provides protection for workers when exposed to contact, droplet and airborne transmissible infectious agents; and OSHA’s TB compliance directive which protects workers against exposure to TB through enforcement of existing applicable OSHA standards and the General Duty Clause of the OSH Act.

Question 15

What information is needed to file a Worker’s Compensation claim?
I. Patient name, address, and phone number
II. Patient Social Security number
III. Employer’s name, address, and phone number
IV. Patient’s employment position
V. Injury details
VI. Workers’ Compensation carrier address and phone number
VII. Workers’ Compensation claim number
VIII. Patient’s insurance carrier and subscriber ID
a. I, II, III, V, VI, VII
b. I, III, V, VI
c. I, III, IV, V, VI, VII
d. I, II, III, V

Answer 15

a. I, II, III, V, VI, VII

Rationale: The information needed to submit a claim for Workers Compensation includes:
· Patient name, social security number, address, and phone number
· Employer’s name, address and phone number
· Worker’s compensation carrier address, phone number, and claim number
· Injury information such as date of injury, place of injury, and detailed explanation of how the injury occurred

Question 16

Which entity(ies) require employers to maintain workers’ compensation coverage?
a. Federal
b. State
c. Federal and State
d. None of the above

Answer 16

c. Federal and State

Rationale: Federal and state laws require employers to maintain workers’ compensation coverage. The employer is required pay for or provide (pay for premiums) insurance to cover lost wages and medical expenses of an employee who is injured on the job.

Question 17

For OSHA, which employees are included as healthcare workers?
I. Medical staff
II. Maintenance staff
III. Housekeeping
IV. Food service staff
V. Administrative staff
a. I only
b. I, III, and V
c. I-V
d. I and V

Answer 17

c. I-V

Rationale: Healthcare workers include medical staff, maintenance, housekeeping, food service, laundry, and administrative staff. Healthcare workers face a number of serious safety and health hazards.

Question 18

Which form is used to submit claims to workers’ compensation insurance?
a. Remittance advice
b. Encounter form
c. CMS-1500
d. Healthcare claim form

Answer 18

c. CMS-1500

Rationale: The claim will be submitted on paper to the workers’ compensation payer on a CMS-1500 form. Along with the claim form a copy of the progress note for the encounter will also need to be submitted.

Question 19

Which of the following allows employers in some states to choose coverage options (state, commercial, or self) to comply with the workers’ compensation coverage requirements?
a. Combination Programs
b. There is no type of coverage that allows this.
c. State Insurance Fund
d. Federal Employees’ Compensation Program

Answer 19

a. Combination Programs

Rationale: In some states, employers are allowed to choose a combination of coverage options (state, commercial or self) to comply with workers’ compensation coverage requirements.

Question 20

The Occupational Safety and Health Act (OSHA) was created to assure safe and healthy work conditions by setting and enforcing standard and provide
a. Training
b. Outreach
c. Education
d. All of the above

Answer 20

d. All of the above

Rationale: This act was created to assure safe and healthy work conditions for workers and employees by setting and enforcing standards and by providing training, outreach, and education assistance.

Question 21

Which scenario would apply for a Workers’ Compensation case?
a. An employee is injured in an auto accident on the way to work.
b. A file clerk is hit by a filing cabinet at work when it fell over.
c. An employee develops food poisoning from the lunch he brought from home.
d. An independent contractor is injured when he falls off a ladder in the office building.

Answer 21

b. A file clerk is hit by a filing cabinet at work when it fell over.

Rationale: In order to qualify for workers’ compensation, an employee must be injured while working within the scope of their job description, injured while performing services required by the employer, or contract an illness that can be directly connected to employment. Independent contractors are not covered under workers’ compensation.

Question 22

__________ sets standards and directives to protect workers against transmission of infectious agents.
a. NCHS
b. JCAHO
c. OSHA
d. HIPAA

Answer 22

c. OSHA

Rationale: OSHA sets standards and directives that are directly applicable to protecting workers against transmission of infectious agents.

Question 23

What does no-fault insurance mean?
a. The insurance will pay regardless of who was at fault.
b. Both insurances pay evenly when no one is found to be a fault.
c. The insurance will pay only if no one was found to be at fault.
d. No payments or benefits are paid.

Answer 23

a. The insurance will pay regardless of who was at fault.

Rationale: Workers’ compensation is considered a no-fault insurance program, meaning an injured employee will receive benefits regardless of who was at fault (the employer, the employee, a patient, etc.). In exchange for these benefits, the worker cannot bring a civil action against the employer for pain and suffering or other damages, except in cases of intentional acts.

Question 24

Which program provides lump-sum compensation and health benefits for eligible Department of Energy nuclear weapons workers injured on the job?
a. Longshore and Harbor Workers’ Compensation Program
b. Federal Employees’ Compensation Program
c. Energy Employees Occupational Illness Compensation Program
d. Federal Black Lung Program

Answer 24

c. Energy Employees Occupational Illness Compensation Program

Rationale: The Energy Employees Occupational Illness Compensation Program provides lump-sum compensation and health benefits for eligible Department of Energy nuclear weapons workers injured on the job.

Question 25

OSHA is an agency of _______________?
a. Department of Health and Human Services
b. Department of Labor
c. Department of Veterans Affairs
d. Department of Inspector General

Answer 25

b. Department of Labor

Rationale: With the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA), an agency of the U.S. Department of Labor.

Question 26

Which federal program provides coverage to three million federal and postal workers around the world for employment-related injuries and occupational diseases?
a. Federal Black Lung Program
b. Energy Employees Occupational Illness Compensation Program
c. Federal Employees’ Compensation Program
d. Longshore and Harbor Workers’ Compensation Program

Answer 26

c. Federal Employees’ Compensation Program

Rationale: Federal Employees’ Compensation Program provides workers’ compensation coverage to three million federal and postal workers around the world for employment-related injuries and occupational diseases.

Question 27

Why must a provider keep a separate chart for documentation of the work-related injury for workers’ compensation cases?
a. To prevent documentation of the patient’s non work-related issues from being disclosed to the workers’ compensation insurance
b. To protect the patient’s commercial insurance from knowing what injuries were sustained in a work-related incident
c. To prevent duplicate payment for similar services
d. To protect the patient’s privacy

Answer 27

a. To prevent documentation of the patient’s non work-related issues from being disclosed to the workers’ compensation insurance

Rationale: Providers who treat patients for workers’ compensation injuries or illnesses must create a separate chart for documentation of the work-related injury and treatment. This prevents any documentation of the patient’s non work-related issues from being disclosed to the workers’ compensation insurance and the State Compensation Boards/Commissions.

Question 28

Workers’ compensation is a(n) ______________ insurance program.
a. No fault
b. Catastrophic
c. Personal injury
d. At fault

Answer 28

a. No fault

Rationale: Workers’ compensation is a “no fault” insurance program that provides benefits to employees who suffer job-related injuries or illnesses.

Question 29

According to OSHA, which industries have the more work related injuries and illness than any other sector?
a. Healthcare and pipeline transportation
b. Healthcare and railroads
c. Healthcare and social assistance
d. Shipyards and railroads

Answer 29

c. Healthcare and social assistance

Rationale: According to OSHA, the healthcare and social assistance industry have more work-related injuries and illnesses than any other sector.

Question 30

What type of plan covers private and public employers and acts as an agent in state workers’ compensation cases involving state employees?
a. Combination Programs
b. State Insurance Fund
c. Self-Insurance Plans
d. Commercial Workers’ Compensation Insurance

Answer 30

b. State Insurance Fund

Rationale: State Insurance Fund is an agency that provides workers’ compensation insurance coverage to private and public employers and acts as an agent in state workers’ compensation cases involving state employees.

Question 31

For an employer to have a self-funded plan, the employer must:
a. set aside a state mandated percentage of capital funds.
b. payout at least one Workers’ Compensation claim per year.
c. require employees to sign a waiver so they cannot be sued for additional damages.
d. set aside a federally mandated percentage of capital funds.

Answer 31

a. set aside a state mandated percentage of capital funds.

Rationale: Employers with adequate capital to qualify can self-insure. Self-insurance plans require the employer to set aside a state-mandated percentage of capital funds to cover medical expenses, wage compensation, and other benefits payable to employees who have an on-the-job injury and/or illness.

Question 32

Who is NOT entitled to Workers’ Compensation Benefits?
a. Part-time employee
b. Full-time employee
c. The President of a company
d. Independent contractor with the company

Answer 32

d. Independent contractor with the company

Rationale: Independent contractors are not entitled to workers’ compensation benefits. In some states domestic workers and agricultural workers are excluded or only partially covered.

Question 33

An employer hires an independent contractor to run errands such as bank deposits, mail pick-up, etc. The independent contractor is in an auto accident while running to the bank for the employer in his personal car. Is this covered under Workers’ Compensation? Why?
a. No; independent contractors are not covered by workers’ compensation.
b. No; because he was driving his personal car, it is not covered by Workers’ Compensation.
c. Yes; because the employee was working at the time, it is covered.
d. Yes; any injury while driving on company time is covered.

Answer 33

a. No; independent contractors are not covered by workers’ compensation.

Rationale: Independent contractors are not entitled to workers’ compensation benefits. In some states domestic workers and agricultural workers are excluded or only partially covered.