Workers Compensation Claims Flashcards
7 cards from real CALA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Workers Compensation Claims flashcards as text
Which of the following injuries would most likely NOT be compensable under standard workers compensation?
Answer: An injury sustained during a voluntary off-site company social event
Injuries during purely voluntary social events that are not in the course and scope of employment are generally not compensable under workers compensation.
A workers compensation insurer exercises subrogation rights. This means the insurer:
Answer: Seeks reimbursement from a liable third party after paying benefits to the injured worker
Subrogation allows the workers compensation insurer to recover benefits paid from a negligent third party who caused or contributed to the worker's injury.
What is the 'waiting period' in workers compensation?
Answer: The number of days an employee must miss work before indemnity benefits begin
The waiting period is the initial number of days of disability that must pass before an injured worker becomes eligible to receive indemnity benefits.
A workers compensation claim involves a cumulative trauma disorder. Which of the following best describes this type of claim?
Answer: An injury caused by repetitive work activities over time rather than a single incident
Cumulative trauma disorders arise from repetitive motions or chronic exposures over time, such as carpal tunnel syndrome from repetitive typing.
When adjusting a workers compensation death claim, survivor benefits are most commonly paid to:
Answer: The deceased worker's spouse and dependent children
Workers compensation death benefits are primarily paid to surviving dependents, typically the spouse and minor children of the deceased employee.
An employer has five employees and operates in a state with a five-employee threshold for mandatory workers compensation coverage. The employer is:
Answer: Required to carry workers compensation coverage
If a state requires coverage at five or more employees and the employer has exactly five, they meet the threshold and must carry workers compensation insurance.
What is an 'experience modification factor' (e-mod) in workers compensation?
Answer: A multiplier applied to the standard premium based on an employer's actual loss history compared to expected losses
The experience modification factor adjusts workers compensation premiums up or down based on whether an employer's actual losses are better or worse than the industry average.