Quiz 3

Question 1

What are the 3 requirements for a BJO

Answer 1

1. AP is notified of the tasks.
2. AP agrees with commute necessary
3. EAI Does a written letter

Question 2

What are the 7 elements of a BJO

Answer 2

1. Start Date and Time
2. Hours/Days
3. Wages
4. Location
5. Duration
6. Description of Mod Duty
7. Statement that AP approves it

Question 3

Describe Open Claims Management

Answer 3

During the open/accepted claim the adjusters assist the IW in recovery and return to work by paying benefits accurately and time and ensuring the worker receives reasonable and necessary medical services related to the accepted conditions and bring the claim to the appropriate resolution.

Question 4

What is the purpose of an MCO medical treatment review and when would you request it?

Answer 4

To review the current and past medical treatment and provide the AP with a treatment course recommendations with specific timelines and goals

Question 5

When to consider a medical treatment review by an MCO? (6 reasons)

Answer 5

1. No clear diagnosis for ongoing symptoms
2. No treatment plan
3. Worker is not released to an appropriate level of work.
4. Treatment is ongoing without resolution
5. Excessive on going medication use
6. Worker may have motivation issues delaying or stalling the recovery

Question 6

What OAR Division is responsible for guiding Vocational Services?

Answer 6

Division 120

Question 7

What are the two types of vocational services an eligible worker may receive?

Answer 7

Direct Employment Plan

Authorized Training Plan

Question 8

How many days do insurers have to pay medical bills in an accepted claim?

Answer 8

45 days from the receipt of the bill.

Question 9

When to consider enrolling a worker in an MCO?

Answer 9

1. If the claim is disabling
2. The services offered by the MCO
3. Which panel of providers the current AP belongs too
4. The complexity of the medical conditions
5. The workers locations and access to medical services.

Question 10

What is the goal of vocational assistance?

Answer 10

To return the worker back to suitable work at a wage close to 100% of the adjusted weekly wage as possible.

Question 11

What are the 5 incentives of the PWP?

Answer 11

1. Wage Subsidy
2. Premium Exemption
3. Worksite Modifications
4. Employment purchases
5. Claim Cost Reimbursments