Flashcards in Quiz #3 Deck (20)
What is the definition of Impairment?
A permanent loss of use or function of a body part or system related to the compensable condition
Palliative Care: Medical service rendered to _________ or _______________, but does not include those medical service rendered to t diagnose, heal, or permanently alleviate or eliminate to a medical condition.
- Moderate temporarily the intensity of an otherwise stable medical condition
What are examples of medical services? (3)
- Prosthetic appliances
Work disability means the separate factoring of impairment as modified by ___________, to perform the job at which the worker was injured
- Age, education, and adaptability
Which are elements of a bona fide (formal) job offer of modified work? (2)
- The attending physician is notified of physical tasks to be performed.
- The attending physician agrees with the modified work and commute is within capabilities
What are the seven elements of the written bona fide (formal) job offer from the employer?
- start date and time, duration of the modified work, statement that AP has approved the modified work, description of physical requirements, place or location of the modified work, hours and days to be worked, wages
What are the elements needed to stop or prorate time-loss benefits when a worker has been terminated from the employer at injury? (2)
- Employer has a written RTW policy
- Approved modified job description from attending physician
In order to stop or prorate time-loss benefits when a worker has been terminated from the employer at injury, what elements must be included in the Memo to the file? (4)
- state date and time
- wages (aww/salary)
- Hours and days work available
- statement that modified work is available but for termination
Which of the Type B medical providers is also able to rate impairment
How many days can an authorized nurse practitioner provide medical services?
180 days from the date of the first visit on the initial claim
How many days do insurers have to pay medical bills that were received prior to a claim decision once the claim has been accepted?
14 days from the date of acceptance
How many days do insurers have to pay worker reimbursements?
30 days from the receipt of the request for reimbursement.
The worker has up to one year to report an occupational disease to the employer. What are the event triggers that may start the time frame? (4)
- 1 year from the date the worker first discovered the OD
- 1 year from the date the worker became disabled
- 1 year from the date the worker is informed by a doctor of the OD
- 1 year from the date of death or when discovered the OD was the cause of the death
True or False - The legal standard for determining compensability of a combined condition claim is material contributing cause of either the disability or the need for treatment of the combined condition.
Which items of the information must be included on the denial?
- appeal rights
- the factual and legal reasons for the denial
- whether the denial was based in whole or in part of an IME
What information is needed before closing a claim? (4)
- Actual work status
- Medically stationary status
- Status and date of the work release
- Information concerning permanent impairment, if any
How many days do injured workers have to appeal the Notice of Closure?
- 60 days from the mailing date of the Notice of Closure
How much time does an insurer have t respond to the attending physician’s request for palliative care?
30 days from the receipt of the request from the attending physician
How many days does an adjuster have to issue a decision on an aggravation claim?
60 days from the receipt of the request to reopen the claim