Chapter 9 - Worker's Comp

Question 0

What type of law is Texas Workers Compensation, monopolistic or competitive?

Answer 0

Competitive

Question 1

What code is the Texas workers compensation established under?

Answer 1

Texas Labor Code - Title 5

Question 2

Is Texas Workers Compensation Compulsory or Elective

Answer 2

Elective

Question 3

What are the 3 defenses that an employer has?

Answer 3

Contributory negligence - employee contributed to the cause of the injury

Assumption of risk - employee was involved in actions that were not part of their job when they were injured and therefore assumed the risk

Fellow servant - injury caused by the negligence of a fellow employee

If an employer does not have workers compensation, they do lot have these defenses

Question 4

What is a legal beneficiary under Texas Workers Compensation?

Answer 4

Spouses and children only

Question 5

What is Maximum Medical Improvement?

Answer 5

The earliest date after which, based on reasonable medical probability, further medical recovery from or lasting improvement to an injury can no longer be reasonably anticipated or the expiration of 104 weeks from the date when income benefits began to accuse, whichever comes first

Question 6

What is occupational disease?

Answer 6

A disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive injury

Question 7

What is a sanction in Texas Workers Compensation ?

Answer 7

A penalty or other punitive action or remedy imposed by the Commission on an insurance carrier, representative, employee, employer, or health care provider for an act or omission in violation of the Workers Compensation Law or a rule or order of the Commission

Question 8

What is a settlement under Texas Workers Compensation?

Answer 8

A final resolution of all the damages in a workers compensation claim

Question 9

What is the subsequent injury fund?

Answer 9

A fund used to compensate an injured employee for lifetime income benefits if a subsequent compensable injury, together with the effects of a previous injury, results in a condition which entitles the injured employee to receive lifetime income benefits.

The fund receives money by collecting the benefits from insurers when a compensable death occurs and there is no legal beneficiary.

Question 10

Who is eligible to purchase Texas Workers Compensation?

Answer 10

An employer who has at least 1 employee

Question 11

Can an employee reject workers compensation ?w

Answer 11

Yes, an employee can reject workers compensation

Question 12

What is exclusive remedy under Texas Workers Compensation ?

Answer 12

A one time settlement except in cases of gross negligence

Question 13

What is the waiting period for Texas Worker’s Compensation?

Answer 13

Employee must be disabled for at least one week.

Compensation begins after 1 week

If disability continues for at least 4 weeks, the compensation is retroactive back to the first day of the injury.

Question 14

What are the statue of limitations for Texas Worker’s Compensation?

Answer 14

The employer must be notified within 30 days after injury

Failure to do so will relive employer of all liability

Employee must file claim within 1 year

Question 15

Medical Care under Texas Workers Compensation

Answer 15

All reasonable and necessary medical expenses are paid without a time limit or dollar amount.
Continues to be paid until the injured employee has either recovered or reached a point where no further recovery is possible.

Question 16

What is Average Weekly Wage under Texas Workers Compensation?

Answer 16

Average weekly wage is determined by averaging the last 12 weeks of pay to determine an employee’s usual salary on which to base benefits.
The average weekly wage is also compared with statewide AWW for same occupation

Question 17

What is temporary income benefits under Texas Workers Compensation?

Answer 17

Benefits paid to disabled employees who have not yet reached maximum medical improvement.
Benefits are payable at least 70% of difference between their AWW before injury to to 100% of the statewide AWW

Question 18

Computation of benefits under Texas Workers Compensation

Answer 18

Loss of income is paid on a varying scale for a maximum of 104 weeks, 2 years

Question 19

Impairment Income Benefits under Texas Workers Compensation

Answer 19

These benefits begin the day after the employee reaches maximum medical improvement

3 weeks of income benefits, based on AWW, for every percentage point of permanent impairment.

Question 20

Supplemental Income Benefits under Texas Workers Compensation

Answer 20

If an employee has an impairment rating of at least 15% permanent disability and is unable to obtain employment earning at least 80% of the previous AWW, this fund will supplement income until it reaches 80%

May also receive vocational rehabilitation

Question 21

What is Lifetime Income Benefits under Texas Workers Compensation

Answer 21

Paid for the loss of 2 of the same body parts

75% of AWW up to 100% of statewide AWW with an automatic 3% annual increase.

Question 22

Death and burial benefits under Texas Workers Compensation

Answer 22

Are paid to legal beneficiaries

Spouse until they die or remarry
Children under 18 or if a full time student until 25

Burial allowance of $6,000

If no beneficiaries benefits are paid to the subsequent injury fund

Question 23

Compensation procedure for Texas Workers Compensation

Answer 23

30 days for the employee to report injury to employer
8 days for employer to report claim to TWCC
7 days for the insurance company to pay or contest claim

Question 24

What are prohibited acts under Texas Workers Compensation

Answer 24

These are automatic denials

The employee creates an occasion to hurt him/herself through activities not a part of their job

The employee’s injury or death is a result of willful intention

Intoxication on the job causing harm to employee unless the employer was aware of the intoxication and allowed the situation to continue.

Question 25

U.S. Longshore and Harbor Workers Compensation Act

Answer 25

Workers in maritime employment who are not masters or crew are ahi next to this law

Dockworker, harbor worker, ship builder

Question 26

Outer Continental Shelf Lands Act

Answer 26

Requires benefits for workers exploring and developing natural resources (oil & gas) on fixed structures permanently attached to submerged land off coast

Question 27

Federal Employers Liability Act

Answer 27

Requires workers compensation for employees of interstate railroads

Question 28

The Jones Act

Answer 28

Applies to the injury or death of masters or the crew of vessels involved in commerce on navigable bodies of water

Question 29

What is the information page on a Texas Workers Compensation policy?

Answer 29

The decelerations page

Question 30

What is Part 1 of Texas Workers Compensation

Answer 30

Workers Compensation Insurance

Standard benefits

No dollar limit for medical expenses

Question 31

What is the extra territorial clause on Texas Workers Compensation

Answer 31

Texas benefits are available to Texas workers injured anywhere in the world if they have significant contacts in Texas or their principle employment is located in Texas.

Question 32

What is Part 2 of Texas Workers Compensation

Answer 32

Employers Liability Insurance

Covers lawsuits

$100,000 per occurrence

Covers:
Third parties suing on the basis of contributory negligence; subrogation
Spouses and children of injured employees may sue employer for loss of care and loss of services
Employees may sue based on dual capacity doctrine, product liability
Spouses and children of an employee killed on the job may sue for exemplary damages based on gross negligence of the employer

Question 33

What are exclusions to employers liability under Texas Workers Compensation

Answer 33

Liability assumed under contract
Intentional injury
Discharge or dissemination of employees

Question 34

What is Part 3 of Texas Workers Compensation

Answer 34

Other States Insurance

You can use other states workers compensation if that state offers better coverage.

Question 35

What is Part 4 under Texas Workers Compensation

Answer 35

Your Duties of Injury Occurs

Must inform insurer within 30 days

Question 36

What is Part 5 of Texas Workers Compensation

Answer 36

Premium

Rates are based on payroll per each $100

Question 37

What is Part 6 of Texas Workers Compensation

Answer 37

Conditions (rules)

Inspect workplace
Annual aggregate
Assignment
Cancellation/non-renewal

Question 38

What is Part 7 of Texas Workers Compensation

Answer 38

Our Duty to You for Claim Notification

The insurer is obligated to notify employer of any claim filed against their policy

Question 39

Texas Workers Compensation Insurance Fund

Answer 39

Must maintain a 3:1 premium to surplus ratio

For high risk insureds that cannot find coverage with private insurers

Question 40

Self-Insured Employers and Employee Groups

Answer 40

Self-insured companies keep their workers compensation defenses because they are still providing protection for their employees

Question 41

Texas Workers Compensation Insurance Fund is capitalized by

Answer 41

Revenue bonds

Question 42

Who protects policyholders of Texas Workers Compensation ?

Answer 42

Texas Certified Self-Insurer Guaranty Association