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C32 Bodily Injury > MC Questions > Flashcards

MC Questions Flashcards

1
Q

What is a reservation of rights letter?

A

An insurers’ notification that coverage for a claim may not apply

Feedback: A reservation of rights letter is an insurer’s notification to an insured that coverage for a claim
may not apply. Such notification allows the insurer to investigate or defend a claim to determine whether
coverage applies without waiving its right to later deny coverage based on the information revealed by the
investigation.

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2
Q

Why is obtaining a statement important for the adjuster?

A

Facts need to be verified so that the adjuster knows he or she is dealing with an accurate
chain of events.

Feedback: Statement-taking is important because the adjuster needs to ensure that the events as
reported are accurate.

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3
Q

What are the different categories of bodily injury claims?

A

Soft tissue, catastrophic, and psychological injuries

Feedback: The different types of bodily injury claims an adjuster may deal with include soft tissue,
catastrophic, and psychological injuries.

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4
Q

What is the definition of estoppel?

A

When someone, by his or her action or lack thereof, indicates that a right will not be
exercised

Feedback: Estoppel is a bar created when someone by his action or lack of it indicates that he will not
exercise a right he has. He estops himself from exercising that right later.

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5
Q

What is the definition of subrogation?

A

When a company has paid a loss for which someone other than the policyholder is
responsible and may therefore have the right to recover this loss from the guilty party

Feedback: Subrogation is when a company that has paid a loss for which someone other than the
policyholder is responsible may have the right to recover this loss from the guilty party.

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6
Q

What are other possible sources of information an investigator may wish to explore when investigating
a claim?

A

Questioning the claimant more thoroughly as the case develops

Feedback: An adjuster will always have to obtain permission to review medical files and tests from the
injured parties when investigating a claim. It is through good questioning techniques and thorough
investigations that complete, accurate information is obtained.

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7
Q

What is a forensic expert?

A

A person connected to a court of law who can be hired by an insurer or an insured to appear
in court as a witness

Feedback: A forensic expert is a person connected to a court of law who can be hired by an insurer or an
insured to appear in court as a witness. The expert applies knowledge of legal cases to the principles of a
profession. The expert can help prove or contradict the clause of a claim.

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8
Q

What is the skin?

A

A sensory organ

Feedback: The skin is the largest organ of the human body. Since it covers the body, it responds to
many different stimuli. It is a sensory organ.

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9
Q

What is the cause of neurological deficit?

A

Traumatic nerve damage

Feedback: Nerves can also become damaged in traumatic injury and cause neurological deficit.

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10
Q

Which type of burn is deemed to be superficial?

A

First degree

Feedback: First-degree burns are superficial. The skin becomes reddened and inflamed on the skin
surface. The inflammation usually subsides in a couple of days and the outermost layer of skin peels.

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11
Q

What is the definition of shock?

A

A condition brought on by the collapse of the circulatory system, often caused by severe
injury

Feedback: Shock is a condition brought on by the collapse of the circulatory system, often caused by
severe injury. The symptoms include pallor, sweating, weak pulse, and very low blood pressure.

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12
Q

Which one of the following muscle groups is responsible for movement?

A

Skeletal muscles

Feedback: Skeletal muscles move the bones of the body. They must be stimulated by a nerve to function
and are known as the voluntary muscles. They are sometimes called striated muscles. They have a great
capacity for healing because of the large number of blood vessels that run through them.

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13
Q

What is the definition of a sprain?

A

A sprain involves the partial or complete tearing of the ligament.

Feedback: If stress or force results in the tearing of a ligament it is called a sprain. A sprained ligament is
often referred to as a torn ligament. A sprain involves the partial or complete tearing of the ligament.

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14
Q

What is the definition of a strain?

A

A strain is the overstretching and possible tearing of muscle or tendon fibres.

Feedback: A strain is overstretching or tears to muscle or tendon fibres. Strains can be mild, moderate,
or severe. It is the overstretching and possible tearing of muscle or tendon fibres.

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15
Q

What is fibromyalgia?

A

A condition that is persistent, causing disabling pain in the muscles over a long period of time

Feedback: A diagnosis of fibromyalgia—also called chronic pain syndrome—is used for conditions of
disabling pain that persists three to six months beyond a normal recovery period for a soft tissue injury. It
is a persistent, disabling pain in the muscles over a long period of time.

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16
Q

What is chronic pain syndrome?

A

Pain that persists over a long period of time

Feedback: Chronic pain syndrome is a diagnosis for conditions of disabling pain that go beyond the
normal recovery period. It is pain that persists over a long period of time. It is another term for
fibromyalgia.

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17
Q

What are some of the most common injuries that adjusters deal with?

A

Muscle injuries

Feedback: Muscular injuries are some of the most common injuries dealt with by adjusters. It is important
that adjusters understand the injury described in medical reports and documents as well as the
associated treatments.

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18
Q

How many bones are there in the human skeleton?

A

206

Feedback: There are 206 bones in the human skeleton

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19
Q

How are bones classified?

A

By shape

Feedback: Bones are classified according to shape.

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20
Q

What is the sternum?

A

A bone that is flat and narrow and linked to the clavicles (collarbones) and the true ribs

Feedback: The sternum is a flat and narrow bone linked to the clavicles (collarbones) and the true ribs.

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21
Q

What are the most common injuries to the pelvis?

A

Fractures and dislocations

Feedback: The most likely traumatic injuries to the pelvis are mainly fractures and dislocations.

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22
Q

What is avascular necrosis?

A

The death of bone from the absence or restricted flow of blood

Feedback: Avascular necrosis is the death of bone from the absence or restricted flow of blood.

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23
Q

What is a condyle?

A

Condyles are rounded projections found on the humerus, femur, tibia, and scapula.

Feedback: Condyles are rounded projections found on the humerus, femur, tibia, and scapula.

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24
Q

What is the most common type of joint in the human body?

A

Movable joints

Feedback: Movable joints are the most common types of joints in the human body and are needed to
facilitate basic movement like walking, bending, or gardening.

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25
Q

Where is a ball and socket joint found?

A

Hip and shoulder

Feedback: Types of movable joints include ball and socket joints, which are found in the hip and
shoulder.

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26
Q

What is synovitis?

A

An inflammation of the synovial membrane, which lines the capsule of a joint

Feedback: Synovitis appears as swelling and is characterized by generalized discomfort. It is an
inflammation of the synovial membrane, which lines the capsule of a joint.

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27
Q

How would one describe a comminuted fracture?

A

One that is a complete break into three or more fragments. The smaller fragments are found
between the two main fragments.

Feedback: A comminuted fracture is a complete break into three or more fragments. The smaller
fragments are found between the two main fragments.

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28
Q

Vertebrae are divided into how many groups?

A

5

Feedback: The spinal column is made up of 33 vertebrae, divided into five groups.

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29
Q

What is spinal fusion?

A

The fusing or rigid joining together of two or more vertebrae

Feedback: It is a surgical procedure whereby two or more of the vertebrae are fused together. This may
result in a decrease in bending ability.

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30
Q

What is kyphosis?

A

An exaggerated increase in the thoracic curve

Feedback: The spine may develop abnormal, exaggerated curves from disease, injury, or postural
problems. Kyphosis is the exaggerated increase in the thoracic curve.

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31
Q

What is osteomyelitis?

A

An inflammation of bone caused by a pus-producing organism. It is treated with antibiotics

Feedback: Sometimes pain can be symptomatic of other issues, such as a congenital condition. While
trauma is a common cause of this complaint, often a disease that is already present is the real villain.
Diseases of the spine include tuberculosis, osteomyelitis, rheumatoid arthritis, and cancer.

32
Q

At what age do the primary teeth appear?

A

Six to 24 months

Feedback: The primary or milk teeth appear at 6 to 24 months of age.

33
Q

Which types of tissue make up our teeth?

A

Enamel, dentine, dental pulp, cementum

Feedback: Teeth are composed of four types of tissue: enamel, dentine, dental pulp, and cementum.

34
Q

What is an extradural hemorrhage?

A

Bleeding on the outside of the outer membrane of the brain

Feedback: Extradural hemorrhage may present when there is a linear fracture in the skull. This fracture
may involve blood vessels on the inner surface of the skull, which will cause bleeding outside the brain
covering.

35
Q

What are the two parts of the nervous system?

A

Central and peripheral

Feedback: The nervous system is the electrochemical information pathway of the body. It can be divided
into two main parts: the central nervous system and the peripheral nervous system.

36
Q

What are the three parts of the brain?

A

The forebrain, the midbrain, and the hindbrain

Feedback: The brain is divided into three main parts: the forebrain, the midbrain, and the hindbrain.

37
Q

Why is trauma to the nervous system potentially devastating?

A

The permanence of the injury if central nervous tissue is damaged and because recovery
could take a very long and be limited in terms of regaining functionality if peripheral nerves are damaged.

Feedback: Trauma to the nervous system is one of the most potentially devastating of all injuries. This is
because of its permanence if central nervous tissue is damaged and because it takes a long time to heal
and regain function (whether partial or complete) following damage to a peripheral nerve.

38
Q

Which organ pumps blood through the blood vessels of the circulatory system?

A

The heart

Feedback: The heart is a muscular organ that pumps blood through the blood vessels of the circulatory
system.

39
Q

What carries oxygen and nutrients to various parts of the body?

A

The blood

Feedback: Blood is an important bodily fluid with many complex functions. One of its principal functions is
to carry oxygen and nutrients to the various tissues of the body for cellular respiration and to carry away
the by-products of respiration for elimination by various means.

40
Q

What is the impact of massive blood loss to the body?

A

Shock

Feedback: Blood loss can result in shock.

41
Q

What is the name given to a blood clot that enters the blood stream and forms in the circulatory
system?

A

Thrombosis

Feedback: When a clot of blood forms in the circulatory system, it is called thrombosis.

42
Q

What will help reduce the risk of an embolus occurring?

A

Anticoagulants

Feedback: Administering anticoagulants reduces most of the risk of an embolus occurring. An
anticoagulant is a medication that inhibits the blood’s clotting process.

43
Q

What is the largest glandular organ in the body?

A

The liver

Feedback: The liver is the largest glandular organ and is located in the right upper area of the abdomen
next to the diaphragm.

44
Q

What causes the lung to collapse?

A

Pneumothorax

Feedback: When trauma produces a hole in the thoracic cavity, or a rib fracture penetrates the lungs,
there is no longer a pressure differential to allow air to move in and out of the chest. This condition is
known as a pneumothorax and causes the lung to collapse in the same way an inner tube collapses when
punctured.

45
Q

What is the stomach used for?

A

To digest food

Feedback: The stomach is an extremely resilient organ used to digest food.

46
Q

Which primary organ is used in respiration?

A

The lungs

Feedback: The lungs are the primary organs of respiration. Their function is to extract oxygen from the
atmosphere and transfer it into the bloodstream, and to release carbon dioxide from the bloodstream into
the atmosphere.

47
Q

What do red blood cells do?

A

They carry oxygen to the tissues of the body.

Feedback: One of its principal functions of red blood cells is to carry oxygen and nutrients to the various
tissues of the body for cellular respiration and to carry away the by-products of respiration for elimination.

48
Q

What is the definition of rehabilitation?

A

The process by which an individual is returned to his or her original state after suffering an injury

Feedback: Rehabilitation is the process by which an individual is returned to his or her original state after
suffering an injury. Insurers generally promote the use of rehabilitation to return injured claimants to selfcare, gainful employment, and recreational activities at the levels enjoyed before the accident occurred in
the shortest possible time.

49
Q

What is the key to successfully administering rehabilitative services for an individual?

A

Teamwork

Feedback: It is important that the right specialists are working for the patient to resolve the injury or disability. Teamwork is the key to the successful administration of diverse services.

50
Q

What must the claimant have before rehabilitation can begin?

A

A rehabilitation assessment

Feedback: Before a claimant can enter into a rehabilitation program of any kind, a rehabilitation
assessment must be done.

51
Q

Which medical specialist is a medical professional responsible for rehabilitation of catastrophic spinal
cord injuries?

A

Physiatrist

Feedback: A physiatrist specializes in rehabilitative medicine that involves the medical management of
catastrophic spinal cord injuries. They are knowledgeable about the effects of prolonged inactivity on
muscle tissue.

52
Q

What is work hardening?

A

The process used by vocational experts to help prepare individuals to re-enter the workforce

Feedback: Work hardening refers to the process used by vocational experts to help prepare individuals
to re-enter the workforce. Often exercises to simulate work activities are prepared so that individuals can
practise work skills and increase their stamina gradually. Sometimes a real work environment is used.

53
Q

What is a prosthesis?

A

An artificial substitute for a missing body part.

Feedback: An artificial man-made substitute for a missing body part. Prosthetic devices may serve both a cosmetic and functional purpose. Most prosthetic devices are for arms and legs, however there are other
parts of the body such as the eye can also benefit from a prosthesis.

54
Q

What is ergonomics?

A

The application of scientific principles to improve the fit between people and their jobs to achieve the best possible result in work production

Feedback: Ergonomics refers to the application of scientific principles to improve the fit between people
and their jobs to achieve the best possible result in work production. A chair that can be adjusted for the
employee’s height and back support is a simple example of the operation of ergonomics. The employee can reduce the potential of injury by ensuring that the chair is adjusted appropriately.

55
Q

What is an orthotic?

A

An appliance or apparatus used to support, align, prevent, or correct deformities, or to improve function of movable parts of the body

Feedback: An orthotic is an appliance or apparatus used to support, align, prevent, or correct deformities, or to improve function of movable parts of the body. Orthotic refers to devices that serve to protect, restore, or improve function.

56
Q

What is a rehabilitation case manager?

A

A professional who develops goals and objectives for rehabilitation in concert with claimants

Feedback: A rehabilitation case manager is a professional who develops goals and objectives for
rehabilitation in concert with claimants. They are responsible for coordinating and facilitating effective
delivery of services.

57
Q

What is a functional capacity assessment?

A

A review conducted by a rehabilitation expert based on the collection of comprehensive
medical and non-medical information to determine a claimant’s fitness for work

Feedback: A functional capacity assessment is a review conducted by a rehabilitation expert based on
the collection of comprehensive medical and non-medical information to determine a claimant’s fitness for work. It includes measurements and evaluations of aerobic ability, endurance, strength, range of motion,
lifting, pulling, and pushing.

58
Q

What is PIPEDA?

A

A federal statute that governs the collection and use of personal information

Feedback: PIPEDA is a federal statute that governs the collection and use of personal information. It
states that personal information to be collected must be relevant, and that all information that has been
collected, is being collected, or will be collected must be held in the strictest of confidence.

59
Q

What is the Glasgow Coma Scale?

A

A scoring system used by doctors to describe the level of consciousness of a patient after a traumatic brain injury

Feedback: The Glasgow Coma Scale is a common scoring system used to describe the level of
consciousness of a patient after a traumatic brain injury. It is used to gauge the severity of an acute brain
injury.

60
Q

What is etiology?

A

The study of causation of symptoms in a patient

Feedback: Etiology is the study of causation.

61
Q

What is a plaintiff-oriented doctor?

A

A doctor who exaggerates the symptoms of the patient

Feedback: A plaintiff-oriented doctor is a doctor who emphasizes or dramatizes the injuries, perhaps not
intentionally or consciously, but rather because the sum total of his or her experience leads in this
direction. This type of doctor tends to act as an advocate for a patient.

62
Q

What is a defence-oriented doctor?

A

A doctor who minimizes the effects of an injury

Feedback: A defence-oriented doctor is a doctor who assumes a critical position that tends to minimize
the effects of an injury. A patient’s subjective complaints are less likely to be accepted at face value
unless supported with other evidence.

63
Q

Why are clinical notes important?

A

Because they represent a clear and accurate medical history of the patient

Feedback: These records are a key component in obtaining a clear medical history of the patient.
Generally, the treating physician’s observations include comments on complaints, diagnosis, treatment
recommendations, and prognosis for each visit. These records are essential to a bodily injury adjuster to
understand exactly the claimant’s pre-loss health history.

64
Q

Why is it important for an adjuster to have background information on a claimant when engaging the
services of an IME?

A

To ensure that the adjuster is well acquainted with the case and that any bias he or she has
does not taint the IME’s findings

Feedback: It is important for adjusters to maintain neutrality when engaging the services of an IME.

65
Q

What is another term for a medical review?

A

Independent medical examination

Feedback: Independent medical examinations (IMEs) are essentially medical–legal reports ordered by
adjusters when sufficient medical information is lacking or certain facts need confirmation to make a
decision on a file. They represent a second medical opinion—a medical review.

66
Q

What are adjusters interested in when reviewing a medical–legal report?

A

Diagnosis, causation, treatment, and prognosis of the claimant

Feedback: When reviewing a medical–legal report, adjusters are particularly interested in the diagnosis,
causation, treatment, and prognosis of the claimant.

67
Q

How is pain graded when examining a patient?

A

Pain is graded according to severity.

Feedback: The pain should be graded according to severity—severe, moderate, or mild.

68
Q

The standard by which a claim must be proven to prevail is known as what?

A

Burden of proof

Feedback: Burden of proof is the standard by which a claim must be proven to prevail; the burden of proof is typically borne by one party or another.

69
Q

What is the definition of damages?

A

The monetary compensation recovered by a party who has suffered a loss or injury to person or property through the negligence of another

Feedback: Damages are the monetary compensation recovered by a party who has suffered a loss or
injury to person or property through the negligence of another.

70
Q

What is the crumbling skull rule?

A

A rule of damages where the tortfeasor is only required to put the plaintiff back in the place he or she would have been had the tort not occurred, not in a better position

Feedback: The crumbling skull rule is a rule of damages whereby the tortfeasor is only required to put
the plaintiff back in the position he or she would have been in had the tort not occurred, and not in a
better position. It is a well-established legal doctrine used in some tort law systems. A defendant is only
liable for the degree the injury was worsened or the hastening or acceleration of the damage caused by
the tort.

71
Q

What is the name of the policy that is designed to cover financial losses rather than liability for bodily
injury or property damage?

A

Errors and omissions insurance

Feedback: Errors and omissions insurance is an insurance form that protects the insured against liability for committing an error or omission in the performance of professional duties. Generally, such policies are designed to cover financial losses rather than liability for bodily injury or property damage.

72
Q

What is a nuisance settlement?

A

An insurer makes an economic business decision to dispose of a claim without merit by making a small payment to avoid the trouble of keeping it open

Feedback: Sometimes insurance companies consider making a nuisance settlement on economic
grounds rather than on the obvious merits of a case. A relatively inconsequential claim paid today may
save legal fees and other associated court costs that are likely to exceed the value of the claim. If counsel
assesses what will be spent on defending or trying a case and finds that to litigate will cost more than to
pay the claim in full immediately, the insurer may prefer to settle.

73
Q

What is arbitration?

A

A process whereby the dispute is submitted to one or more impartial parties for a final and binding decision

Feedback: Arbitration is a method of resolving disputes between parties whereby impartial, neutral
individuals are chosen by the parties in dispute to determine their rights and/or obligations. The parties
agree in advance to abide by the arbitrament. Each party has a chance to be heard, issues are examined,
and a settlement is developed. The settlement can be final and binding.

74
Q

What are punitive damages?

A

Damages awarded to punish the defendant for offensive, wilful, and reckless conduct.

Feedback: Punitive damages are damages in excess of those required to compensate the plaintiff for the
wrong done, which are imposed to punish the defendant because of the particularly wanton or wilful
nature of his or her wrongdoing. Also called “exemplary damages.”

75
Q

An agreement in claims settlement that involves many payments made over a period of time rather
than one lump sum is called what?

A

Structured settlement annuity

Feedback: A structured settlement annuity is an agreement in the settlement of a claim involving specific payments made over a period of time instead of a single lump sum. Annuities are usually used as the
funding mechanism.

76
Q

What are compensatory damages?

A

Compensation that will return the party to the same or similar position enjoyed prior to the accident or loss.

Feedback: Compensatory damages are a sum of money to which a plaintiff is entitled that makes amends for an actual loss sustained and nothing more.

77
Q

Damages that are applied in a third-party claim are known as what?

A

General damages

Feedback: Damages awarded by a court of law for the pain and suffering of an individual are called
general damages; applied in a third-party injury claim.

C32 Bodily Injury (12 decks)

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