Key Terms

Question 1

Accepted claim/Admitted claim

Answer 1

A workers’ compensation claim in which the claims administrator agrees that the worker’s injury or illness is covered by workers’ compensation. Even if a claim is accepted, however, there may be delays or other problems.

Question 2

Agreed medical evaluation (AME)

Answer 2

A doctor who is selected by agreement between the injured workers’ attorney and the claims administrator to conduct a medical examination and prepare a medical-legal report to help resolve a dispute.

Question 3

Alternative work

Answer 3

If the treating physician reports that the injured worker will probably never be able to return to the usual and customary occupation that was held at the time of the injury, the employer has the option of offering an alternative position. The new position must be at least 12 months in duration and must pay at least 85 percent of the wages and benefits that were being paid at that the time of injury. It also must be within a reasonable commuting distance of where the injured worker lived at the time of the injury.

Question 4

AOE/COE

Answer 4

Arising Out of Employment, and in the Course Of Employment or caused by a worker’s job and occurring while working. An injury or illness must be AOE/COE to be covered by workers’ compensation

Question 5

Appeals board

Answer 5

A group of seven commissioners who review and reconsider decisions of workers’ compensation administrative law judges. Also called the Reconsideration Unit. For additional information, visit the California Workers’ Compensation Appeals Board website.

Question 6

Social Pro Plus Price

Answer 6

$695

Question 7

Full-Day of Surveillance Price

Answer 7

$1150.00

Question 8

Half-Day of Surveillance Price

Answer 8

$695

Question 9

3/4 Day of Surveillance Price

Answer 9

$895

Question 10

Social Pro Price

Answer 10

$595

Question 11

Social Pro Elite Price

Answer 11

$1295

Question 12

Geosocial Sweep Price

Answer 12

$1495

Question 13

Medical / Specialty Sweep Price

Answer 13

$400

Question 14

Research Time Price

Answer 14

$125 per HR

Question 15

Records Retrieval Price

Answer 15

$125 per HR

Question 16

Investigator Service Price

Answer 16

$105 per HR

Question 17

Recorded Statement Price

Answer 17

$105 per HR

Question 18

Targeted Claims Investigation Price

Answer 18

$105 per HR

Question 19

Claim form (DWC-1)

Answer 19

A form used to report a work injury or illness to your employer

Question 20

Application for adjudication of claim (application or app)

Answer 20

A form you file to open a case at the local Workers’ Compensation Appeals Board (WCAB) office if you have a disagreement with the insurance company about your claim.

Question 21

Applicants’ attorney (A/A)

Answer 21

A lawyer who represents injured workers in their workers’ compensation cases.

Question 22

Applicant/associate/employee (EE)

Answer 22

The injured worker

Question 23

LA Affiliate cover what Counties?

Answer 23

Santa Barbara County (Parts of), Ventura County, Los Angeles County, Orange County (Parts of)

Question 24

Compromise and release (C&R)

Answer 24

A type of settlement where the workers receive a lump sum payment, which includes the permanent disability amount and the estimate future medical care costs.

Question 25

Claim adjuster/claim administrator/claim examiner

Answer 25

A person who handles workers' compensation claims for employers. Some claims administrators work directly for large employers that handle their own claims.

Question 26

Cumulative trauma (CT) injury

Answer 26

An injury that was caused by repeated events or repeated exposures at work. Examples: hurting your wrist from doing the same motion over and over or losing your hearing because of constant loud noise.

Question 27

Date of injury (DOI)

Answer 27

If the injury was caused by one event (a specific injury), this is the date of the event. If the injury was caused by repeated exposures (a cumulative injury), this is the date that the worker knew of should have known that the injury was caused by work. death benefits. Money paid to qualified surviving dependents of a worker who dies from a work-related illness or injury. These benefits are paid usually at the same weekly rate as the maximum TD benefits in effect at the time of injury/illness. The maximum benefits will vary depending on the number of total and/or partial dependents.

Question 28

Defense attorney (DA)

Answer 28

The employer or the employer's insurance carrier’s legal representative.

Question 29

Independent medical evaluator (IME)

Answer 29

A physician selected by the judge (in California) or by the adjuster (in Arizona) to determine the cause of the medical condition, the permanent impairment of the injury, and/or the permanent limitations, if any, that the worker has sustained.

Question 30

Modified job (mod work)

Answer 30

If the treating physician reports that the injured worker will never be able to return to the same job duties that they had at the time they were injured, the employer is permitted to offer the injured worker a modified job instead of vocational rehabilitation benefits; that is the current job at the time of the injury with changes that meet the doctor’s work restrictions. It must last at least 12 months and pay the same wages and benefits as the job at the time of the injury.

Question 31

Permanent partial disability (PPD) benefits

Answer 31

Payments to a worker who can still work, but whose ability to compete in the open labor market is reduced.

Question 32

Permanent total disability (PTD) benefits

Answer 32

Payments to a worker who is considered permanently unable to compete in the open labor market.

Question 33

Qualified injured worker (QIW)

Answer 33

An injured worker who probably will never be able to return to his or her usual job and working conditions, and who probably could find a suitable job after receiving vocational rehabilitation services.

Question 34

Qualified medical evaluator (QME)

Answer 34

A doctor who is selected by either the injured worker, the worker’s attorney, of the claims administrator to conduct a medical examination and prepare a medical-legal report to help resolve a dispute. QMEs are certified by the state Industrial Medical Council.

Question 35

Temporary disability (TD)

Answer 35

Paid if a physician verifies that an injured employee cannot work because of work-related illness or injury. TD benefits are not paid for the first three days of work missed unless the employee is off more than fourteen days or hospitalized. The amount of TD compensation is determined by law and is two-thirds of the employee’s wages. Payments must be made every two weeks for as long as the employee is eligible. TD benefits stop when the employee returns to work or treating physician releases the employee for work or says that the injury has reached a point of maximum improvement.

Question 36

Temporary partial disability benefits (TPD)

Answer 36

Payments to a worker who can do some work while recovering but who earns less than before the injury.

Question 37

Temporary total disability benefits (TTD)

Answer 37

Payments to a worker who cannot work at all while recovering.

Question 38

Work restrictions

Answer 38

A doctor’s description of clear and specific limits on an injured worker’s job tasks, usually designed to protect the worker from further injury.

Question 39

Investigator Testimony Price

Answer 39

$ame as $urveillance

Question 40

Main Components of an SPP

Answer 40

Social Media Investigation, Background Check

Question 41

Main Components of an SP

Answer 41

Social Media Investigation

Question 42

Main Components of an SPE

Answer 42

Social Media Investigation, Background Check, Signed Affidavit by Investigator, Metadata to preserve content and links.

Question 43

What Case type is a Physicians View Assignment

Answer 43

Field Intel Assignment

Question 44

What services are included in a Claims View 360 Order?

Answer 44

3 days of Surveillance, SPP, and a (15 Facility) Med Sweep

Question 45

Do SMU's get edited by workflow? How do we Invoice?

Answer 45

No report needed, we simply can pdf a cover letter or the last update provided on the file into the case folder. Eship Invoice only.

Question 46

NDV

Answer 46

Next Day Video (Update sent to client when video is obtained)

Question 47

NDU

Answer 47

Next Day Update (Update sent to client when no footage is obtained, client will receive a setup shot)

Question 48

Medical Sweep order with a quantity 1 includes how many facility searches?

Answer 48

15 Facilities

Question 49

County of LA Rates?

Answer 49

2019 Standard

Question 50

Coach USA Rates?

Answer 50

2019 Standard

Question 51

COLA SPP Price?

Answer 51

$695

Question 52

The City of Torrance Rates?

Answer 52

Surveillance ($950 Full-Day, $550 Half-Day, 3/4 Day $750, Spot Check $325, MURF $450)

Question 53

For City of Torrance reports, who are reports addressed to if no DA is provided?

Answer 53

Patrick Sullivan

Question 54

Who are Sedgwick Ontario (COLA) Reports addressed to?

Answer 54

Chief County Counsel

Question 55

How many complimentary copies of DVD footage do clients receive?

Answer 55

1 free copy with all surveillance ordered.

Question 56

TPA

Answer 56

A third-party administrator is a company that provides operational services such as claims processing and employee benefits management under contract to another company. Insurance companies and self-insured companies often outsource their claims processing to third parties. Thus, such companies are often called third-party claims administrators

Question 57

JPA

Answer 57

A joint powers authority (JPA) is an entity permitted under the laws of some U.S. states, whereby two or more public authorities (e.g. local governments, or utility or transport districts), not necessarily located in the same state, may jointly exercise any power common to all of them. Ex. California Schools JPA & ASCIP