Quiz 4 Flashcards
Why is it important to set reserves on a claim?
- It enables SAIF to estimate future liabilities
- Reserves are used in ratemaking and employers modification ratings
- It is used to calculated premium for retrospective policies
- Reserves facilitate underwriting decisions
- It meets statutory requirements
What 4 areas is a claims adjuster responsible for setting reserves?
- Medical
- Temporary Disability (Time Loss)
- Permanent Partial Disability (impairment)
- Legal Fees
What are type b providers?
Chiropractor, Physician Assistance, Naturopathic physicians
How long can type b provide medical services?
60 days or 18 visits
How long can type b authorize time loss?
30 days
How many AP can a worker have during the life a claim
3
What are not considered changes by choice of work?
- Emergency Services
- Exams requested by insurer
- AP is not available and the worker sees a covering physician
- Changes out of the workers control
How many days do insurers have to close a claim?
14 days from the receipt of the last info for claim closure.
What info is needed before closing the claim?
- Med Stat
- Work Release
- Work Status
- Impairment
What are types of post closure medical services covered under ORS 656
- Prescription Meds
- Repair or replacement prosthetic devices
- Diagnostic Test
- Office visist
- Palliative care
Define PPD
Permanent lose of function of a body part or system or permanent impairment and work disability resulting from a compensable injury or occupational disease.
