Test Study

Question 1

Statutory Closure Date Means

Answer 1

The claim satisfies the criteria for closure under

Question 2

“Work disability” for purposes of determining permanent disability, means the separate factoring of impairment as modified by:

Answer 2

Adaptability to perform the job at injury, education, age

Question 3

Name the three main forms used in the closure process:

Answer 3

1503, 1644, 2807

Question 4

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?

Answer 4

True

Question 5

The Insurer must issue a notice of closure on nondisabling claims?

Answer 5

False

Question 6

When a worker requests claim closure, the insurer has how many days to respond?

Answer 6

10

Question 7

What can a worker do if they disagree with the notice of refusal to close?

Answer 7

Request a hearing

Question 8

In which of the following instances must an insurer issue a notice of closure:

Answer 8

• 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

Question 9

When a claim qualifies for closure how many days does an insurer have to issue a notice of closure on an accepted disabling claim?

Answer 9

14

Question 10

Which of the following are requirements of a closing report if there is a reasonable expectation of permanent disability?

Answer 10

• 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

Question 11

Who should receive a copy of the notice of closure?

Answer 11

Employer at injury, worker attorney, director, injured worker

Question 12

In which instances would a corrected Notice of Closure by used?

Answer 12

Incorrect statement of TD
Incorrect Mailing date
Permanent disability computation error

Question 13

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.

Answer 13

30 days, within

Question 14

An insurer can close a worker’s claim for failing to attend a mandatory closing exam for reasons within the workers control.

Answer 14

True

Question 15

In which instances must an insurer close a claim even though a worker may not be med stat?

Answer 15

• 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.

Question 16

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.

Answer 16

objective findings, clear and concise reasoning

Question 17

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.

Answer 17

True

Question 18

What are the elements of a formal job offer, also known as Bona fide job offer (BJO)?

Answer 18

• Attending physician is notified of tasks performed
• Attending physician agrees with modified work
• Employer provides written offer to the worker.

Question 19

For a Bona fide job offer(BJO), what information needs to be included in the written offer?

Answer 19

• 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

Question 20

What elements are needed to stop or prorate time-loss benefits when a worker has been terminated?

Answer 20

• The employer has a written return-to-work policy
• The attending physician has approved the modified work description.
• Memo to the claim file

Question 21

What information is needed in the memo included in claim file, for stopping or prorating time-loss benefits when a worker has been terminated?

Answer 21

• 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.

Question 22

What situations can a worker refuse modified work without facing a reduction or termination of time-loss benefits?

Answer 22

• 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

Question 23

Define Medically Stationary

Answer 23

No further material improvement would reasonably be expected from medical treatment or the passage of time.