QME testing 5 Flashcards
(15 cards)
What are the four main types of benefits under California workers’ compensation?
Medical care, temporary disability (TD), permanent disability (PD), and supplemental job displacement benefits (SJDB).
What is the time limit for reporting a work injury to an employer to maintain eligibility for benefits?
30 days from the date of injury.
What is the time limit for the employer to authorize medical treatment after a claim is filed?
Within 1 working day per Labor Code §5402(c).
How much treatment must be authorized during the investigation period following a claim?
Up to $10,000 in medical care must be authorized while the claim is being investigated.
When does the employer’s liability for workers’ compensation benefits become presumed under California law?
After 90 days without denial, the claim is presumed accepted per Labor Code §5402(b).
What are the two types of temporary disability (TD) benefits?
Temporary total disability (TTD) and temporary partial disability (TPD).
How long are temporary disability benefits typically available?
Up to 104 weeks within 5 years of the date of injury, with exceptions for certain injuries.
What triggers the start of permanent disability (PD) payments?
When the injured worker reaches maximum medical improvement (MMI).
What factors determine the permanent disability (PD) rating?
Impairment rating, age, occupation, and apportionment to non-industrial factors.
What are supplemental job displacement benefits (SJDB)?
A voucher for retraining/education if the injured worker does not return to regular or modified work within 60 days of TD ending.
What is the maximum burial expense for injuries before January 1, 2013?
5000
What is the maximum burial expense for injuries on or after January 1, 2013?
10000
Who is responsible for ensuring timely delivery of workers’ compensation benefits?
The claims administrator (adjuster).
What form must be given to an injured worker within one working day of reporting the injury?
DWC Form 1 (Workers’ Compensation Claim Form).
What is the function of utilization review (UR)?
To determine the medical necessity of requested treatment based on guidelines.
