General Claims Handling – California Workers Compensation, Self Insurance Practice Test

These questions are part of the practice quiz. Start practicing

• What information is not required in the Claim Log?
• What is your responsibility when an employee with a back injury is declared to have permanent disability?
• When is it unnecessary to notify the Manager of a change in status?
• What is the focus of training for claim adjusters in California Workers Compensation?
• Which two fingers are most commonly involved in Dupuytren's contracture?
• What is the role of the Workers Compensation Appeals Board (WCAB) in cases of unreasonable refusal of treatment?
• What is the primary focus of workers' compensation insurance?
• What is the standard rating for a knee injury that produces no objective disability but prescribes a local knee brace?
• What is typically a consequence of not handling a workers’ compensation claim in good faith?
• Which of the following best describes a reasonable refusal of medical treatment?
• After examining the injured worker, how long does the Independent Medical Reviewer have to make a determination?
• How long does an employer have to initiate a self-insurance program after obtaining a Certificate to Self-Insure?
• How long does the employer have to respond to an Independent Medical Review request for medical records?
• What can be a result of an effective safety program?
• What options do employers have for managing vocational rehabilitation?
• For a 39-year-old mechanic with slight knee instability and preclusion from heavy lifting, what is the level of permanent disability?
• What does ‘maximum medical improvement’ (MMI) indicate?
• What happens to an employee’s compensation if their permanent disability is under the limit while being guilty of serious and willful misconduct?
• What should an injured worker do if they disagree with a medical evaluation conducted by a QME?
• What percentage is assigned for complete immobility of the great toe?
• Prior to April 19, 2004, what was the limit of temporary disability (TD) payments?
• What standard rating is given for occasional severe back pain?
• If an injured worker has an aphakic eye with vision capable of being corrected, what is the standard rating for this condition?
• What does a self-insured employer's failure to fund their trust account affect?
• Dupuytren's contracture specifically involves which part of the body?
• Which of the following is true regarding the employer's responsibility in claims handling?
• Which aspect is NOT relevant when discussing good faith in claims handling?
• When can rehabilitation benefits be settled?
• If an employee is hit by a passerby while arriving at work early in the parking lot, what is the status of the injury?
• Who can impose a penalty if you fail to notify the excess carrier of a claim?
• What is an 'LCM rate' in relation to permanent disability?
• What standard rating is assigned for hoarseness?
• Who is the current Chief of the Office of Self Insurance Plans?
• What is the significance of managing claims in good faith?
• What does achieving a ‘good faith’ claim resolution imply for the injured worker?
• Which of the following is a condition for exclusive remedy in workers' compensation claims?
• In what context is the term "Independent Medical Review" used in California Workers Compensation?
• What factor generally indicates a higher level of disability rating?
• When is a proof of service necessary?
• When is a document considered filed with the Workers Compensation Appeals Board?
• Can an injured worker select their own treating physician in California Workers' Compensation?
• How can an employer demonstrate good faith in a workers' compensation claim?
• To be considered an Experienced Med Only Claims Adjuster, how many years of recent experience are required?
• What document details the terms of medical treatment for an injured worker?
• What are the three basic elements of rating for knee disability?
• What is the time frame in which an Employer's First Report of Occupational Injury or Illness must be filed?
• What can be the consequence of paying a Med/Legal bill late?
• What should you do if you find missing indemnity files while auditing claims?
• Which entity is responsible for resolving disputes in California workers' compensation claims?
• In California Workers' Compensation, what is a key characteristic of disability benefits?
• What condition is likely to lead to a rating of 0% disability?
• If an insurance carrier files an Application for Adjudication of Claim against an employee and they later get represented, who pays for attorneys' fees when settled?
• What are the financial requirements for employers to become self-insured in California?
• What type of claims does the Chief of the Office of Self Insurance Plans oversee?
• Define the term 'Second Injury Fund' within the California Workers' Compensation system.
• Which of the following best defines ‘permanent partial disability’ in California Workers' Compensation?
• When must every self-insurer file their Annual Report?
• If a retired employee working as a reserve police officer gets injured, how should their temporary and permanent disability benefits be calculated?
• What is the least amount of loss of motion of a finger(s) that is considered rateable using the 1997 schedule?
• What is the nature of an aggregate stop loss excess insurance policy for an employer?
• What type of medical report must the treating physician provide for continuing treatment?
• For an employee with Permanent Disability between 15% - 25% between 2004 - 2013, what is the benefit amount?
• For an employee whose right major index finger fails to flex properly and has a 25% grip loss, what is the percentage of permanent disability?
• If an employee has a Permanent Disability between 26% - 49% from 2004 - 2013, what is the benefit provided?
• What were the limits for reasonable burial expenses prior to 1991?
• If an employer wants an employee to sign a waiver for a pre-existing condition, what should you advise?
• What is the maximum benefit for an employee with a Permanent Disability between 50% - 99% within the 2004 - 2013 range?
• What does a finding that the injuries resulted from the employee's serious and willful misconduct imply?
• How many working days does an employer or insurance carrier have to provide an employee with a change of physician upon request?
• How many days does a physician have to submit a Doctor's First Report of Occupational Injury or Illness?
• What does 'subrogation' refer to in workers' compensation claims?
• Under what circumstance does exclusive remedy for injury or death not apply?
• A 21-year-old baker has a Colles fracture resulting in specific grip strength readings. What is the percentage of permanent disability for this case?
• What aspect is considered when determining the benefit amount for Permanent Disability?
• Can injured workers in California receive benefits for mental health injuries?
• How is temporary disability compensation calculated in California?
• If an injured worker unreasonably refuses medical treatment, what action should be taken regarding their workers compensation benefits?
• What is the time limit for an injured worker to report their injury to their employer in California?
• What is the amount of the death benefit for an employee who dies from injuries sustained in 2000, but is deceased in 2006?
• How long must a self-insured administrator maintain the claim file?
• What does the concept of ‘good faith’ in workers' compensation claims primarily refer to?
• Which statement is true regarding pre-existing conditions in workers' compensation claims?
• For a knee injury on January 15, 2011, to a 38-year-old cook, what effect does adjusting for occupation have on age rating?
• What are the three main benefits provided under California Workers' Compensation?
• What type of injuries are not covered by California Workers' Compensation?
• What is the maximum income a person can have to qualify for total dependency in workers compensation claims?
• How long does one have to pay a Med/Legal bill?
• How does the ‘California Small Employer Program’ assist small businesses?
• What is a key benefit of informing employees about their workers' compensation rights?
• What is the maximum penalty for failing to comply with California Workers' Compensation reporting requirements?
• What is the percentage rating for a knee injury that produces no objective disability but requires a stretch knee brace?
• If an employer forces an injured worker to accept less money than they are due, what penalty do they face?
• What should be compensated when an injury causes both grip loss and atrophy?
• Who has the authority to petition for a change of an employee-selected physician?
• What should an injured employee do if their claim is denied?
• What must self-insured employers do annually to maintain their status?
• Under California Workers' Compensation, what is an expected outcome of disability benefits?
• How are non-work-related injuries characterized in workers' compensation claims?
• Loss of the radial head is considered what percentage of absolute disability?
• Which of the following best describes a compensable injury?
• When encountering an occupation not listed in the schedule, what should you do?
• When the treating physician releases an employee to return to work after patella removal, what is the next step?
• Within how many days must a Petition for Reconsideration be filed following service of a Finding and Award by the Workers Compensation Appeals Board?
• What is the primary role of the Chief of the Office of Self Insurance Plans?
• Who is the current Director of Industrial Relations?
• If you disagree with the findings of an Agreed Medical Examiner, what should you do?
• Which of the following injuries would most likely not require a rating?
• How does a permanent partial disability affect an employee's earning capacity?
• What type of expenses are typically covered in Permanent Disability benefits?
• Who do you apply to for a Certificate of Consent to Self-Insurance?
• What should be done if a physician did not perform a particular exam or prepare the report?
• What is the fine for late annual reports capped at?
• How many hours of post-certification training is required for a claim adjuster every 2 years?
• What is a ‘Notice of Employee’s Injury’ in California Workers' Compensation?
• What is defined as a "compensable injury"?
• What type of dependency is typically acknowledged by workers' comp regulations?
• In California workers compensation, how is medical treatment typically initiated post-injury?
• What is the consequence for an employer that does not comply with self-insurance regulations?
• How long does an employer have to file a Petition to Terminate Liability for continuing payments after terminating payments for temporary disability?
• What role do insurers play in maintaining good faith in claims processing?
• What time frame is allowed for reporting inadequate funding of a self-insured trust account?
• In California, under what circumstances would a physician be required to provide a Med/Legal bill?
• What is the total training hours required for Med Only Claim Adjusters to be certified?
• Why is it important for employers to keep accurate records of workplace injuries?
• If there are no dependents to pay an inmate's benefits to, who is the recipient of those benefits?
• If an employer is guilty of serious and willful misconduct and an employee loses both hands, what percentage should reserves be increased by?
• If an employer directs you to deny a meritorious claim, what should your response be?
• What is the requirement for an employee to be considered a covered employee in the Medical Provider Network?
• What is the permanent disability percentage for an electrician with a knee injury resulting in a 10-degree loss of detention?
• What impact does ‘permanent partial disability’ have on an employee?
• How are work-related injuries defined in the context of workers' compensation claims?
• Which of the following contributes most to an employer's decision in managing claims?
• If three persons are wholly dependent on a deceased employee and there are additional partial dependents, what would the partial dependents receive?
• Which of the following does not contribute to rateable disability?
• When is rateable disability not allowed to increase based on subjective descriptions?
• Where must out-of-state self-insurers maintain their claims files?
• For what reason might an employee appeal a Permanent Disability rating?
• What can estimates of future liability never be reduced by, unless there is an Order of Credit?
• What type of pain would be tolerated but significantly hinder performance of an activity?
• If a worker files a claim and is later found to have been injured outside of work, what happens to their claim?
• What is typically not included in the calculation of a permanent disability rating?
• What should you obtain if an employee is guilty of serious and willful misconduct and has a permanent disability of 50%?
• Who can receive benefits if an inmate has no dependents under California Workers Compensation?
• What is the function of a Claims Administrator in workers' compensation?
• For a 46-year-old electric arc furnace operator limited to light work due to silicosis, what is the level of Permanent disability?
• What is the role of a Qualified Medical Evaluator (QME)?
• What types of medical treatment are included under California Workers' Compensation?
• Under what condition can an employee's compensation be reduced by 50% if they are seriously injured due to their own serious and willful misconduct?
• In the event of a third-party recovery, who has the first right to recover expenses if the employer's line does not exceed the amount recovered?
• Are medical-only claims included in the Annual Report?
• What does "substantial cause" mean for a victim of a violent act?
• Who are primarily responsible for ensuring fair treatment of injured workers in claims?
• What does the ‘disability rating’ signify in workers' compensation claims?
• What happens when a self-insured certificate is revoked?
• Who is entitled to filing for a workers’ compensation claim?
• What penalty does a self-insured employer face for denying a claim without proper documentation?
• What is the standard rating for an individual with moderate vertigo?
• How many years of experience is required to be considered an Experienced Claims Adjuster?
• What is the primary role of the insurance carrier in a workers' compensation claim?
• How often should employers review their workers' compensation insurance coverage?
• Which specialist should an employee with a herniated disc be referred to?
• What document must a physician submit to report an occupational injury or illness?
• What must an employer provide for an employee to be part of the Medical Provider Network?
• If an employee suffers an injury in 1992 resulting in a permanent disability award, and the appeals board finds the injury was due to the employee’s serious misconduct, what is the outcome for their compensation?
• What action should you take when an employee is sent to a physician for the removal of a foreign object from their eye?
• What is the maximum amount allowed for reasonable burial expenses for a death resulting from a 2013 injury?
• What are the limits for reasonable burial expenses between 1991 and 2012?
• How often should the Med/Legal fee schedule be updated?
• How much stronger is the dominant hand compared to the non-dominant hand?
• What is the time frame in which an insurer must notify authorities about a suspected fraudulent act in a workers compensation claim?
• What is typically included in the determination of Med/Legal bill payments?
• When an employer wants to compromise a claim for an employee with a 15% permanent disability, what should the claims handler advise?
• What is the primary purpose of the Employer's First Report of Occupational Injury or Illness?
• Which DWC notice requires proof of service?
• If an employee is injured on March 2, 2011, but not reported until March 4, when does disability begin?
• To safeguard the right to recover workers' compensation payments from a negligent third party, what legal action should be filed?
• What is the penalty for late payment of a Med/Legal bill?
• How soon must injured workers in California report their injury to their employer?
• What is a ‘Return-to-Work’ program?
• What should you do if an injured employee who is temporarily disabled becomes incarcerated for an unrelated crime?
• What is the purpose of a ‘claim form’ (DWC-1) in California Workers’ Compensation?
• Under what circumstance can an employee pursue a civil action against a co-employee while also receiving workers compensation?
• What documents should be filed with the WCAB if you choose not to be represented after the applicants' attorney files an Application for Adjudication of Claim?
• If temporary disability payments are awarded, what is the significance of the 10-day timeline for filing a petition?
• What does the California Self-Insurers’ Security Fund provide?
• Are injured workers in California entitled to reimbursement for out-of-pocket medical expenses?
• When is reapplication for a Certificate of Consent to Self-Insure needed?
• What does 'temporary disability' refer to in the context of workers’ compensation?
• What should occur when a trust account for self-insured claims is not funded adequately?
• What is a consequence of failing to report a claim to the excess carrier in a timely manner?
• When can the employer request a second opinion under Labor Code 4062(b)?
• Who must establish a self-insured program in California?
• What methods can employers use to communicate about workers' compensation benefits?
• Which legislation governs the Workers' Compensation system in California?
• What does pronation of the forearm refer to?
• What is the period of time extended for the hernia, heart, and pneumonia presumption upon termination?
• What are the limits for reasonable burial expenses after January 1, 2013?
• How long does an injured employee have to wait before they can go to their own doctor if their employer does not have a Medical Provider Network?
• A Disability Evaluation Unit Rater with a report that apportions permanent disability for an unrepresented worker must send the report to?
• What defines a Medical Only claim in workers compensation?
• What is the penalty percentage for failing to obtain worker's compensation coverage based on the compensation paid?
• What is the primary function of self-insurance in California Workers’ Compensation?
• How can claims be resolved through alternative dispute resolution (ADR) in workers' compensation?
• If an employee has an admitted injury resulting in permanent disability of 72% and is guilty of serious and willful misconduct, what should the Board award?
• Within how many days is the treating physician required to provide a medical report for continuing treatment?
• What factors are considered in evaluating permanent disability in California?
• What is the standard rating for a knee injury that produces no objective disability but requires a long leg brace?
• For a master certificate applied for after July 1, 1994, what are the minimum net worth and income requirements?
• What effect do effective safety programs have on workers' compensation costs?
• In which Claim Log will an injury that occurs in December but is reported in January be recorded?
• What is essential for a Claims Administrator to effectively manage a claim?
• What is the primary purpose of a Self-Insurer's Annual Report?
• As an examiner handling a third party case, what should be your primary concern?
• If an employee is terminated after filing a claim for compensation benefits, what are they entitled to?
• What is the primary purpose of the California Workers' Compensation system?
• What is the burial expense limit for workers' compensation claims after 2012?
• Who is responsible for enforcing benefit notices and ensuring timely payments?
• What is the liability of an employer who forces employees to receive workers compensation benefits at a lower rate?
• In workers’ compensation claims, what does ‘apportionment’ refer to?
• If the Director of Industrial Relations finds a private self-insured employer has failed to pay benefits, what can they do?
• What is ‘voluntary compensation coverage’ in workers' compensation?
• When is it permissible to close a claims file?
• What is the level of permanent disability for a 39-year-old baker with a knee injury precluding heavy lifting?
• What do 'disability benefits' in California Workers' Compensation comprise?
• What is the maximum penalty for failure to file a complete or timely annual report?
• What is the 'statute of limitations' for filing a workers' compensation claim in California?
• Which of the following is NOT a benefit amount category for Permanent Disability?
• What are potential consequences of providing false information on a workers' compensation claim?
• What does 'Aggravation' refer to in workers' compensation claims?
• What is the status of an employer's Certificate to Self-Insure once issued?
• What authority governs the approval of necessary medical services in California Workers' Compensation?
• For an injured employee aged 38, how would their disability rating generally be treated?
• Which type of permanent disability is considered total?
• Formal rating determinations shall be considered evidence for which aspect?
• How long after termination of service is the hernia, heart, and pneumonia presumption extended?
• What action is appropriate if an insurance claim is denied due to a lack of evidence?