Test Study Flashcards
Statutory Closure Date Means
The claim satisfies the criteria for closure under
“Work disability” for purposes of determining permanent disability, means the separate factoring of impairment as modified by:
Adaptability to perform the job at injury, education, age
Name the three main forms used in the closure process:
1503, 1644, 2807
The insurer has to send written notice to the worker when the claim qualifies for closure within 3 working days from the date the insurer receives the information?
True
The Insurer must issue a notice of closure on nondisabling claims?
False
When a worker requests claim closure, the insurer has how many days to respond?
10
What can a worker do if they disagree with the notice of refusal to close?
Request a hearing
In which of the following instances must an insurer issue a notice of closure:
- Medical information indicates the compensable condition is med stat
- The worker fails to attend a mandatory closing exam for reasons within there control and the worker has been notified of actions
When a claim qualifies for closure how many days does an insurer have to issue a notice of closure on an accepted disabling claim?
14
Which of the following are requirements of a closing report if there is a reasonable expectation of permanent disability?
- A type A attending physician serving as such must provide or concur with the closing report
- Include detailed documentation of all measurements, finding, and limitations regarding many permanent impairment caused in any part by an accepted condition or sequela of one
Who should receive a copy of the notice of closure?
Employer at injury, worker attorney, director, injured worker
In which instances would a corrected Notice of Closure by used?
Incorrect statement of TD
Incorrect Mailing date
Permanent disability computation error
The insurer must close a claim when the worker is not medically stationary and fails to seek treatment for more than – days without approval of the AP/ANP. This must be for reasons —– the workers control.
30 days, within
An insurer can close a worker’s claim for failing to attend a mandatory closing exam for reasons within the workers control.
True
In which instances must an insurer close a claim even though a worker may not be med stat?
- The workers is not med stat, but has not sought treatment for more than 30 days with an MCO (when enrolled in an MCO) provider, but has continued to treat with a non-MCO provider.
- The worker is not med stat, but a major contributing cause denial has been issued on the accepted combined conditions.
When there are conflicting medical opinions about the medically stationary date, the opinions that are based on the, —, —— are used to determine which opinion has more weight.
objective findings, clear and concise reasoning
The insurer must request the attending physician concur or comment when the worker is seen by another physician (including an IME Physician) for a closing exam.
True
What are the elements of a formal job offer, also known as Bona fide job offer (BJO)?
- Attending physician is notified of tasks performed
- Attending physician agrees with modified work
- Employer provides written offer to the worker.
For a Bona fide job offer(BJO), what information needs to be included in the written offer?
- Start date and time
- Duration of the modified work
- statement that the attending physician approved modified work
- description of physical requirements
- place and location of the modified work
- days and hours worked
- Wages for modified work
What elements are needed to stop or prorate time-loss benefits when a worker has been terminated?
- The employer has a written return-to-work policy
- The attending physician has approved the modified work description.
- Memo to the claim file
What information is needed in the memo included in claim file, for stopping or prorating time-loss benefits when a worker has been terminated?
- Hours and days modified work would have been available
- Wages for modified work
- Start date and time
- Statement that modified work would have been available if the worker had not been terminated.
What situations can a worker refuse modified work without facing a reduction or termination of time-loss benefits?
- Commute to the modified work is beyond physical capacities of worker.
- Worksite is more than 50 miles from worksite.
- Not with the employer-at-injury
- Not at worksite belonging to employer-at injury
- Shift difference from
Define Medically Stationary
No further material improvement would reasonably be expected from medical treatment or the passage of time.
