CCA CCA Workers Compensation Claims 2 — Questions and Answers
Question 1: Which form is commonly used to report a workers' compensation claim to the insurer in many US states?
- ACORD 1
- First Report of Injury (FROI) (Correct answer)
- OSHA 300 Log
- CMS-1500
Correct answer: First Report of Injury (FROI)
The First Report of Injury (FROI) is the standard form used by employers to notify the workers' compensation insurer and state agency of a workplace injury.
Question 2: A worker injures their back while lifting at work and later develops a psychological condition due to chronic pain. Is the psychological condition likely compensable?
- No, psychological conditions are never covered under workers' compensation
- Yes, if the psychological condition is a direct consequence of the compensable physical injury (Correct answer)
- Only if a psychiatrist certifies the condition before the physical injury heals
- No, only the original physical injury is compensable
Correct answer: Yes, if the psychological condition is a direct consequence of the compensable physical injury
Secondary psychological conditions that are causally related to a compensable physical work injury are generally covered under workers' compensation.
Question 3: What is a 'scheduled loss of use' award in workers' compensation?
- A lump sum payment for permanent impairment to a specific body part based on a statutory schedule (Correct answer)
- A weekly benefit paid during temporary disability
- A penalty imposed on employers who delay claim reporting
- A structured settlement for permanent total disability
Correct answer: A lump sum payment for permanent impairment to a specific body part based on a statutory schedule
Many states use a statutory schedule assigning a fixed number of weeks' compensation for permanent loss of function to specific body parts.
Question 4: When a third party (not the employer) causes a work injury, the injured worker may:
- Only collect workers' compensation and waive all other claims
- Sue the third party AND receive workers' compensation, with potential subrogation by the insurer (Correct answer)
- Sue the employer and the third party simultaneously for double recovery
- File only a personal injury lawsuit and waive workers' compensation benefits
Correct answer: Sue the third party AND receive workers' compensation, with potential subrogation by the insurer
An injured worker can receive workers' compensation benefits and pursue a third-party tort claim; the workers' comp insurer typically has a subrogation lien on any third-party recovery.
Question 5: What does 'light duty' mean in a workers' compensation context?
- The employer is not required to provide any accommodation
- Modified or restricted work assignments within the injured employee's medical restrictions (Correct answer)
- A permanent demotion due to the work injury
- Part-time work without any wage replacement benefits
Correct answer: Modified or restricted work assignments within the injured employee's medical restrictions
Light duty refers to temporary work assignments modified to accommodate the injured worker's medical restrictions while they recover.
Question 6: Which of the following injuries would likely be found NON-compensable under workers' compensation?
- A slip and fall while carrying work supplies
- A repetitive strain injury from data entry duties
- An injury sustained during a voluntary company social event held off-premises (Correct answer)
- An occupational disease caused by chemical exposure at work
Correct answer: An injury sustained during a voluntary company social event held off-premises
Injuries at voluntary, off-premises social events are generally not considered to arise 'out of and in the course of employment,' making them non-compensable.
CCA CCA Workers Compensation Claims 2
Which form is commonly used to report a workers' compensation claim to the insurer in many US states?