Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
118 Cards in this Set
- Front
- Back
|
Who is required to obtain specific excess insurance?
|
A group of self insurers |
|
|
What is the max 2010-2011 indemnity rate?
|
986.69 |
|
|
Where is the latisimuss doris located?
|
The Back
|
|
|
What is the minimum required security deposit for an existing private self-insured? |
Equal to the self insurers losses at the non-discounted "expected level" or "actuarial central estimate" |
|
|
For a self insurer who has not been self insured how long must they contract with a 3rd party administrator?
|
the 1st 3 years |
|
|
For an injury in 2005 what is the max permissible add on for subjectives?
|
3% |
|
|
The 1st payment of TD is due no later than how many days after the knowledge of the injury and disability?
|
14 Days
|
|
|
What are the penalties for failure to secure payment of compensation? (3 things)
|
2. Employer loses their exclusive remedy protection 3. IW gets 10% more |
|
|
Olecranon (o-lec-ron-on) is located in the:
|
Elbow |
|
|
What is the role of the investigator assigned to pursue issues of compensability? |
Determine all the facts
|
|
|
What is the rating for constant moderate pain?
|
50% |
|
|
2005/2006 Max TD rate? |
$840.00 |
|
|
2010/2011 Max TD Rate? |
$986.69
|
|
|
2012 Max TD rate?
|
$1010.50 |
|
|
2013 Max TD rate? |
$1066.72 |
|
|
2016 Max TD rate? |
$1128.43 |
|
|
2014 MAx TD rate? |
$1074.64 |
|
|
How do you calculate stat max?
|
multiply by 3 and divide by 2 |
|
|
How do you calculate stat min?
|
After getting stat max slide the decimal point one spot to the left |
|
|
What are the death benefits for 3 or more total dependents?
|
$320,000.00 |
|
|
What are the death benefits for 2 total dependents? |
$290,000.00 |
|
|
What are the death benefits for 1 total dependent? |
$250,000.00 |
|
|
What is excess insurance?
|
Coverage available for risks that choose to self insure the majority of work comp loss exposures |
|
|
What is the conversion factor for lower extremity? |
0.4 |
|
|
What is the conversion factor for upper extremity? |
0.6 |
|
|
An employer desiring a change of employee- selected physician can petition the... |
administrative director |
|
|
Labor code 4062 is regarding what and how long to do something? |
Objection to a PTPs treatment recommendation in writing- 20 days if AA, 30 is not represented. |
|
|
If an employee has 2 jobs and cannot work at both jobs but the injury occurred at the lower paying job. how do you calculate their comp rate?
|
Total hours worked at LOWER hr. pay x 2/3 |
|
|
What is the penalty for failure to file a complete or timey annual report? |
An amount up to 5% of the incurred liabilities in the last report or $1500.00, whichever is less |
|
|
Where is the scaphoid bone located?
|
The hand |
|
|
a self insurer and its admin agency shall submit to the manager a self insurer annual report if one/any of the following occurs and how long must they notify? |
2. a change from agency to self 3. a change from self to agency due w/in 30 days |
|
|
What are assessments? (2 things) |
2. Provide stable funding source to resolve claims more quickly |
|
|
(3 things) |
1. The prior three years incurred liability 2. the stat min 3. a higher amount approved by the director |
|
|
To whom do you apply for a cert to consent to self-insure?
|
the director of industrial relations |
|
|
How many days do you have to delay TTD and send notice? |
14 Days |
|
|
If an IW unreasonably fails or refuses to get medical treatment for their injury you should do what? |
Not pay benefits occurred during that time period. |
|
|
For private self insures the 6 month interim report shall cover what period of time and when is it due?
|
1/1 to 6/30 and it is due 9/1 each year |
|
|
How long do you have to file a petition to terminate liability for TD after terminating benefits?
|
10 Days |
|
|
A petition for reconsideration must be filed within how many days of service of a findings and award by the WCAB? |
20 Days |
|
|
Paid leave of absecene for specified public employees- paid full salary- who is eligible?
|
2. police and sheriffs 3. firefighters 4. employees of a sheriff 5. Inspectors/Detectives 6.Probation officers |
|
|
What are the three types of ratings that the disability evaluation bureau can prepare?
|
2. summary 3.consultative |
|
|
An employee is terminated following an industrial injury b/c he filed a claim for compensation benefits. The employee is entitled to:
|
Compensation increased by 1 half up to $10,000.00 plus reinstatement and reimbursement for lost wages and work benefits
|
|
|
What is Subrosa?
|
surveillance |
|
|
How does the manager value approved securities for any private self-insurer?
|
Par value or market value, whichever is less
|
|
|
When should formal rating determinations shall be deemed to constitute evidence?
|
Only as to the relationship between the disability described and the % of PD
|
|
|
When an IW is incarcerated and doesn't have a dependent where do you send their indm payments?
|
To the state treasury to credit the uninsured employers fund |
|
|
What does incurred liabilities for the payment of compensation mean?
|
The sum of an estimate of future compensation and an estimate of the amount necessary to provide for admin and legal |
|
|
An employee excludes? (4 things)
|
2. services in return for aid 3. voluntary services 4. preforming officiating services |
|
|
If an employee works 2 jobs and cannot work at both jobs, and the injury occurred at the higher paying job how do you calculate their comp rate?
|
Total both wages and multiply by 2/3 |
|
|
Death benefits are paid how and to whom if there are no dependents? |
paid to the department of industrial relations and as a lump sum
|
|
|
What is associated with carpal tunnel syndrome? |
2. ulnar nerve 3. medial nerve 4. head of the ulna |
|
|
What bone does a colles fracture involve? |
radius
|
|
|
The DEU will prepare the following kinds of rating determinations:
|
2.summary 3. consultative 4. informal |
|
|
As a self insured admin, how long do you have to maintain the claims file?
|
5 years from DOI or date on which the last provision of comp benefits occurred, whichever is later. |
|
|
How long from the DOI does an IW's beneficiaries have to file a death claim?
|
240 weeks from DOI |
|
|
For an injury in 2005, what is the max permissible add-on for subjective and when do you add it?
|
3%, added at the beginning |
|
|
how many weeks of TD do you get with... -hep c -burns -amputations -eye injuries -lung disease |
240 weeks within 5 years from DOI |
|
|
Shall means what in labor codes?
|
mandatory |
|
|
UR policies and procedures shall be filed with the: |
administrative director |
|
|
Voucher post 2013- expired when? |
-5 years after DOI whichever is later |
|
|
If a physician bills the IW. instead of WC and the IW pays the bill, what is the IW entitled to from the physician?
|
3X the amount unlawfully collected |
|
|
How long does a public service officer have to file a claim under LC 3212?
|
3 months for each year of service not to exceed 60 months |
|
|
What is the alternative composite deposit? |
A security deposit system pursuant to LC 3701-8 whereby all eligible private self-insurers collectively secure, in whole or in part, aggregate self insured WC liabilities through self-insurers security fund.
|
|
|
The employer or insurance carrier shall submit a plan for the medical provider network for approval by whom?
|
The administrative director
|
|
|
What is the amount of supplemental job displacement benefits due for an injury in 2004 that caused permanent disability of 25%? |
$6,000.00 |
|
|
What pain is not ratable? |
minimal |
|
|
(what type of activity or job) |
2. a private, non-profit |
|
|
What labor code covers hernia, heart trouble, and pneumonia for firemen?
|
LC3212 |
|
|
If a physician didn't perform particular exam or prepare the report you should:
|
object to the report as inadmissible
|
|
|
apportionment of permanent disability shall be based on?
|
causation |
|
|
Characteristics of the uninsured employers fund? |
2. publically funded 3. fund pays IW and goes after employer for money and penalties |
|
|
Unless there is an order of credit, estimates of future liability may:
|
never be reduced by the amount of the 3rd part recoveries |
|
|
What does preponderance of the evidence mean?
|
evidence that, when weighed with that opposed to it, has more convincing force and the greater probability of truth |
|
|
What are the two benefits that you cannot commute?
|
1. subsequent injuries fund payment (2nd injury) 2. supplemental job displacement benefits |
|
|
What is the acetabulum?
|
the head of the femur |
|
|
What should you file to protect your right to recover WC payments from a negligent 3rd party? |
a complaint for intervention |
|
|
When are coffee and lunch breaks covered? |
when on the premise |
|
|
Case example of coffee and lunch breaks rule
|
hinkle vs WCAB |
|
|
When is there no compensation in regards to the coming and going rule?
|
En route to and from work |
|
|
Exceptions to the coming and going rule? |
If ER pays transportation or IW is running a special mission/errand |
|
|
To whom do you apply for a cert of consent to self insure? |
the director of industrial relations |
|
|
What may be used if the employer has refused to pay wc benefits?
|
The self insured security deposit |
|
|
What is the penalty for failure to file a complete or timely annual report?
|
an amount up to 5% incurred liabilities or $1,500.00 whichever is less. |
|
|
When an IW unreasonable fails or refuses to get medical treatment for his injuries you should?
|
File a petition to suspend benefits |
|
|
For an injury in 2007 what invokes the jurisdiction of the workers compensation appeals board? |
Application for adjudication of claim |
|
|
You investigate an employees claim of injury and issue a denial. Just before the one year anniversary of the alleged injury the IW meets with an information and assistance officer who takes the case under submission. The statute of limitations:
|
Is tolled for the period of time the matter is under consideration and for 60 days after issuance of information and assistance officer recommendation
|
|
|
For the 2005 schedule what word do you look for?
|
impairment |
|
|
for the 1997 schedule what word do you look for? |
disability |
|
|
If settlement is delayed what is the IW entitled to? |
10% due to unreasonable delay |
|
|
An employer desiring a change of employee selected physician can petition the: |
The administrative director
|
|
|
A dia form 510 in a death case must be filed unless the employer has actual knowledge that:
|
The deceased employee left a surviving minor child |
|
|
Formal rating determinations shall be deemed to constitute evidence
|
Only as to the relationship between the disability described and the percentage of permanent disability
|
|
|
When are medical only claims supposed to be included on the annual report?
|
When they are for the reporting year of that report |
|
|
When is proof of service necessary?
|
for a notice of denying liability only |
|
|
You do not agree with the agreed medical examiner findings- you should do what?
|
Send a letter to the agreed medical examiner requesting a clarification with a copy to the attorney for the injured employee
|
|
|
The employee has an injury resulting in perm disability of 15%. the employer calls and wants you to compromise and release the claim $12,500.00 if the employee voluntarily resigns- you should?
|
Advise the employer it is against public policy |
|
|
How long do you have to provide a change of PTP form?
|
5 Days |
|
|
Length of time to file a petition to term liability? |
10 days |
|
|
How long do you have to respond to a request for treatment? |
14 days |
|
|
How many days for a petition of reconsideration after findings and awards? |
14 days |
|
|
How many days for a private application will you be notified? |
45 days |
|
|
How long for a public service officer to file a claim? |
2 years |
|
|
You are paying TD pursuant to an award. How long do you have to file a petition to terminate liability for TD after terminating payments? |
10 days |
|
|
How many days do you have to respond to a request for medical treatment? |
7 days
|
|
|
Who is the top title at the department of industrial relations?
|
Director of industrial relations |
|
|
What is the most serious type of violation in regards to audits? |
an undocumented DWC-500E
|
|
|
What is the fine for an undocumented DWC-500 E form in regards to an audit?
|
$5,000.00
|
|
|
The administrative director is authorized to impose penalties given due consideration with respect to what following factors? |
2. good faith 3. the hx of past violations 4. the frequency of those violations |
|
|
What are the reasons for a civil penalty? |
2. refusal to comply w/known and legally indisputable compensation obligations 3. administrated compensation obligations in a dishonest manner. 4. administrated compensation obligations in a manner as to cause injury to the public |
|
|
How many working days does the director have to assign a 3-member panel for a medical evaluation? |
within 5 working days after receiving the request |
|
|
If a panel for QME is not picked w/in 5 working days the WI has how many days to pick a qualified med evaluator of his or her own choice w/in a reasonable geographical area? |
20 days
|
|
|
No fault system means what?
|
without regard to negligence
|
|
|
Labor code 3600 regards to:
|
conditions of compensation for employer liability |
|
|
Supplemental job benefits for less than 15% impairment
|
$4,000.00 |
|
|
Supplemental job benefits for 15%-25% impairment
|
|
|
|
Supplemental job benefits for 26%-49% impairment
|
$8,000.00
|
|
|
Supplemental job benefits over 50% impairment
|
$10,000.00 |
|
|
For PUBLIC self insurer's 6 month interim report shall cover what time period and when is it due? |
7/1–12/31 and is due 3/1 of each year |
