CCA Workers Compensation Claims Flashcards

Workers' compensation is considered a 'no-fault' system because:

Answer: Employees receive benefits regardless of who caused the accident

Workers' compensation provides benefits to injured employees without requiring them to prove employer negligence, and in exchange, employees generally cannot sue their employer.

Which of the following is typically NOT a benefit provided under workers' compensation?

Answer: Pain and suffering damages

Workers' compensation covers medical expenses, lost wages, and rehabilitation, but does not include non-economic damages such as pain and suffering.

A 'maximum medical improvement' (MMI) determination in a workers' comp claim means:

Answer: The worker's condition has stabilized and is unlikely to improve further with treatment

MMI is the point at which the injured worker's medical condition has stabilized and additional treatment is not expected to produce significant improvement.

Which type of workers' compensation disability benefit covers a worker who can return to work in a limited capacity at reduced wages?

Answer: Temporary partial disability (TPD)

Temporary partial disability (TPD) benefits compensate for the wage difference when an injured worker returns to modified or light-duty work at reduced earnings.

What is an 'independent medical examination' (IME) in a workers' compensation claim?

Answer: A medical evaluation by a neutral physician chosen by the insurer or employer to assess the claim

An IME is conducted by a physician selected by the insurer or employer to provide an objective opinion on the nature, extent, and causation of the injury.

The 'exclusive remedy' doctrine in workers' compensation means:

Answer: Workers' compensation is the sole remedy for injured employees against their employer

Exclusive remedy bars employees from suing their employer in tort for work-related injuries; workers' compensation is their only recourse against the employer.