CALA Workers Compensation Claims 2 — Questions and Answers
Question 1: An employee is injured while traveling from one job site to another during the workday. Under workers compensation, this injury is most likely:
- Compensable as it occurred in the course of employment (Correct answer)
- Not compensable because it occurred off the employer's premises
- Compensable only if the employee was using the employer's vehicle
- Not compensable under the going and coming rule
Correct answer: Compensable as it occurred in the course of employment
Travel between job sites during the workday is considered within the course and scope of employment and is therefore compensable.
Question 2: Which of the following best describes the 'odd lot' doctrine in workers compensation?
- A worker who cannot compete in the regular labor market due to injury may be deemed totally disabled (Correct answer)
- A worker injured during unusual work tasks receives reduced benefits
- Injuries to odd body parts receive different compensation rates
- Claims filed in odd-numbered months have different statutes of limitations
Correct answer: A worker who cannot compete in the regular labor market due to injury may be deemed totally disabled
The odd lot doctrine holds that a claimant may be considered permanently totally disabled if their injury renders them unable to compete in the open labor market.
Question 3: A workers compensation claimant reaches Maximum Medical Improvement (MMI). What does this mean for the claim?
- The claimant's medical condition has stabilized and further treatment is unlikely to improve the condition (Correct answer)
- The claimant has fully recovered and no further benefits are owed
- The claim must be closed immediately upon reaching MMI
- The employer is no longer liable for any medical expenses
Correct answer: The claimant's medical condition has stabilized and further treatment is unlikely to improve the condition
MMI means the claimant's condition has plateaued and further medical treatment is not expected to result in significant improvement.
Question 4: Under workers compensation, a 'scheduled loss' benefit typically applies to:
- Permanent partial disability involving specific body parts like limbs or digits (Correct answer)
- Temporary total disability lasting a set number of weeks
- Fatal claims with a fixed survivor benefit schedule
- Medical-only claims with no lost time
Correct answer: Permanent partial disability involving specific body parts like limbs or digits
Scheduled loss benefits are fixed statutory amounts for permanent loss or loss of use of specific body parts listed in the workers compensation statute.
Question 5: Which of the following is generally considered a 'compensable consequence' in a workers compensation claim?
- A secondary injury that directly results from a compensable primary injury (Correct answer)
- A pre-existing condition that worsens due to age
- An injury sustained while commuting to work
- A stress-related illness unrelated to the original injury
Correct answer: A secondary injury that directly results from a compensable primary injury
A compensable consequence is an injury or condition that arises directly as a result of a compensable work injury, making it also covered under workers compensation.
Question 6: A workers compensation adjuster discovers the claimant has returned to light-duty work. The adjuster should:
- Reduce temporary total disability benefits and begin paying temporary partial disability if applicable (Correct answer)
- Immediately terminate all benefits as the claimant has returned to work
- Continue paying full TTD benefits until the claimant returns to full duty
- Transfer the file to the employer's HR department for handling
Correct answer: Reduce temporary total disability benefits and begin paying temporary partial disability if applicable
When a claimant returns to modified or light-duty work at reduced wages, TTD stops and TPD benefits may be payable to compensate for the wage difference.
Question 7: In most states, the workers compensation exclusive remedy doctrine means:
- An injured employee cannot sue the employer in tort but is entitled to statutory benefits (Correct answer)
- The employee must accept the first medical provider assigned by the employer
- Workers compensation is the only policy that can cover occupational injuries
- The adjuster has exclusive authority to determine the claim outcome
Correct answer: An injured employee cannot sue the employer in tort but is entitled to statutory benefits
The exclusive remedy doctrine bars employees from filing civil lawsuits against employers for work injuries, limiting their recovery to workers compensation benefits.
CALA Workers Compensation Claims 2
An employee is injured while traveling from one job site to another during the workday.
Under workers compensation, this injury is most likely: