Test Study 2 Flashcards

1
Q

Which WCD Bulletin provides information about the fors to be used for a worker or an insurer to request reconsideration?

A

227

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2
Q

A Worker is considered permanently and totally disabled when they are —— incapacitated from ——- performing work in a suitable and gainful occupation.

A

Permanently, Regularly

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3
Q

The insurer has ——days from, ——————- to provide the director with documents pertaining to the claim in reconsideration process.

A

14 days ….. the date of the directors notice of the start of the recon proceeding

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4
Q

Which of the following can occur in a reconsideration order?

A

Affirm compensation award, Increase compensation award

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5
Q

The statutory time frame for appealing a notice of closure is

A

60 days for a worker and

7 days for the insurer

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6
Q

Under what circumstances would we provide surveillance film for the medical arbiter to view?

A

When a physician involved in the evaluation and treatment of the worker has seen the video

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7
Q

The insurer selects the medical arbiter in accordance with ORS 656.268 (8)(d)

A

False

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8
Q

If a worker fails to attend a medical arbiter exam it could result in suspension of all the workers disability benefits.

A

True

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9
Q

What does the acronym EDOK stand for at Saif Corporation?

A

Employer date of Knowledge

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10
Q

What does the acronym EAI stand for at SAIF Corporation?

A

Employer at injury

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11
Q

What does the acronym MOI stand for at SAIF Corporation?

A

Mechanism of injury

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12
Q

Which section number of the Oregon revised statues covers the laws concerning workers compensation?

A

656

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13
Q

Which chapter of the Oregon Administrative Rules covers the laws concerning the processing of workers compensation claims?

A

436

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14
Q

Which Oregon Administrative Rule Division Covers Claims Administration Rules?

A

60

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15
Q

Which two divisions under the Department of Consumer and Business Services regulate the workers compensation process?

A

Workers Compensation Board, Workers Compensation Division

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16
Q

Which Form is used by the worker and the employer to report an injury to the insurer?

A

801

17
Q

Which of the following are uses of the form 827- worker’s and Health Care Providers’ report of Workers’ Compensation Claim?

A

Report of aggravation, first report of an injury or disease, request for a new or omitted medical condition, notice of change of attending physician or nurse practitioner

18
Q

Which of the following are uses of the form 1502- Insurer’s report?

A

First report of an injury, acceptance or denial of the claim, aggravation

19
Q

How much time does a physician have to send the form 827 to the insurer if it is being sent as the first report of an injury?

A

72 hours of the initial office visit

20
Q

How much time does the employer have to send the form 801 to the insurer?

A

5 days from the date of the employer’s knowledge that a claim is made

21
Q

When must the notice of change of attending physician or nurse practitioner be sent to the insurer using the 827 form?

A

Within 5 days of the office visit

22
Q

Attending Physician:

A

A doctor or physician who is primarily responsible for the treatment of a workers compensable injury or illness.

23
Q

Claim:

A

a written request for compensation from a subject worker or someone on the workers behalf, or any compensable injury of which a subject employer has notice or knowledge

24
Q

Compensable Injury:

A

An accidental injury, or accidental injury to prosthetic appliances, arising out of an in the course of employment requiring medical services or resulting in disability or death, an injury is accidental if the result is an accident, whether or not due to accidental means, if it is established by medical evidence supported by objective findings.

25
Q

determining compensability in an injury claim and in an occupational disease claim:

A

Injury claim. Material contributing case of the need for treatment or disability.
Occupational disease claim. Major contributing cause of the condition.

26
Q

What does the phrase “course and scope” mean?

A

“arising out of” Causal relationship to work

“in the course” time, place, and circumstances

27
Q

How many days can an emergency physician authorize time loss benefits?

A

14 days

28
Q

Which of the following is not a type b medical provider.

A

Cardiologist

29
Q

How many days of office visits can a type b medical provider provide medical services. Page 18

A

60 days or 18 office visits from the date of the first visit.

30
Q

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

A

45 days from receipt of bill

31
Q

How many days can a type b medical provider authorize time loss.

A

30 days

32
Q

Which of these type of medical providers is also able to rate impairment?

A

Chiropractor

33
Q

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

A

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

34
Q

How many days can an authorized nurse practitioner authorize time loss benefits?

A

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

35
Q

How many days does an insurer have to respond in writing to a written request for diagnostic preauthorization.

A

Within 14 days of receiving the request from the provider.

36
Q

How many days does the insurer have to reclassify a claim from nondisabling to disabling?

A

14 days

37
Q

When a worker is represented by an attorney, when do you need to provide discoverable documents? and how often do you need to provide updates?

A

14 days and updates every 30 days there after

38
Q

What four areas is a claims adjuster responsible for setting reserves?

A

Medical, Temporary disability, Permanent disability, and legal fee’s

39
Q

When a claim denial is appealed, what are the four levels of litigation that can occur?

A

In person hearing before an Administrative Law Judge ALJ.
Board review of the ALJ opinion by the Workers Compensation Board.
Review by Oregon Court of Appeals
Review by the Oregon Supreme Court.