Qme Chapter 15 Workers Compensation
Questions And Answers With Verified
Solutions Already Passed !!! (GRADED+)
Accident - ANSWER✔✔ An unexpected happening, causing injury traceable to a
definite time and place.
Adjudication - ANSWER✔✔ The final determination of the issues involving
settlement of an insurance claim; also known as claim settlement.
By Report - ANSWER✔✔ A report must be submitted with the claim when the
notation "BR" follows the procedure code description. This term is sometimes
seen in workers' compensation fee schedules.
Claims Examiner - ANSWER✔✔ In industrial cases, a representative of the insurer
who authorizes treatment and investigates, evaluates, and negotiates the patient'
s insurance claim and acts for the company in the settlement of claims; also
known as claims adjuster, claims representative, and claims administrator.
Compromise and Release - ANSWER✔✔ An agreement arrived at, whether on or
out of court, for setting a workers' compensation case after the patient has been
declared permanent and stationary.
Deposition - ANSWER✔✔ The process of taking sworn testimony from a witness
out of court. This is usually done by an attorney.
Ergonomic - ANSWER✔✔ Science and technology that seek to fit the anatomic
and physical needs of the worker to the workplace.
, Extraterritorial - ANSWER✔✔ State laws effective outside the state by either
specific provision or court decision. In workers' compensation cases, benefits
under the state law that apply to a compensable injury of an employee hired in
one state but injured outside that state.
Federal Employees' Compensation Act (FECA) - ANSWER✔✔ An act instituted in
1908 providing benefits for on the job injuries to all federal employees.
Fee Schedule - ANSWER✔✔ A list charges or established allowances for specific
medical services and procedures. See also relative value studies (RVS)
Injury - ANSWER✔✔ In a workers' compensation policy, this term signifies any
trauma or damage to a body part or disease sustained, arising out of, and in the
course of employment, including injury to artificial members and medical braces
of all types.
Insurance Adjuster - ANSWER✔✔ An individual at the workers' compensation
insurance carrier overseeing an industrial case, authorizing diagnostic testing and
medical treatment, and communicating with the provider of medical care.
Lien - ANSWER✔✔ A claim on the property of another as security for a debt. In
litigation cases, it is a legal promise to satisfy a debt owed by the patient to the
physician out of any proceeds received on the case.
Medical service order - ANSWER✔✔ An authorization given to the physician,
either written or verbal, to treat the injured or ill employee.
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