AIC AIC Workers Compensation & Liability Claims 1 — Questions and Answers
Question 1: Under workers' compensation law, what is the 'exclusive remedy' doctrine?
- The claimant must use only one doctor
- Workers' compensation benefits are the sole remedy an injured employee has against the employer for work-related injuries (Correct answer)
- The insurer must settle claims exclusively through mediation
- Only one adjuster may handle each claim
Correct answer: Workers' compensation benefits are the sole remedy an injured employee has against the employer for work-related injuries
The exclusive remedy doctrine bars employees from suing their employer in tort for workplace injuries, making workers' compensation the sole source of recovery.
Question 2: What is a 'compensable injury' under workers' compensation?
- Any injury that occurs at home while working remotely
- A work-related injury or illness arising out of and in the course of employment that qualifies for workers' compensation benefits (Correct answer)
- An injury requiring surgery costing more than $5,000
- An occupational disease not covered by health insurance
Correct answer: A work-related injury or illness arising out of and in the course of employment that qualifies for workers' compensation benefits
For an injury to be compensable under workers' compensation, it must arise out of employment (causation) and occur in the course of employment (time and place).
Question 3: What does 'temporary total disability' (TTD) mean in workers' compensation?
- A permanent impairment preventing any work
- A condition where the injured worker is completely unable to work for a limited period while recovering (Correct answer)
- A disability affecting only part of the workday
- A disability caused by a pre-existing condition
Correct answer: A condition where the injured worker is completely unable to work for a limited period while recovering
TTD benefits replace a portion of lost wages when an injured worker is temporarily unable to perform any work while receiving medical treatment and recovering.
Question 4: What is 'maximum medical improvement' (MMI) in workers' compensation claims?
- The point at which the insurer stops paying medical bills
- The point at which the injured worker's medical condition has stabilized and further recovery is unlikely (Correct answer)
- The maximum amount of medical benefits the insurer will pay
- The date the worker must return to full duty
Correct answer: The point at which the injured worker's medical condition has stabilized and further recovery is unlikely
MMI is the point in recovery where the treating physician determines the worker's condition is unlikely to improve further, which is a key milestone for determining permanent disability ratings.
Question 5: In workers' compensation, what is an 'independent medical examination' (IME)?
- A medical exam required before any claim is accepted
- An examination by a physician selected by the insurer or employer to provide an objective opinion on the injury (Correct answer)
- An exam required by the treating physician
- A mandatory annual health screening for all employees
Correct answer: An examination by a physician selected by the insurer or employer to provide an objective opinion on the injury
An IME allows the insurer or employer to obtain an independent medical opinion on the nature, extent, and work-relatedness of the claimed injury.
Question 6: What is the purpose of a 'light duty' offer in managing workers' compensation claims?
- To reduce the employer's OSHA obligations
- To offer modified or restricted work within the injured employee's medical restrictions, reducing wage loss benefits (Correct answer)
- To avoid paying medical bills during recovery
- To transfer the claim to a different insurer
Correct answer: To offer modified or restricted work within the injured employee's medical restrictions, reducing wage loss benefits
A valid light duty job offer within the employee's restrictions can reduce or eliminate temporary disability benefits if the worker refuses appropriate work.
AIC AIC Workers Compensation & Liability Claims 1
Under workers' compensation law, what is the 'exclusive remedy' doctrine?