Claims Adjuster Test Workers Compensation Claims 2

Question 1

What is 'permanent partial disability' (PPD) in workers' compensation?

Accepted Answer

A lasting impairment that limits but does not completely eliminate the worker's ability to earn wages

Answer

A condition requiring the worker to be placed in a permanent light-duty position

Answer

A temporary reduction in work capacity that persists for more than one year

Answer

Full disability that results from a specific partial body injury such as a hand or foot

Question 2

A claims adjuster receives a workers' compensation claim for a repetitive stress injury. The FIRST step should be to:

Accepted Answer

Investigate the claim to determine compensability by gathering medical records and employment history

Answer

Deny the claim because repetitive injuries are excluded from workers' compensation

Answer

Immediately accept the claim and begin paying benefits

Answer

Refer the claim directly to litigation without further investigation

Question 3

What is the purpose of an Independent Medical Examination (IME) in workers' compensation?

Accepted Answer

To obtain an objective medical opinion from a neutral physician about the extent of the injury and treatment needs

Answer

To replace the treating physician with a company-appointed doctor permanently

Answer

To determine the maximum amount the insurer is required to pay for medical treatment

Answer

To allow the injured worker to choose their own specialist outside the network

Question 4

Subrogation in workers' compensation allows the insurer to:

Accepted Answer

Recover benefits paid to the injured worker from a negligent third party who caused the injury

Answer

Subrogate the employer's duty to provide a safe workplace to a third-party safety contractor

Answer

Transfer the claim to a different insurance carrier after the policy period ends

Answer

Recover overpaid benefits directly from the injured employee's wages

Question 5

The 'going and coming' rule in workers' compensation generally states that:

Accepted Answer

Injuries sustained while commuting to and from work are not compensable

Answer

Workers are covered whenever they are traveling in a company vehicle

Answer

All injuries that occur outside the workplace are automatically excluded

Answer

Travel injuries are compensable only if they occur within one mile of the workplace

Question 6

What is the 'second injury fund' (also called the subsequent injury fund) in workers' compensation?

Accepted 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

Answer

A reserve set aside for employees who file more than one workers' comp claim in a year

Answer

A secondary insurance policy that pays benefits after the primary coverage is exhausted

Answer

A state-run fund that reimburses employers for all workers' comp premiums after a second claim

Question 7

In workers' compensation, 'modified duty' or 'light duty' refers to:

Accepted Answer

Temporary job assignments that accommodate the injured worker's medical restrictions while they recover

Answer

A reduction in the worker's permanent job responsibilities after reaching MMI

Answer

Part-time work offered to all employees during a slow production period

Answer

Duties assigned only to workers who have filed a disputed workers' comp claim