Test Study 2

Question 1

Which WCD Bulletin provides information about the fors to be used for a worker or an insurer to request reconsideration?

Answer 1

227

Question 2

A Worker is considered permanently and totally disabled when they are —— incapacitated from ——- performing work in a suitable and gainful occupation.

Answer 2

Permanently, Regularly

Question 3

The insurer has ——days from, ——————- to provide the director with documents pertaining to the claim in reconsideration process.

Answer 3

14 days ….. the date of the directors notice of the start of the recon proceeding

Question 4

Which of the following can occur in a reconsideration order?

Answer 4

Affirm compensation award, Increase compensation award

Question 5

The statutory time frame for appealing a notice of closure is

Answer 5

60 days for a worker and

7 days for the insurer

Question 6

Under what circumstances would we provide surveillance film for the medical arbiter to view?

Answer 6

When a physician involved in the evaluation and treatment of the worker has seen the video

Question 7

The insurer selects the medical arbiter in accordance with ORS 656.268 (8)(d)

Answer 7

False

Question 8

If a worker fails to attend a medical arbiter exam it could result in suspension of all the workers disability benefits.

Answer 8

True

Question 9

What does the acronym EDOK stand for at Saif Corporation?

Answer 9

Employer date of Knowledge

Question 10

What does the acronym EAI stand for at SAIF Corporation?

Answer 10

Employer at injury

Question 11

What does the acronym MOI stand for at SAIF Corporation?

Answer 11

Mechanism of injury

Question 12

Which section number of the Oregon revised statues covers the laws concerning workers compensation?

Answer 12

656

Question 13

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

Answer 13

436

Question 14

Which Oregon Administrative Rule Division Covers Claims Administration Rules?

Answer 14

60

Question 15

Which two divisions under the Department of Consumer and Business Services regulate the workers compensation process?

Answer 15

Workers Compensation Board, Workers Compensation Division

Question 16

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

Answer 16

801

Question 17

Which of the following are uses of the form 827- worker’s and Health Care Providers’ report of Workers’ Compensation Claim?

Answer 17

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

Question 18

Which of the following are uses of the form 1502- Insurer’s report?

Answer 18

First report of an injury, acceptance or denial of the claim, aggravation

Question 19

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

Answer 19

72 hours of the initial office visit

Question 20

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

Answer 20

5 days from the date of the employer’s knowledge that a claim is made

Question 21

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

Answer 21

Within 5 days of the office visit

Question 22

Attending Physician:

Answer 22

A doctor or physician who is primarily responsible for the treatment of a workers compensable injury or illness.

Question 23

Claim:

Answer 23

a written request for compensation from a subject worker or someone on the workers behalf, or any compensable injury of which a subject employer has notice or knowledge

Question 24

Compensable Injury:

Answer 24

An accidental injury, or accidental injury to prosthetic appliances, arising out of an in the course of employment requiring medical services or resulting in disability or death, an injury is accidental if the result is an accident, whether or not due to accidental means, if it is established by medical evidence supported by objective findings.

Question 25

determining compensability in an injury claim and in an occupational disease claim:

Answer 25

Injury claim. Material contributing case of the need for treatment or disability. Occupational disease claim. Major contributing cause of the condition.

Question 26

What does the phrase “course and scope” mean?

Answer 26

“arising out of” Causal relationship to work | “in the course” time, place, and circumstances

Question 27

How many days can an emergency physician authorize time loss benefits?

Answer 27

14 days

Question 28

Which of the following is not a type b medical provider.

Answer 28

Cardiologist

Question 29

How many days of office visits can a type b medical provider provide medical services. Page 18

Answer 29

60 days or 18 office visits from the date of the first visit.

Question 30

How many days do insurers have to pay medical bills for an accepted claim?

Answer 30

45 days from receipt of bill

Question 31

How many days can a type b medical provider authorize time loss.

Answer 31

30 days

Question 32

Which of these type of medical providers is also able to rate impairment?

Answer 32

Chiropractor

Question 33

How many days can an authorized nurse practitioner provide medical service?

Answer 33

180 days from the date of the first visit on the initial claim.

Question 34

How many days can an authorized nurse practitioner authorize time loss benefits?

Answer 34

180 days from the date of the first visit on the initial claim.

Question 35

How many days does an insurer have to respond in writing to a written request for diagnostic preauthorization.

Answer 35

Within 14 days of receiving the request from the provider.

Question 36

How many days does the insurer have to reclassify a claim from nondisabling to disabling?

Answer 36

14 days

Question 37

When a worker is represented by an attorney, when do you need to provide discoverable documents? and how often do you need to provide updates?

Answer 37

14 days and updates every 30 days there after

Question 38

What four areas is a claims adjuster responsible for setting reserves?

Answer 38

Medical, Temporary disability, Permanent disability, and legal fee's

Question 39

When a claim denial is appealed, what are the four levels of litigation that can occur?

Answer 39

In person hearing before an Administrative Law Judge ALJ. Board review of the ALJ opinion by the Workers Compensation Board. Review by Oregon Court of Appeals Review by the Oregon Supreme Court.