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Flashcards in Quiz # 1 Deck (20)
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1

What does the acronym EDOK stand for?

Employer Date of knowledge

2

What does the acronym EAI stand for at SAIF?

Employer at injury

3

What Does the acronym MOI stand for at SAIF

Mechanism of Injury

4

What section number is the Oregon Revised Statute covers the laws concerning workers comp?

656

5

What chapter of the Oregon Administrative Rules covers the laws concerning the processing of workers compensation claims?

436

6

Which Oregon Administrative Rule division number covers Claims Administrations Rules?

60

7

Which two divisions under the Department of Consumer and Business Services

- Workers Compensation Board
- Workers Compensation Division

8

Which form is used by the worker and the employer to report an injury to the insurer?

801

9

Which of the following are uses of the Form 827 - Workers and Health Care Providers report of workers compensation claim?

- Report of aggravation
- First report of an injury or disease
- Request for a new or omitted medical condition
- Notice of change of attending physician or nurse practitioner

10

Which of the following are uses for the Form 1502- Insurer's report?

- First report of an injury (to WCB)
- Acceptance or denial of the claim
- Notice of settlement
- Aggravation

11

How much time does a physician have to send the Form 827 to the insurer if its being sent as the first report of an injury?

72 hours of the initial office visit

12

How much time does the employer have to send the form 801 to the insurer?

5 days from the date of employers knowledge that a claim is being made

13

When must the notice of change of attending physician or nurse practitioner be sent to the insurer using form 827?

Within 5 days of the office visit

14

Attending Physician: A doctor or physician who is ________ or illness

Primarily responsible for the treatment of a workers compensable injury

15

Claim: ________ from a subject worker or someone on the workers behalf, __________.

- A written request for compensation
- Or any compensable injury of which a subject employer has notice or knowledge

16

Compensable injury: ___________ requiring ________; an injury is accidental if the result is an accident, whether or not due to accidental means, if it is _______________.

- An accident injury, or accidental injury to prosthetic appliances, arising out of an in the course of employment
- Medical Services or resulting in disability or death
- established by medical evidence

17

Match the legal standards for determining compensability in an injury claim and in an occupational disease claim.

- Determining compensability in an injury claim - Material contributing cause of the need for treatment or disability

- Determining compensability in an occupational disease claim - Major contributing cause of the condition.

18

Choose the instances when a claim would most likely NOT be compensable (3)

- Injury occurs to any active participant in assaults or combats that are not connected to the job assignment and are a deviation for customary duties

- injury occurs while engaging in or performing any social or recreational activity primarily for the worker's pleasure

- Major contributing cause of the injury is caused by the workers consumption of drugs or alcohol. Major cause must be demonstrated by a preponderance of the medical evidence.

19

What does the phase course and scope mean?

- Arising out of - causal relationship to work
- In the course of - time place and circumstance

20

Which one is not one of the fives claims tenets? (Know the other 4)

- Claims Adjusters will assist employers with labor issues that may arise due to a workers compensation claim and partner with outside labor attorneys when appropriate to ensure efficient claims management.