CCP Workers' Compensation Claims 2 — Questions and Answers
Question 1: Under most state workers' compensation laws, the 'coming and going' rule generally means that injuries sustained while commuting to or from work are:
- Covered if the employer provides the transportation (Correct answer)
- Covered without exception
- Not compensable
- Compensable only if the injury occurs within one mile of the workplace
Correct answer: Covered if the employer provides the transportation
The coming-and-going rule excludes commuting injuries from coverage, but an exception applies when the employer furnishes transportation.
Question 2: A workers' compensation claim involving a gradual-onset condition like carpal tunnel syndrome is classified as a(n):
- Occupational disease (Correct answer)
- Traumatic accident
- Idiopathic injury
- Third-party claim
Correct answer: Occupational disease
Repetitive-motion conditions that develop over time are classified as occupational diseases rather than sudden traumatic accidents.
Question 3: When an employer disputes compensability, the claims professional should first:
- Immediately deny the claim without investigation
- Conduct a thorough investigation before making a coverage decision (Correct answer)
- Accept the claim to avoid litigation
- Refer the matter directly to an attorney
Correct answer: Conduct a thorough investigation before making a coverage decision
A thorough, good-faith investigation is required before any coverage decision, ensuring compliance with prompt-payment statutes.
Question 4: The 'dual-purpose' doctrine in workers' compensation allows coverage when:
- An employee holds two jobs simultaneously
- A trip serves both a personal and a business purpose (Correct answer)
- Two employers share liability for one injury
- An injury occurs at two separate worksites
Correct answer: A trip serves both a personal and a business purpose
Under the dual-purpose doctrine, a trip is compensable if it simultaneously serves an employment purpose, even if personal errands are also conducted.
Question 5: A Maximum Medical Improvement (MMI) determination is significant in workers' compensation because it:
- Ends all medical benefits immediately
- Signals the point at which the claimant's condition is unlikely to improve further with treatment (Correct answer)
- Requires the claimant to return to full-duty work
- Terminates the employer's liability
Correct answer: Signals the point at which the claimant's condition is unlikely to improve further with treatment
MMI marks the transition from temporary disability benefits to evaluation for permanent impairment ratings.
Question 6: Which type of workers' compensation benefit is specifically designed to compensate an injured worker for a measurable anatomical loss even if no wage loss results?
- Temporary Total Disability (TTD)
- Permanent Partial Disability (PPD)
- Specific loss benefit (Correct answer)
- Vocational rehabilitation benefit
Correct answer: Specific loss benefit
Specific loss benefits are scheduled awards for defined anatomical losses (e.g., amputation of a finger) independent of actual wage-loss.
Question 7: Under the 'going and coming' exception known as the 'special errand' rule, an employee traveling to perform a task specifically requested by the employer:
- Remains unprotected throughout the entire journey
- Is covered for the duration of the special errand (Correct answer)
- Is only covered at the employer's premises
- Must file a separate civil lawsuit
Correct answer: Is covered for the duration of the special errand
The special-errand exception extends workers' compensation coverage to the entire trip when the employer directs the employee on a specific mission.
CCP Workers' Compensation Claims 2
Under most state workers' compensation laws, the 'coming and going' rule generally means that injuries sustained while commuting to or from work are: