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
A claimant receiving temporary total disability benefits begins receiving Social Security Disability Insurance (SSDI). What typically occurs?
Answer: Workers compensation benefits may be offset to prevent the combined benefits from exceeding a statutory percentage of pre-injury wages
Most states allow an offset so that combined workers compensation and SSDI benefits do not exceed a set percentage (commonly 80%) of the worker's pre-injury average weekly wage.
Under workers compensation, the 'average weekly wage' (AWW) is primarily used to:
Answer: Calculate the amount of indemnity benefits the injured worker is entitled to receive
The average weekly wage is the basis for calculating indemnity benefits such as temporary total disability, which are typically paid as a percentage of AWW.
A workers compensation adjuster receives a claim from an undocumented worker injured on the job. In most states, this worker is:
Answer: Entitled to workers compensation benefits regardless of immigration status
Most states extend workers compensation coverage to all workers regardless of immigration or documentation status, as the injury occurred in the course of employment.
What is the primary role of an Independent Medical Examination (IME) in a workers compensation claim?
Answer: To obtain an objective medical opinion on the nature, extent, or causation of the claimant's injury
An IME provides an independent, objective medical evaluation to assist adjusters, attorneys, or courts in resolving disputes about diagnosis, causation, or degree of disability.
Which of the following best describes a 'compromise and release' settlement in workers compensation?
Answer: A lump-sum settlement that closes all aspects of the claim in exchange for a release of future liability
A compromise and release is a full and final settlement where the claimant accepts a lump sum in exchange for releasing the employer and insurer from all future obligations on the claim.
An employer intentionally removes safety guards from machinery to increase production speed, and a worker is injured as a result. This may expose the employer to:
Answer: A civil lawsuit outside the workers compensation system due to intentional employer misconduct
Intentional employer misconduct that causes injury may fall outside the exclusive remedy protection of workers compensation, allowing the employee to file a separate civil tort action.
A workers compensation claim is placed in 'litigation hold' status. What does this mean for the adjuster's file handling?
Answer: All documents related to the claim must be preserved and not destroyed due to pending legal proceedings
A litigation hold requires preservation of all claim-related documents and communications to comply with legal discovery obligations in pending or anticipated litigation.