EXAMFX Workers Compensation and Disability Insurance 1 — Questions and Answers
Question 1: Under workers compensation law, which of the following injuries is generally covered?
- Injury sustained during a personal lunch break off premises
- Injury that arises out of and in the course of employment (Correct answer)
- Injury caused by the employee's intentional self-harm
- Injury sustained during a commute to work
Correct answer: Injury that arises out of and in the course of employment
Workers compensation covers injuries that arise out of and in the course of employment, meaning they must be work-related and occur while the employee is performing job duties.
Question 2: Which of the following best describes the 'exclusive remedy' doctrine in workers compensation?
- Employees may only file claims within 30 days of an injury
- Employers are the only party who can report a claim
- Employees cannot sue their employer in civil court for work-related injuries covered by workers comp (Correct answer)
- Only licensed physicians can determine if an injury is work-related
Correct answer: Employees cannot sue their employer in civil court for work-related injuries covered by workers comp
The exclusive remedy doctrine means that workers compensation benefits are the sole remedy available to an injured employee against their employer, preventing civil tort lawsuits.
Question 3: Which benefit type under workers compensation covers the cost of medical treatment, surgery, and rehabilitation for a work-related injury?
- Temporary total disability
- Medical benefits (Correct answer)
- Death benefits
- Permanent partial disability
Correct answer: Medical benefits
Medical benefits under workers compensation pay for all reasonable and necessary medical expenses related to a work-related injury or illness.
Question 4: A worker is injured and cannot perform any work while recovering. Which workers compensation benefit would apply?
- Permanent total disability
- Temporary total disability (Correct answer)
- Permanent partial disability
- Vocational rehabilitation
Correct answer: Temporary total disability
Temporary total disability (TTD) benefits replace a portion of lost wages when an injured worker is completely unable to work during the recovery period.
Question 5: An employee suffers a permanent injury that partially limits their ability to work. Which workers compensation benefit applies?
- Temporary total disability
- Medical-only benefit
- Permanent partial disability (Correct answer)
- Death benefit
Correct answer: Permanent partial disability
Permanent partial disability (PPD) benefits compensate workers who suffer a lasting impairment that reduces but does not eliminate their ability to earn wages.
Question 6: In a workers compensation policy, what does the experience modification factor (e-mod) reflect?
- The number of employees on payroll
- The employer's past loss history compared to similar businesses (Correct answer)
- The state's minimum wage requirements
- The insurance company's profit margin
Correct answer: The employer's past loss history compared to similar businesses
The experience modification factor adjusts workers compensation premiums based on an employer's actual claims history relative to other employers in the same industry.
EXAMFX Workers Compensation and Disability Insurance 1
Under workers compensation law, which of the following injuries is generally covered?