Quiz #3

Question 1

What is the definition of Impairment?

Answer 1

A permanent loss of use or function of a body part or system related to the compensable condition

Question 2

Palliative Care: Medical service rendered to _________ or _______________, but does not include those medical service rendered to t diagnose, heal, or permanently alleviate or eliminate to a medical condition.

Answer 2

• Reduce

- Moderate temporarily the intensity of an otherwise stable medical condition

Question 3

What are examples of medical services? (3)

Answer 3

• Surgery
• Diagnostics
• Prosthetic appliances

Question 4

Work disability means the separate factoring of impairment as modified by ___________, to perform the job at which the worker was injured

Answer 4

• Age, education, and adaptability

Question 5

Which are elements of a bona fide (formal) job offer of modified work? (2)

Answer 5

• The attending physician is notified of physical tasks to be performed.
• The attending physician agrees with the modified work and commute is within capabilities

Question 6

What are the seven elements of the written bona fide (formal) job offer from the employer?

Answer 6

• start date and time, duration of the modified work, statement that AP has approved the modified work, description of physical requirements, place or location of the modified work, hours and days to be worked, wages

Question 7

What are the elements needed to stop or prorate time-loss benefits when a worker has been terminated from the employer at injury? (2)

Answer 7

• Employer has a written RTW policy

- Approved modified job description from attending physician

Question 8

In order to stop or prorate time-loss benefits when a worker has been terminated from the employer at injury, what elements must be included in the Memo to the file? (4)

Answer 8

• state date and time
• wages (aww/salary)
• Hours and days work available
• statement that modified work is available but for termination

Question 9

Which of the Type B medical providers is also able to rate impairment

Answer 9

Chiropractor

Question 10

How many days can an authorized nurse practitioner provide medical services?

Answer 10

180 days from the date of the first visit on the initial claim

Question 11

How many days do insurers have to pay medical bills that were received prior to a claim decision once the claim has been accepted?

Answer 11

14 days from the date of acceptance

Question 12

How many days do insurers have to pay worker reimbursements?

Answer 12

30 days from the receipt of the request for reimbursement.

Question 13

The worker has up to one year to report an occupational disease to the employer. What are the event triggers that may start the time frame? (4)

Answer 13

• 1 year from the date the worker first discovered the OD
• 1 year from the date the worker became disabled
• 1 year from the date the worker is informed by a doctor of the OD
• 1 year from the date of death or when discovered the OD was the cause of the death

Question 14

True or False - The legal standard for determining compensability of a combined condition claim is material contributing cause of either the disability or the need for treatment of the combined condition.

Answer 14

False

Question 15

Which items of the information must be included on the denial?

Answer 15

• appeal rights
• the factual and legal reasons for the denial
• whether the denial was based in whole or in part of an IME

Question 16

What information is needed before closing a claim? (4)

Answer 16

• Actual work status
• Medically stationary status
• Status and date of the work release
• Information concerning permanent impairment, if any

Question 17

How many days do injured workers have to appeal the Notice of Closure?

Answer 17

• 60 days from the mailing date of the Notice of Closure

Question 18

How much time does an insurer have t respond to the attending physician’s request for palliative care?

Answer 18

30 days from the receipt of the request from the attending physician

Question 19

How many days does an adjuster have to issue a decision on an aggravation claim?

Answer 19

60 days from the receipt of the request to reopen the claim

Question 20

What are the elements of a compensable aggravation claim?

Answer 20

• an actual worsening, after the last arrangement of compensation, of an accepted condition, established by medical evidence, supported by objective findings