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 'permanent partial disability' (PPD) in workers' compensation?
Answer: A lasting impairment that limits but does not completely eliminate the worker's ability to earn wages
PPD benefits compensate workers who sustain permanent impairment from a work injury but retain some earning capacity, reflecting the partial and permanent nature of the disability.
A claims adjuster receives a workers' compensation claim for a repetitive stress injury. The FIRST step should be to:
Answer: Investigate the claim to determine compensability by gathering medical records and employment history
The adjuster's first step is always to investigate the claim to determine whether it is compensable, including reviewing medical evidence and the worker's job duties to establish the work-related cause.
What is the purpose of an Independent Medical Examination (IME) in workers' compensation?
Answer: To obtain an objective medical opinion from a neutral physician about the extent of the injury and treatment needs
An IME provides an unbiased medical opinion from a physician not involved in treating the worker, helping adjusters resolve disputes about diagnosis, causation, impairment rating, or treatment necessity.
Subrogation in workers' compensation allows the insurer to:
Answer: Recover benefits paid to the injured worker from a negligent third party who caused the injury
Subrogation gives the workers' comp insurer the right to sue a negligent third party (e.g., a defective equipment manufacturer) to recoup benefits it paid to the injured worker.
The 'going and coming' rule in workers' compensation generally states that:
Answer: Injuries sustained while commuting to and from work are not compensable
Under the going and coming rule, the normal commute to and from work falls outside the course of employment, making injuries during that commute non-compensable, with exceptions for travel-related job duties.
What is the 'second injury fund' (also called the subsequent injury fund) in workers' compensation?
Answer: A fund that covers the portion of disability attributable to a prior injury when a worker suffers a second work injury, reducing employer liability
The second injury fund encourages employers to hire workers with pre-existing conditions by reimbursing insurers for the excess disability caused by combining a new work injury with a prior impairment.
In workers' compensation, 'modified duty' or 'light duty' refers to:
Answer: Temporary job assignments that accommodate the injured worker's medical restrictions while they recover
Modified duty assignments allow an injured employee to return to work in a capacity consistent with their medical restrictions, reducing TTD costs and supporting the worker's recovery.