Workers Compensation Claims Flashcards
7 cards from real Claims Adjuster Test practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Workers Compensation Claims flashcards as text
What is the primary purpose of workers' compensation insurance?
Answer: To provide income and medical benefits to employees injured on the job regardless of fault
Workers' compensation is a no-fault system designed to provide medical treatment and wage replacement benefits to employees who suffer work-related injuries or illnesses.
The 'exclusive remedy' doctrine in workers' compensation means that:
Answer: The workers' compensation claim is the employee's only legal remedy against their employer for a work injury
The exclusive remedy doctrine bars employees from suing their employers in civil court for work injuries, making the workers' comp system their sole avenue for recovery against the employer.
A compensable injury under workers' compensation must:
Answer: Arise out of and in the course of employment
For a workers' comp claim to be compensable, the injury or illness must both arise out of (caused by the work) and occur in the course of employment (during work time/duties).
An employee is injured while attending a mandatory company holiday party held off-site after work hours. This claim is MOST LIKELY:
Answer: Compensable, because attendance was mandatory and the event was employer-sponsored
When an employer mandates attendance at a sponsored event, the employee is considered to be in the course of employment even off-site and outside normal hours, making the injury compensable.
Which of the following injuries would typically NOT be covered under workers' compensation?
Answer: An injury intentionally self-inflicted by the employee
Intentionally self-inflicted injuries are specifically excluded from workers' compensation coverage because the injury was not accidental or work-caused.
What does 'temporary total disability' (TTD) mean in workers' compensation?
Answer: The worker is completely unable to work for a limited period while recovering from a work injury
Temporary total disability (TTD) benefits are paid when an injured worker is completely unable to perform any work duties while recovering, but the condition is expected to improve.
Under workers' compensation, what is 'maximum medical improvement' (MMI)?
Answer: The point at which the injured worker's condition has stabilized and further recovery is not expected
MMI is the medical milestone when a treating physician determines the injured worker's condition has plateaued and no significant additional improvement is expected, triggering evaluation for permanent disability.