Ch14- Worker's Compensation Flashcards
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
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.).
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
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.
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
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.
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
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.
According to OSHA, who has the highest rate of work-related musculoskeletal disorders?
a. Movers
b. Welders
c. Nurses’ aides
d. Manufacturers
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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
