CCP Workers' Compensation Claims 3 — Questions and Answers
Question 1: A subrogation right in workers' compensation allows the employer or insurer to:
- Deny the initial claim
- Recover benefits paid from a negligent third party (Correct answer)
- Reduce future medical benefits
- Convert a state claim to a federal one
Correct answer: Recover benefits paid from a negligent third party
Subrogation lets the insurer step into the claimant's shoes to pursue a negligent third party and recover amounts paid on the claim.
Question 2: Which federal act provides workers' compensation coverage for longshore and harbor workers injured in maritime employment?
- Federal Employees' Compensation Act (FECA)
- Longshore and Harbor Workers' Compensation Act (LHWCA) (Correct answer)
- Jones Act
- Defense Base Act (DBA)
Correct answer: Longshore and Harbor Workers' Compensation Act (LHWCA)
The LHWCA is the primary federal statute covering maritime workers engaged in loading, unloading, building, or repairing vessels.
Question 3: An adjuster receives a workers' compensation claim 45 days after the reported injury date. The primary concern should be:
- Statute of limitations compliance
- Whether a late-reporting penalty applies to the employer
- Potential spoliation of evidence and witness memory degradation (Correct answer)
- Automatic denial due to late filing
Correct answer: Potential spoliation of evidence and witness memory degradation
Delayed reporting hampers investigation because physical evidence may be altered and witness recollections become less reliable over time.
Question 4: In workers' compensation, 'light-duty' work offers are important because:
- They permanently resolve the claim
- They can reduce or eliminate temporary disability benefit obligations if the employee refuses suitable work (Correct answer)
- They waive the employer's right to subrogation
- They are required by OSHA
Correct answer: They can reduce or eliminate temporary disability benefit obligations if the employee refuses suitable work
If a treating physician releases the worker to light duty and a suitable job is offered, refusal may suspend or reduce TTD benefits.
Question 5: The primary purpose of a vocational rehabilitation benefit in workers' compensation is to:
- Provide lifetime income replacement
- Assist the injured worker in returning to gainful employment when pre-injury work is no longer possible (Correct answer)
- Compensate the employer for retraining costs
- Eliminate permanent disability ratings
Correct answer: Assist the injured worker in returning to gainful employment when pre-injury work is no longer possible
Vocational rehabilitation focuses on restoring the worker's earning capacity through retraining, education, or job placement when the pre-injury job is unavailable.
Question 6: A claimant's pre-existing degenerative disc disease is aggravated by a work-related lifting incident. Under the 'aggravation' rule, the employer is generally liable for:
- Only the pre-existing condition
- Nothing, because the condition predated employment
- The full resulting disability, including the aggravated condition (Correct answer)
- Only the portion of disability attributable to the work incident
Correct answer: The full resulting disability, including the aggravated condition
Under the aggravation rule, the employer takes the worker as they are; if work worsens a pre-existing condition, the employer is liable for the entire resulting disability.
Question 7: Which document formally establishes the terms under which a workers' compensation claim is settled and releases the carrier from future liability?
- Compromise and release agreement (Correct answer)
- Medical authorization form
- Employer's first report of injury
- Temporary restraining order
Correct answer: Compromise and release agreement
A compromise and release (C&R) agreement is a lump-sum settlement that closes a claim in exchange for a release of future liability.
CCP Workers' Compensation Claims 3
A subrogation right in workers' compensation allows the employer or insurer to: