Deck 11: Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Question 1

Which of the following employers are not required to provide workers' compensation insurance to their employees?

A) Employers with fewer than three full-time employees
B) Individuals who are business partners
C) Volunteers
D) All of the above

Answer 1

All of the above

Question 2

An individual responsible for investigating and resolving workers' complaints against the employer is called a/an:

A) ombudsman.
B) personal claims representative.
C) arbitrator.
D) investigator.

Answer 2

ombudsman.

Question 3

The Federal Employment Compensation Act (FECA)provides workers' compensation for _____ employees.

A) military federal
B) nonmilitary federal
C) military nonfederal
D) nonmilitary nonfederal

Answer 3

nonmilitary federal

Question 4

Which of the following is not one of the responsibilities of the health insurance professional?

A) Filling out the necessary forms for the patient
B) Acquiring the necessary information for claims processing
C) Photocopying all forms for the patient's health record
D) Maintaining a well-documented health record

Question 5

A maximum amount paid per month for short-term disability policies is called a _____ cap.

A) short-term
B) maximum
C) disability
D) benefit

Question 6

Workers' compensation insurance is considered to be "no-fault insurance," which means

A) benefits are paid regardless of who is to blame for the injury.
B) benefits are not paid because it is considered nobody's fault.
C) if it is unclear whose fault the injury is, workers' compensation does not have to pay.
D) the employee and employer share medical expenses.

Question 7

The standard form for billing disability claims is:

A) CMS-1500.
B) UB-04.
C) Form 2129.
D) nonexistent.

Question 8

Companies pay premiums for workers' compensation insurance;in return,their employees agree to:

A) pay employers back for their insurance.
B) not file claims for on-the-job injuries.
C) split the cost of medical bills for on-the-job injuries.
D) give up the right to sue employers for on-the-job injuries.

Question 9

The condition in which the employee has reached a state of maximal medical improvement is called:

A) chronic.
B) temporary.
C) permanent and stationary.
D) partial and rehabilitating.

Question 10

Workers' compensation is considered a/an:

A) fringe benefit.
B) optional bonus.
C) legally mandated right.
D) employee's responsibility.

Question 11

Most state laws exclude coverage for injuries sustained while an employee is commuting to and from work.This exclusion is referred to as the _____ rule.

A) commuting
B) coming-and-going
C) in-transit
D) to-and-from-work

Question 12

To qualify for Social Security benefits,an individual must have worked a specified number of:

A) weeks at the same job.
B) years as a full-time employee.
C) minimum wage hours.
D) covered work credits.

Question 13

All of the following are benefits of the workers' compensation program,except:

A) medical expenses.
B) disability pay.
C) food and housing expenses.
D) death benefits.

Question 14

In which era did workers' compensation get its start?

A) 1700s
B) 1800s
C) 1900s
D) 2000s

Question 15

There are no work requirements for SSI,but the individual must establish:

A) financial need.
B) inability to perform activities of daily living (ADL).
C) 5 years of legal state residency.
D) all of the above

Question 16

Which act provides workers' compensation to employees of private maritime employers?

A) Longshore and Harbor Workers' Compensation Act
B) Federal Employment Liability Act
C) Merchant Marine Act (Jones Act)
D) Black Lung Benefits Act

Question 17

What is the first step an employee should take for a first report of a nonemergency on-the-job injury?

A) The employee should complete an initial accident report.
B) The employee should notify a supervisor of the accident.
C) The employee should have the employer report the incident to a workers' compensation carrier.
D) The employee should go or be sent to a medical facility for treatment or diagnosis.

Question 18

A detailed and comprehensive questionnaire that establishes monetary need is a/an:

A) patient/provider interview.
B) evaluation questionnaire.
C) financial means test.
D) SSDI funding form.

Question 19

The time limit for filing a workers' compensation claim is established by:

A) the employer.
B) the federal government.
C) individual state statutes.
D) the insurance company that issues the policy.

Question 20

Which program was created to help individuals who receive SSDI or SSI benefits find and keep employment by offering them more options for services and supports?

A) PACE
B) Ticket to Work
C) Workers' Compensation
D) FECA

Question 21

Workers' compensation is considered no-fault,and benefits are paid regardless of who is to blame for the injury.

Question 22

Each state has established rules under which an employee is required to file a claim within a certain time limit.

Question 23

Some commonly used factors federal programs look at in assessing disability include all of the following,except:

A) sensory impairments.
B) cognitive/mental impairments.
C) activities of daily living.
D) earned income.

Question 24

 Income from employment (wages)is considered:

A) supplement income.
B) tax free income.
C) earned income.
D) certified income.

Question 25

Name the two distinct roles of the attending physician in workers' compensation claims.

Question 26

Certain classifications of businesses are not required to provide workers' compensation for their employees.List at least four.

Question 27

The Federal Employment Compensation Act (FECA)provides workers' compensation for federal military employees.

Question 28

The national website that provides workers compensation news and information for employees,employers,insurers,and medical providers is:

A) the Online Workers' Comp Service Center.
B) Centers for Medicare and Medicaid Services.
C) Disability and Health Team.
D) Americans with Disabilities.

Question 29

List at least six of the nine federal disability programs.

Question 30

As an alternative to traditional workers' compensation coverage,some employers choose a/an __________________ to provide medical care to injured employees.

A) health benefit plan
B) employee-sponsored fund
C) managed care system
D) OSHA funded plan

Question 31

Name the five specific items the attending physician's statement must typically include when a disability claim is filed.

Question 32

Any physical or mental impairments resulting from a work-related incident are normally determined on the basis of the:

A) attending physician assessment.
B) employer's report.
C) employee's complaints.
D) the workers' compensation insurer's opinion.

Question 33

Workers' compensation benefits are not paid for certain work-related incidents when injury occurs as a result of certain irresponsible actions by the employee.Name four of these.

Question 34

All business organizations are required to purchase workers' compensation.

Question 35

List at least four of the health insurance professional's responsibilities for facilitating disability claims processing.

Question 36

Workers' compensation is insurance,regulated by state laws,that pays medical expenses related to on-the-job injuries and/or illnesses.

Question 37

List and explain the two major classifications of disability coverage.

Question 38

Workers' compensation insurance is no-fault insurance.Explain what this means.

Question 39

List the steps for filing a workers' compensation claim.

Question 40

Name the major benefit components to workers' compensation.

Question 41

Vocational rehabilitation is not available for employees who cannot return to their job because of a workers' compensation injury.

Question 42

If the individual sustains a job-related injury,benefits often begin immediately.

Question 43

Because of the extensive information and forms required for workers' compensation claims,it is almost impossible for fraud to occur.

Question 44

Most short-term disability policies have a maximum benefit amount that is paid each month.

Question 45

The health insurance professional has no tangible responsibilities in facilitating disability claims.

Question 46

HIPAA mandates that if an employer provides insurance to its employees and their dependents,all employees and dependents must be covered regardless of medical condition.

Question 47

There is no wage base limit for the Medicare Part A (hospital insurance)payroll tax.

Question 48

Federal rules and regulations do not allow individual states to use claim forms other than the CMS-1500 to report workers' compensation claims.

Question 49

Balance billing is not allowed on workers' compensation claims.

Question 50

Supplemental Security Income (SSI)and Social Security Disability Income (SSDI)are identical programs with the same requirements for enrollment.

Question 51

Disability income insurance replaces a portion of earned income when an individual is unable to do his or her work resulting from nonemployment-related injuries.

Question 52

HIPAA permits covered entities to disclose PHI to workers' compensation insurers and/or employers without the individual's written authorization.

Question 53

The purpose of disability income insurance is to replace a portion of salary or wages lost due to injury or illness that is not work related.

Question 54

The CMS-1500 is the standard form for billing disability claims.

Question 55

There are two major types of disability coverage,short-term and long-term.