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
A 'lump sum settlement' in workers' compensation means that:
Answer: The worker receives a single payment that closes out future benefits in exchange for releasing the employer/insurer from ongoing liability
A lump sum settlement (often called a compromise and release) resolves the claim by trading future periodic benefits for a negotiated one-time payment, closing the case.
What are 'vocational rehabilitation' benefits in workers' compensation?
Answer: Services that help an injured worker who cannot return to their previous job train for and find suitable alternative employment
Vocational rehabilitation benefits assist permanently injured workers who cannot return to their former occupation by providing job skills training, education, and job placement services.
Under workers' compensation, death benefits are typically payable to:
Answer: The surviving spouse and dependent children of a worker who died from a work-related injury or illness
Workers' comp death benefits provide wage replacement to financially dependent survivors — most commonly the spouse and minor children — of a worker who dies as a result of a work-related injury or illness.
Which of the following BEST describes 'compensability' in a workers' compensation claim?
Answer: Whether the claim meets the legal requirements for benefits to be owed under the workers' compensation system
Compensability refers to the determination of whether a claim qualifies for workers' comp benefits — specifically whether the injury arose out of and in the course of employment.
An employer has a 'managed care' program for workers' compensation. This PRIMARILY means:
Answer: A network of approved medical providers is used to coordinate and control medical treatment costs and outcomes
Managed care in workers' comp uses a coordinated network of physicians and case managers to direct treatment, reduce unnecessary procedures, and improve recovery outcomes while controlling costs.
What is a 'reservation of rights' letter in the context of a workers' compensation claim investigation?
Answer: A notice to the claimant that the insurer is investigating the claim and reserves the right to deny benefits if investigation reveals non-compensability
A reservation of rights letter notifies the claimant that while the insurer is not yet denying the claim, it reserves the right to deny or limit benefits pending investigation of compensability.
Which workers' compensation benefit covers the cost of medical treatment, surgery, prescriptions, and rehabilitation for a work-related injury?
Answer: Medical benefits
Medical benefits in workers' compensation pay for all reasonable and necessary medical care to treat the work-related injury or illness, including hospital stays, surgery, medications, and physical therapy.