Benefits (TD, Time Loss, TL, TTD, TPD) Flashcards Preview

Adjuster Certification Test > Benefits (TD, Time Loss, TL, TTD, TPD) > Flashcards

Flashcards in Benefits (TD, Time Loss, TL, TTD, TPD) Deck (16)
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What is the three-day waiting period?

Three consecutive calendar days


How is the 3 Day Waiting Period Determined

- It begins with the first day the worker loses time or wages due to their injury.
-It is three consecutive calendar days (not working days).


When is the three-day waiting period payable?

- The worker is authorized and is totally disabled for a period of 14 consecutive days,
-The worker is admitted as an inpatient to a hospital within 14 days of the onset of total disability.
-If the three-day waiting period is payable, pay one-half for the initial workday lost if worker leaves during first half of the shift and does not return. No compensation is due on the first day if the worker leaves during the second half of the shift


What information is required before an adjuster pays time loss?

The attending physician or authorized nurse practitioner (or Type B provider if appropriate) must be able to verify the worker’s inability to return to work and then authorize time loss.


Generally, when is the first time-loss payment due by statute?

14 days from the employer’s date of knowledge and/or the worker’s disability.


When is the first time-loss payment due by SAIF’s best practice?

13 days from the employer’s date of knowledge.


After the first time-loss payment is issued, how often is the time-loss benefit paid?

Every 14 days


When are time-loss benefits NOT payable?

- A person has withdrawn from the workforce. For example, an injured worker is not working and has made no reasonable effort to obtain employment or the injured worker is a full-time student.
- The attending physician or authorized nurse practitioner (or Type B provider) is unable to verify the worker’s inability to work.
-The worker is incarcerated for the commission of a crime.


What are some situations when an adjuster may stop paying time-loss benefits?

- The Type B Provider time frames have expired.
- The claim is denied
- The worker is released to reg work
- The worker returns to modified work and making their full AWW
- A bona fide job offer is made for modified work and the worker refuses the job (if the BJO was made for the full AWW).
-The terminated worker process has been completed.
- The claim is closed


What are the basic rules for determining the injured worker’s rate of time loss?

- Generally, the TD rate is 662/3 percent of the weekly wage.
- It’s based on the worker’s wages at the time of injury.
- Monthly wages are divided by 4.35 to determine the weekly wage.
- For seasonal, on call, paid hourly, paid-by-piece work, or with varying hours, shifts or wages, request 52 weeks of payroll records to determine the average weekly wage.
-For workers employed less than four weeks, use the intent at hire as confirmed by the employer and worker.
-Overtime hours are only included in the calculation when worked on a regular basis.
-Bonus pay is only included in the calculation when provided as part of the verbal or written employment contract.


When would an adjuster pay TPD? (Temp Partial Disability)

When the worker has returned to modified work, but at reduced hours or reduced wages.


When would an adjuster pay Sup TD benefits?

When an injured worker has more than one job at the time of injury and because of the work injury is unable to work the other jobs. Note: there is no three-day wait taken for Sup TD benefits.


Can Sup TD be paid on a nondisabling claim?

Yes. Sup TD may be due on a nondisabling claim even if time loss is not due on the primary job.


When would you pay the PPD award in a lump sum?
(Permanent Partial Disability)

If the award is less than $6,000
If the award is more than $6,000 and the IW requested a lump sum payment


When would an insurer not approve the workers request for a lump sum payment?

- The worker has not waived the right to appeal the closure
- the award is not final by operation of law
- the payment of compensation has been stayed pending a request for hearing
- the worker is enrolled in a voc training program


How many days does the insurer have to pay the PPD award granted by Notice of Closure?

30 days from mailing date of notice of closure