Quiz Questions Flashcards
What is the definition of impairment
“Impairment” means the loss of use or function of a body part or system due to the compensable industrial injury or occupational disease
Palliative Care
Palliative care means that medical services are provided to temporarily reduce or moderate the intensity of an otherwise stable medical condition.
Work Disability
If a worker is eligible for an award for work disability, the factors of age, education, and adaptability are determined
How many days do insurers have to pay medical bills that were received prior to a claim decision once the claim has been accepted?
14 days from the date of acceptance
How many days do insurers have to pay worker reimbursements?
30 days from the receipt of the request for reimbursement
The worker has up to one year to report an OD to the employer. What are the event triggers that may start the time frame?
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
The legal standard for determining compensability of a combined condition
Combined condition: major contributing cause of the combined condition’s need for treatment.
How many days do insurers have to pay medical bills that were received prior to a claim decision once the claim has been accepted?
14 days from the date of acceptance
What information is needed before closing a claim?
Actual Work Status
Med Stat status
Status and date of the work release
Information concerning permanent impairment, if any
How many days do injured workers have to appeal the Notice of Closure?
60 days from the mailing date of the Notice of Closure
How much time does an insurer have to respond to the attending physician’s request for palliative care?
30 days from the receipt of the request from the AP
How many days does an adjuster have to issue a decision on an aggravation claim?
60 days from the receipt of the request to reopen the claim
What are elements of a compensable aggravation claim?
An actual worsening, after the last arrangement of compensation, of an accepted condition, established by medical evidence, supported by objective findings
