CDMS Workers' Compensation and Claims Management 3

Question 1

What does an 'experience modification factor' (EMR or e-mod) measure in workers' compensation insurance?

Accepted Answer

An employer's claim history compared to industry average losses

Answer

The degree of an employer's OSHA compliance

Answer

The severity rating of a specific workplace injury

Answer

The percentage of injured workers who return to work

Question 2

Which benefit type compensates a worker for permanent loss of function to a specific body part under workers' compensation?

Accepted Answer

Scheduled loss of use (SLU)

Answer

Permanent total disability (PTD)

Answer

Temporary total disability (TTD)

Answer

General damages award

Question 3

Under workers' compensation, an occupational disease is generally defined as a condition that:

Accepted Answer

Arises naturally from common employment conditions over time

Answer

Results from a single traumatic event at work

Answer

Is diagnosed within 30 days of hire

Answer

Is caused by a pre-existing hereditary condition

Question 4

What is the primary role of a disability management specialist during the workers' compensation claims process?

Accepted Answer

Coordinating medical, vocational, and administrative resources to facilitate return to work

Answer

Adjudicating whether a claim is compensable

Answer

Auditing the insurer's reserve calculations

Answer

Litigating disputed claims on behalf of the employer

Question 5

Which of the following is an example of a 'light duty' or modified work assignment?

Accepted Answer

Allowing a worker with a lifting restriction to perform clerical tasks temporarily

Answer

Placing a worker on paid leave until fully recovered

Answer

Terminating the worker and offering a lump-sum settlement

Answer

Referring the worker to a pain management specialist

Question 6

A disability management specialist reviews a workers' comp case and identifies delayed recovery patterns. Which intervention is MOST appropriate?

Accepted Answer

Performing a biopsychosocial assessment to identify barriers to recovery

Answer

Immediately terminating the worker's benefits

Answer

Conducting an independent medical examination only

Answer

Referring the case to litigation