DC DC Workers' Compensation Insurance 2 — Questions and Answers
Question 1: Under DC workers' compensation, medical benefits provided to an injured employee:
- Are capped at $50,000 per injury
- Cover reasonable and necessary medical treatment with no dollar cap (Correct answer)
- Only cover emergency room visits
- Must be paid by the employee and later reimbursed
Correct answer: Cover reasonable and necessary medical treatment with no dollar cap
DC workers' compensation medical benefits cover all reasonable and necessary medical treatment related to a work injury without a statutory dollar limit.
Question 2: In DC, a workers' compensation insurer must provide notice of acceptance or denial of a claim within how many days of receiving the claim?
- 14 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
DC workers' compensation regulations generally require insurers to accept or deny claims within 30 days of receiving formal notice.
Question 3: A DC worker suffers a permanent partial disability (PPD) as a result of a work injury. Benefits are calculated based on:
- The worker's age at the time of injury only
- The degree of impairment and the worker's pre-injury average weekly wage (Correct answer)
- A flat benefit amount set by statute regardless of wages
- The employer's size and industry classification
Correct answer: The degree of impairment and the worker's pre-injury average weekly wage
PPD benefits in DC consider the percentage of permanent impairment and the worker's average weekly wage to determine the compensation amount.
Question 4: Which of the following is true about a DC workers' compensation policy's 'experience modification factor' (e-mod)?
- It is set by the DC government and is the same for all employers
- It adjusts the employer's premium based on their actual loss history compared to expected losses for their industry (Correct answer)
- It only applies to employers with more than 500 employees
- It increases every year regardless of claims history
Correct answer: It adjusts the employer's premium based on their actual loss history compared to expected losses for their industry
The experience modification factor compares an employer's actual claims experience to the average for their industry, adjusting premiums up for worse-than-average experience and down for better-than-average.
Question 5: Under DC workers' compensation law, vocational rehabilitation benefits are designed to:
- Provide a lump-sum settlement to injured workers
- Help injured workers who cannot return to their previous job retrain for suitable alternative employment (Correct answer)
- Cover the cost of the employer's OSHA fines
- Replace lost wages after the maximum medical improvement is reached
Correct answer: Help injured workers who cannot return to their previous job retrain for suitable alternative employment
Vocational rehabilitation services help injured workers who cannot return to their previous occupation gain skills for alternative employment.
Question 6: If a DC employee's death is caused by a work-related injury or illness, workers' compensation death benefits are payable to:
- The employer's insurance carrier as reimbursement
- The employee's surviving dependents (Correct answer)
- The DC Second Injury Fund exclusively
- The employee's estate only if no dependents exist
Correct answer: The employee's surviving dependents
Death benefits under DC workers' compensation are paid to the deceased worker's surviving dependents, such as a spouse or minor children.
DC DC Workers' Compensation Insurance 2
Under DC workers' compensation, medical benefits provided to an injured employee: