IRAT 1 - WC/TOS/CTS Flashcards
Compensation to injured workers dates back to
2500 BC
The origins of WC are placed
At the beginning of the industrial revolution (19th century)
Three principals gradually developed which determined what injuries would be compensable
Contributory negligence
The fellow servant rule
The assumption of risk
Held that employers were NOT held liable if the worker’s injury resulted from the negligence of a fellow worker
The fellow servant rule
Held that the employee knew of the hazards of the job when he signed on thereby agreeing to all the inherent risks
The assumption of risk
Western nations began to adopt a model for workers compensation in the
Late 1800s
In 1910 representatives from teh industrial states met
In chicago to outline a set of guidelines for WC
The 1st WC law was passed in ____ in 1911 and 9 states followed shortly thereafter
Wisconsin
Physician attitudes toward worker injuries changes in the 1930s when
Social security disability insurance was created
Social security disability insurance was created and shortly after the AMA published th
Guides to teh evaluation of permanent disability
WC coverage eventually advanced to a no fault system
A system that allows for an injured worker to be treated and compensated for an niury without negligence being allocated to the employer
in california today there are
More than 300,000 claims per year
Billions of dollars are spent in CA each year in
Benefits
The CA WC law requires that the injured worker prove that the injury
Arose out of and occurred in the course of employment
Injuries WC in CA can be either
Specific
Cumulative
Psychiatric, mental or emotional
Benefits in CA include
Temporary disability Medical treatment Permanent disability Vocational retraining Serious and willful misconduct Death benefits
Temporary disability WC in CA
Paid at 2/3 of the injured workers average wage
Max is 1066.72 per week
Minimum is 160 per week
Phone rings at office WC filed
Dr. Files DFRI
You will then after DFRI have to
Request authorization for treatment
The UR (utilization review) process is to determine the medical necessity and appropriateness of treatment and is not
An approval or guarantee for payment of medical services.
Only the ___ can approve payment off UR
Insurance carrier or claims representative
After review of the request, based on teh medical information submitted, the following specific treatment and/or service for patient is denied
Adverse determination
Requested service meets the established criteria of medical necessity and reasonableness based on the information provided. If additional treatment is required, please forward request for ongoing/concurrent care in writing at least 3 days prior to start/implementation date.
Approval letter
You determine the patient to be at
MMI or P&S
Now determine PD and apportionment
