California Self-Insurance Plans (SIP) Practice Exam

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• A self-insured employer has denied a claim but the file does not properly document the reason for the denial. What is the amount of the penalty?
• If a physician didn't perform a particular exam or prepare the report, you should:
• Where the injury is to an employee under 16 years of age and illegally employed at the time of injury, the entire compensation otherwise recoverable shall be increased by what percent?
• A Doehny fracture describes a fracture of which bone with outward displacement?
• Knee injury with long leg brace case—what is the standard rating for the knee?
• The metatarsals are located in what part of the body?
• Where is the lacrimal bone located?
• What is the standard rating for someone with moderate vertigo?
• Dupuytren's contracture involves which part of the body?
• What does not have to be included in the Claim Log?
• An ER and EE file 3rd party actions and obtain a recovery. Who has first right of recovery?
• Which scenario best describes a medical-only claim?
• Two employees are involved in a workplace altercation about a task at work; A hits B. Who is entitled to workers' compensation benefits?
• Otitis media involves which part of the body?
• Aggregate disability payments for an injury in 2006 shall not extend for more than how many weeks from commencement of TD?
• Your client is a city. An EE is a police officer in the city and injures his shoulder. He is placed on TTD for 6 months and is receiving 4850. When he returns to work, he quits and starts working as a deputy sheriff for the county. While he is working for the county, he decides to have surgery on his shoulder and applies for 4850 through both the city and the county. Who will The WCAB say is responsible for the 4850?
• Pott's fracture involves which joint?
• A knee injury produces no objective disability for work restrictions but the physician prescribes a stretch knee brace. What is the rating for the knee?
• The cervical region contains how many vertebrae?
• Which of the following statements correctly describes the tolling when the case is under submission?
• A nursing student works part-time 20 hours per week at $10/hour. After graduating she works 40 hours per week and is promised a raise to $1,000 per week after receiving her certificate. If she is injured during her part-time work in 2005 and later graduates and receives her certificate, which set of temporary disability rates would apply?
• You reduce a medical provider's bill by $500 under the Official Medical Fee Schedule. The physician bills the applicant who pays and informs you. What is the physician's responsibility?
• When is the annual report due for private self-insurers?
• A Petition for Reconsideration must be filed within how many days of service of an F&A by the WCAB?
• In workers' compensation proceedings, AME stands for what?
• What is the penalty for failure to file a complete or timely annual report?
• Which bone is the smaller of the two bones in the lower leg and bears relatively little weight?
• Which form must be used to file the Self-Insurer's Annual Report?
• An employee is attacked while performing a job-related task offsite due to a hazard unique to the employer's operations. The injury is:
• Lacrimation refers to which physiological process?
• A pain that could be tolerated but would cause a marked handicap in the performance of the activity precipitating the pain corresponds to which level?
• Who can modify, delay and deny requests for treatment?
• Is proof of service required on a delay?
• What is the penalty for denial without proper documentation?
• A bank robbery victim alleges a psych injury. The claim shows 37% of causation from the industrial injury and 63% from marital problems. Is the case compensable?
• EE is seriously injured as a result of his own serious and willful misconduct. The EE's compensation is reduced by 50% unless:
• The first payment of TD is due no later than how many days after knowledge of the injury and disability?
• Which notice requires proof of service?
• Lacrimation is defined as which of the following?
• An employee's diabetes worsens; after work he faints and fractures elbow; what should be paid?
• Which benefit should not be considered when calculating average weekly earnings?
• If an employer directs you to deny a compensable claim, what is the proper action for a claims examiner?
• A Doehny fracture is a fracture of which bone with outward displacement?
• A finding that the injuries results from the injured EE's serious and willful misconduct means:
• A volunteer nurse’s aide for a nonprofit hospital injures her back lifting a patient. The injury is:
• In the context of illegal employment and injury, the entire compensation otherwise recoverable shall be increased by what percent?
• The penalty for failing to obtain worker's compensation coverage is what percentage of the compensation paid? 10%, 15%, 20%, or 25%?
• Under rehabilitation benefits, rehabilitation benefits can be settled only when:
• An employee forces IWS to accept less money than due. The ER faces which civil penalty scenario?
• During the submission phase overseen by I&A, the statute of limitations is tolled in which of the following ways?
• In the dependency rule, a child who is incapacitated from earning would be considered _______ for support.
• What is the rating for a 30 year old heavy furniture assembler with a soft tissue injury to the cervical spine causing a loss of range of motion resulting in an 8% impairment?
• Which bone is commonly known as the heel bone?
• Any person rendering service for another, other than as an independent contractor is ______ to be a(n) ______.
• What is the TD rate for a baker earning $1,400 per week for an injury on May 1, 2010?
• A Petition for Reconsideration must be filed within 20 days of service of an F&A.
• How long do you have to file a petition to terminate liability for temporary disability after terminating payments?
• Administrative Director is head of which agency?
• You find a doctor's medical-legal bill in a claims file 62 days after the bill was date stamped received. You should:
• If the ER desires a change of physicians or chiropractor, who may he petition?
• A 100% upper extremity impairment is what percentage of a whole person impairment?
• If the applicant has received a prior award of PD, it shall be conclusively presumed that ...
• Which term describes the socket of the hip joint?
• Colles fracture grip strength question: The permanent disability is which percentage?
• LC 4610 is used in SIP to designate:
• What is the most common type of arthritis?
• Under AMA Guides apportionment is based on?
• Dorsiflexion of the foot means which movement?
• An employee's husband shoots her at work due to marital discord. Which statement best describes compensability?
• The socket of the hip joint is called the acetabulum. Which option names this structure?
• Formal rating determinations shall be deemed to constitute evidence:
• In pursuing a master certificate after July 1, 1994, the required financial metric includes net worth and what other metric?
• How many days do you have to dispute a medical bill?
• Where is the lacrimal bone located?
• Which of the following is true about the deadline for filing a death-case related filing?
• When is a document considered filed with the WCAB?
• Arthroplast means what?
• A knee injury treated in 2004 with a knee brace and no loss of motion; what is the standard rating?
• What about a payment made more than two years from DOI for a period of disability within the first two years?
• To whom do you apply for a Certificate of Consent to Self-Insure?
• Dupuytren's contracture most commonly affects which two fingers?
• In a serious and willful misconduct injury, the compensation is reduced by 50% unless the injury results in death or PD of 70% or more.
• A metacarpus is:
• Zygoma involves which part of the body?
• An injury to the trapezius muscle would most directly affect which region?
• Reapplication to the director for a certificate of consent to Self-Insure is required if an ER:
• In a salary continuation scenario, is a DWC notice required?
• How much can you pay for burial expenses for DOI on or after 1/1/13?
• Which value correctly completes the sentence: There are ___ cervical vertebrae?
• Which bone forms part of the eye socket and is the smallest facial bone?
• The Disability Evaluation Unit Rater's report that apportions permanent disability must be sent to which entity?
• An experienced examiner must have spent how many years within the past eight years?
• Temporary disability payments are calculated as two-thirds of the wage loss, up to the maximum TD rate in effect for the injury year.
• Which bone is part of the facial skeleton and forms part of the orbit's medial wall?
• When is the Self-Insurer's Annual Report due for a private vs public self-insurer?
• When would an IW be justified for missing or refusing to attend a medical exam arranged by his ER?
• Who shall adopt and revise periodically an official medical fee schedule after public hearings?
• If an employee is terminated after filing for compensation benefits, which option best describes the compensation increase?
• Which bone is the thigh bone?
• Wage loss is calculated as pre-injury earnings minus post-injury earnings.
• A man goes to his wife's work upset over a custody issue and shoots her. Is this compensable?
• In case of incapacitated dependent turning 18, what happens to benefits?
• Which bone is the long bone of the upper limb extending from the shoulder to the elbow?
• In a 3rd party case there is a $100k recovery, attorney fees = $36k, costs = $4k, WC lien = $40k. What is the net recovery to the IW/Petition for Credit for the 3rd party recovery?
• The employer is guilty of serious and willful misconduct and the employee loses both hands. By what percentage should reserves be increased?
• Is it true that the employer is required to notify the administrative director of every employee death, regardless of survivorship?
• The employer provides a wage statement for the employee showing irregular earnings. What is the correct TD rate?
• Which day is listed as the waiting period start for the Friday injury scenario?
• Which of the following does not produce rateable disability?
• This division and Division 5 shall be liberally constructed by the courts.
• To whom do you apply for a Certificate of Consent to Self-Insure?
• Apportionment is based on which of the following factors?
• If there are two or more wholly dependent for support upon a deceased employee, how many partial dependents shall receive benefits?
• A 21 year old baker has a Colles fracture of the wrist in his dominant hand in 2000 resulting in grip strength readings of: 65,55, 60 / 107,106,105. What is the permanent disability?
• If the ER has an aggregate excess (stop loss) workers' comp policy, does the ER receive credit against the security deposit?
• Which entity provides guarantees for insolvent insurers in California?
• The injured worker is a maximum earner for an injury July 21, 2006. You are making a TD payment in August 2008. What is the correct TD rate?
• Which statement accurately describes the relationship between compensation and negligence?
• Which bone is the smallest and most fragile bone of the face, near the eye?
• Which factor determines PD apportionment?
• Pronation of the forearm means to turn the hand so the palm faces which direction?
• A 47-year-old actor has a chemical burn to an upper extremity producing a cosmetic disfigurement resulting in a 5% WPI. What is the rating?
• Which entity's annual report is due on October 1?
• In managing a third-party case, what should be the examiner's primary concern?
• A Petition for Writ of Review must be filed within ____ days after a Petition for Reconsideration is denied or, if a petition is granted within ____ days, after the filing of the order, decision or award.
• Which bone is the bony projection of the ulna at the elbow?
• What is the 2010 maximum temporary total disability (TTD) rate?
• The calcis is the:
• If an injured worker has both grip loss and atrophy, what is the standard outcome for the rating?
• What should be included on the Annual Report?
• If there is a new TPA, who is responsible for filing the report with the Director of Industrial Relations and what is the timeframe?
• For a victim of a violent act, substantial cause means?
• An injured worker incurred medical expenses in 2004, 2005, and 2006 of $600, $1,200 and $800 respectively. What is the appropriate annual reserve for the medical expense?
• An injured employee with dependents is incarcerated for an unrelated offense. Temporary Disability otherwise payable is:
• For an injury in 2013, resulting in death, reasonable expenses of the ER's burial are allowed up to:
• Which bone forms the hip socket?
• The head of the femur articulates with which structure?
• Under the compensable consequences doctrine, which statement best describes the scope of coverage?
• What is his TD rate for an injury in 2005?
• During stipulation to a permanent disability award, a furniture company says the employee owes them $2,000. How should you proceed?
• The calcis is the which of the following?
• The employee's right major index finger fails to clear the mid-palm on active flexion by 3/4 inch, and there is a 25 percent weighted grip loss. What is the permanent disability percentage?
• An employee is at home receiving temporary disability and contracts measles from a child. Which liability is applicable under workers’ compensation rules?
• Which of the following statements about the Official Medical Fee Schedule is true?
• Where is the latissimus dorsi muscle located?
• Which bone is the breastbone?
• How many days do you have to respond to a request for medical treatment?
• In a private self-insured ER scenario, who has the authority to determine that benefits were not paid as required and to take action?
• What are the supplemental job displacement benefit amounts by PD rating?
• Which party is authorized to modify, delay and deny treatment in UR when it involves a specific specialty?
• The navicular bone belongs to which group of bones?
• A chef with average weekly earnings of $1,300 is injured May 16, 2010. After this, he returns to part-time earnings of $450 per week. What is the wage loss TD rate?
• Which pair are the primary weight-bearing bones of the leg?
• Conjunctivitis involves which part of the eye?
• Which authority is the proper channel for petitions to change an employee-selected physician?
• An experienced indemnity examiner has to have how many hours within what timeframe?
• An employee sustains an injury in February 2000 and, in July 2000, experiences an aggravation of the injury. What is the recommended handling?
• Which two bones are the primary weight-bearing bones of the leg?
• What must occur for a C&R to be valid?
• In the SIP context, what does the abbreviation ER stand for?
• Which item is not considered indemnity?
• Which bone is the outer forearm bone located on the thumb side?
• Which statement about aggregate stop loss policies is NOT true?
• If an employee is terminated after filing a claim for workers' compensation, what compensation terms apply?
• The metatarsals are located in what part of the body?
• What is the maximum cap for payments to partial dependents?
• Synovial refers to which of the following?
• An employer fires an employee for reporting an industrial injury. Which action may the employee file?
• In 2004, which statement correctly describes how disability is rated for a bilateral loss of vision injury?
• Which term describes inflammation of a joint?
• Are medical-only claims included on the Annual Report, and if so, for what period?
• A 27-year-old chemist has a chemical burn to the eyes in 2010 producing a 14% whole person impairment. What is the rating?
• What is specific excess insurance?
• When can you close a claims file?
• Which term describes surgical fixation of a joint?
• Under the 1997 Schedule, the minimum loss of motion used to rate finger impairment is described as which?
• An employee has an admitted injury resulting in PD of 72%. The employee is also guilty of serious and willful misconduct. What should the Board award?
• In evaluating a major index finger impairment, which factor is considered along with finger motion to determine permanent disability?
• The employee earns $2,000 per week while working six months per year and collects EDD benefits the rest of the year. He returns to work and is injured on his first day back. The correct total TD rate is?
• What was the weekly maximum TD rate in 2010 used to calculate indemnity?
• A DIA form 510 in a death case must be filed unless the employer has actual knowledge that:
• Injury in the kitchen after a meeting where colleagues drank alcohol and the drinking was condoned by the supervisor. What is the likely result for compensability?
• For a scenario with a 3rd party recovery of 150k, attorney fees 42k, costs 8k, WC lien 35k, what is the net recovery to the IW?
• You do not have to notify the Manager about a change in status where which situation occurs?
• What level of pain is not ratable?
• In knee rating assessment, which element is not part of the standard three elements?
• Colles fracture involves which bone?
• True or False: The Administrative Director is the head of the DWC.
• Under SIP rules, which type of provider is allowed to modify, delay, or deny UR requests for medical treatment?
• Which term refers to the heel bone?
• Formal rating determinations are deemed to be evidence limited to which aspect?
• What happens when a physically or mentally incapacitated dependent turns 18?
• If a self-insured employer has not adequately funded its trust account for over a week, preventing payments on claims, what action is required?
• The typical adult spine has how many vertebrae in total?
• How many days does an employee have to return the QME form before a panel is selected?
• Do UR Policies and Procedures and a description of the process have to be filed with the administrative director?
• What was the maximum Temporary Disability rate for an injury in 2010?
• When determining the TD rate for a payment made in a later year, the rate used is the rate in effect on which date?
• If you are not represented when the applicant's attorney files an application for adjudication, which documents should you file with the WCAB?
• When is a proof of service necessary?
• In 2004 an employee becomes permanent and stationary for a bilateral loss of vision injury. How is the disability rated?
• A nurse gets an F&A in April 2002 for HIV. She dies in May 2007. A death case may be filed within how long?
• A high school teacher parked on school property, is assaulted offsite two blocks away, and the claim is evaluated under special risk. Which conclusion is most consistent with the special risk concept?
• Which anatomical term refers to the hip socket?
• The ilium is located in which region of the body?
• An employee is injured at work, sent home, off work next day, sees a doctor two days after injury, and hospitalized three days after injury. When does the waiting period start?
• In relation to attorney fees, which option demonstrates proper procedure to pay from the end of the award when using a STIP?
• When determining TD for a worker who is out of season, which earnings data should be used?
• Occasional severe back pain takes what standard rating?
• Loss of the radial head is a ____% absolute.
• Is proof of service required on a delay?
• The Judge's Order approving a settlement issues June 5, 1992. Payment on the order is not made until August 15, 1992, because the order was misfiled by the insurance carrier. The EE is:
• Which bone is the shoulder blade?
• Which statement correctly describes when medical-only claims are included on the Annual Report?
• In which Claim Log is an injury recorded if it is reported in January of the following year?
• When is a document considered filed at the WCAB?
• Which bone is also known as the navicular bone?
• Which wrist bone is also known as the navicular?
• As an out-of-state self-insurer where must the claims files be kept and maintained?
• Calcaneus, or os calcis, is commonly known as which bone?
• What is the formula for TPD?
• When a worker has both grip loss and atrophy in the hand, which approach best reflects the rating?
• Which entity is the recipient of an apportioned permanent disability report?
• How many days does a physician have to submit the Doctor's First Report of Occupational Injury or Illness?
• If a prior PD award exists, it is conclusively presumed that the prior PD exists at the time of any subsequent industrial injury. Which option reflects this?
• A finding that injuries resulted from serious and willful misconduct means:
• The DWC-1 claim form timeframe: The ER shall provide the DWC-1 form within 1 working day.
• Which disability is described as presumed total in character in the hand?
• Once an employer has initiated a self-insurance program, the employer's Certificate to Self-Insure is:
• Which bone is the thigh bone?
• A waiver releasing an employer from liability for a pre-existing condition is generally considered which of the following?
• What is aggregate excess insurance?
• Which statement best describes when offsite injuries can be compensable due to a job related special risk?
• Which bone is a large triangular bone at the base of the spine?
• An employee on an unpaid lunch break is injured while driving to the bank to cash his paycheck and does not receive mileage reimbursement. What is the proper determination regarding the claim?
• How many total vertebrae are in the typical human spine?
• A self-insured employer has not adequately funded their trust account, preventing you from making payments on claims. You are required to report it to the Manager within how many days?
• How many days does an ER or insurance carrier, from the date of request, have to provide an employee with a change of physician form?
• Which document invokes the jurisdiction of the WCAB for an injury in 2007?
• Proof os service is mandatory with what type of notice?
• What option best defines the future liabilities shown on the annual report?
• Carpal tunnel syndrome involves compression of which nerve?
• A seasonal employee works six months a year and is a max earner. While not working he is a min earner. What is his TD rate out of season?
• An ER has established a UR department under LC 4610 and hired a nurse to approve or deny requests. This is:
• A medical clinic physician who refers patients invites you to lunch weekly to thank you for referrals. What should you tell the doctor?
• Which statement about death benefits is true?
• For a death prior to January 1, 1991, the maximum burial expenses payment is:
• What is the purpose of an implementation notice in the Medical Provider Network context?
• You are applying for a master certificate after July 1, 1994. what is the amount of net worth and net income needed to qualify for self-insurance
• In a third-party case, what items must be subtracted to determine the net recovery for the IW?
• Using an out-of-state bank to issue indemnity payments in a CA WC claim is acceptable only if:
• A child under the age of 18 years old, or a child of any age found by any trier of fact to be physically or mentally incapacitated from earning shall be _______ _______ to be wholly dependent for support upon a deceased EE.
• In handling an attorney's fee under a STIP, which action is appropriate?
• Which statement correctly describes when the 50% reduction for serious misconduct applies?
• If you do not agree with the Agreed Medical Examiner's findings, you should:
• An employee is considered a covered employee in the Medical Provider Network when the employer?
• As a self-insured administrator how long do you have to maintain the claims file?
• What is a compound fracture?
• Which bone is the weight-bearing and larger bone of the lower leg?
• An employer provides vans to employees for carpooling, and an injury occurs while commuting. Under California workers’ compensation, what is the injury’s compensability status?
• In a break room, a worker is drinking vodka and a conveyor injures him; the doctor reports intoxication. What is the appropriate action?
• Which bone is the longer of the two bones of the forearm, on the side of the little finger?
• The employee is guilty of serious and willful misconduct. His PD is 50%. You should:
• Which of the following statements describes the hours requirement for an experienced indemnity examiner?
• If an employer forces workers to accept workers' compensation benefits at a lower rate, the employer's liability can reach which amount?
• Palmarflexion of the wrist involves moving the wrist in which direction?
• The nucleus pulposus is best described as which of the following?
• An employee is receiving salary continuation from the employer in lieu of temporary disability. Is a DWC notice required?
• If an injury occurs in December but is not reported until January of the following year, in which claim log is the injury reported?
• Within what timeframe must the employer provide the employee with a DWC-1 claim form?
• If you fail to notify the excess carrier of a claim, what may the excess carrier do?
• Who should you report fraud to?
• Which bone is the kneecap?
• Colles fracture involves which bone?
• Which of the following is true about the private annual report?
• A 47 year old actor has a chemical burn to an upper extremity producing a cosmetic disfigurement resulting in a 5% WPI. What is the rating?
• What is the rating for immobility of the hip where the arc of motion is 0 - 60 degrees?
• Where is the olecranon located?
• Which option defines future liabilities as used in the context of annual reporting?
• What is the rating for a 40 year old forester with an elbow injury resulting in loss of motion and a 50% upper extremity impairment?
• In cases of serious and willful misconduct, by how much may compensation otherwise recoverable be reduced?
• IW files a claim on 9/3/07 with a DOI of 8/29/07. There is no documentation to support the injury and the IW was terminated 5/30/07. You should:
• Which of the following does not involve the lungs?
• When can the ER request a 2nd opinion under LC 4062(b)?
• A 39-year-old auto mechanic has a slight instability of the knee, no atrophy and a preclusion from heavy lifting. What is the level of permanent disability?
• A Safeway employee breaks his leg while working in 2010 and has 10 weeks of TTD. He is a max earner, recovers fully and has no permanent impairment. How should you reserve this claim for indemnity?
• If an ER is guilty of serious and willful misconduct the EE's compensation is:
• Which of the following actions are valid responses to challenging an AME's determination?
• The treating doctor releases the employee to return to work on June 3, but the examiner cut off TD and the employee does not return until June 14. What is the correct action?
• For an out-of-state self-insurer seeking to administer from outside California, what action must the Manager take?
• Which bone is the kneecap?
• The two most common fingers involved in Dupuytren's Contracture are which pair?
• A notice of Employee Death must be filed with the Administrative Director within how many days when the employee left no surviving minor child?
• A TPA receives a Notice to Pay Benefits from the WCAB after the employer denied a work injury and failed to report it. What should the TPA do?
• Which statement best describes what a private self-insurer must do if it has not been self insured previously?
• A medical only claim is best described as which of the following?
• Which is the largest artery in the body?
• In a salary continuation arrangement, which statement best describes what must be included in the initial DWC notice?
• If an employee has a permanent disability of 15 percent and the employer offers a $12,500 compromise for resignation, what is the appropriate stance?
• An injury occurred during an off-premises break that was customary and approved by the employer. Why should the employer have reported the injury?
• When an Employer's First Report of Injury is filed but accurate weekly wages cannot be determined, how should Temporary Disability be determined?
• When is the annual report due for public self-insurers?
• An employer seeking to change an employee-selected physician can petition which authority?
• When a self-insured license has been revoked, the Director retains jurisdiction for what period of time?
• An employee injury in 1992 resulting in a permanent disability award is found to be serious and willful misconduct. The employee's compensation otherwise recoverable may be reduced by:
• Which kinds of ratings may the disability evaluation bureau prepare?
• May and John Doe adopt their 8 year old grandson Joseph. John dies in a work-related accident. Mary is a dependent spouse. How many dependents are there?
• When is the interim report due? (private and public cases)
• For an injury in 2005 what is the maximum permissible add-on for subjectives?
• Which term describes a tear of the medial meniscus of the knee?
• When a self-insured certificate has been revoked, the Director retains jurisdiction for what period of time:
• An EE, not paid for mileage, going to the bank on his lunch break to cash his paycheck, had an injury, the injury is:
• In salary continuation cases, which type of DWC notice is required?
• If a physician didn't perform a particular exam or prepare the report you should:
• Shall' when used in the LC means?
• What are the death benefits in 2006 for 1, 2 and 3 or more total dependents?
• If a second eye injury occurs with prior impairment in the other eye, how should the reserve be determined?
• You do not have to notify the Manager of a change in status when which scenario occurs?
• What is the penalty for failure to deposit and maintain a security deposit?
• Synovial fluid is found within which structure?
• How many days do you have to respond to a medical treatment request? (alternative wording)
• Apportionment of PD shall be based on what?
• The employer has an aggregate stop loss excess insurance policy. It is:
• Which document is used to notify the insurer of a workplace injury?
• The statute of limitations for subro claims is 2 years.
• A compound fracture is defined as which of the following?
• Which factor is not used to determine Temporary Disability (TD) benefits rate?
• What is the function of the Trust Account in the context of third-party recoveries?
• UR Review Policies and Procedures shall be filed with the:
• Who does CIGA insure?
• Who is responsible for enforcing benefit notices and timeliness of first payments?
• Under what condition can a volunteer be deemed an employee for workers’ compensation?
• When both instability and thigh atrophy are present what is the rating?
• When can an injured worker not attend a QME/AME exam?
• A knee injury produces no objective disability or work restrictions but the physician prescribes a long leg brace. What is the standard rating for the knee?
• Arthrodesis means which of the following?
• If a worker experiences wage loss partially due to returning to part-time work, the wage loss used to compute the TD rate is calculated as pre-injury earnings minus post-injury earnings, and the result is then multiplied by two-thirds.
• A 17-year-old was injured and the PD rate is sought. Which option correctly identifies the PD rate?
• Which statement correctly defines 'Compensation' under this division?
• During palmarflexion, the wrist moves toward which direction?
• If a claim is not denied within 90 days it can only be denied later based on what?
• Pott's fracture is specifically described as which of the following?
• For deaths between January 1, 1991 and December 31, 2012, what is the maximum burial expenses payment?
• What is the deadline to file a petition to terminate temporary disability after termination of payments?
• If an employee works 40 hours at $16/hour and 20 hours at $12/hour and is unable to work both jobs, what is the TD rate for an injury in 2008 that occurs on the $16 per hour job?
• The scaphoid bone is located in the:
• Which rule covers that commuting injuries are generally not compensable unless an exception applies?
• A totally dependent minor grandchild is entitled to the same special death benefit as a totally dependent minor child.
• Which bone is known as the breastbone and helps protect the heart?
• A Colles fracture involves the:
• The best description for a comminuted fracture is:
• Which factor makes an off-premises break injury compensable?
• A material change in management affects notification requirements how?
• If an attorney requests that payments be sent to his office, you should:
• Which action most accurately reflects the requirement for reporting a change in minority shareholders?
• The Director may not accept as a deposit to secure incurred liabilities for the payment of compensation and the performance of obligations of a self-insured ER.
• What is the least amount of loss of motion of a finger(s) that is ratable under the 1997 Schedule?
• In cases of serious and willful misconduct by the employee, the 50% reduction in indemnity benefits applies unless which of the following occur?
• An IW unreasonably fails or refuses to get medical treatment for his injuries. You should:
• Which bone is the cheek bone?
• Which statement accurately describes the 'presumed employee' rule?
• Can an EE bring his personal physician to a medical exam requested by his ER?
• Is an insurance company allowed to keep claim files out of state?
• Which bone is the outer bone of the forearm, on the side of the thumb?
• The latissimus dorsi muscle is primarily located in which region of the body?
• Orthoscopy is the examination of which anatomical structure?
• If there are three persons wholly dependent for support on a deceased employee and additional partial dependents the partial dependents would receive:
• An experienced examiner or supervisor is defined by how many years handling claims within the past eight years?
• After starting continuing treatment, the treating physician must provide a medical report within how many days?
• In 2006, death benefits for three or more total dependents were:
• An accountant took work home for an annual report. The employee left work at the normally appointed hour and was not reimbursed for mileage. The employee was injured in an auto accident at an intersection one block from home and his supervisor found paperwork in the car. You should?
• An insurer issues indemnity payments on a CA WC claim using an Ohio bank. This is:
• Formal rating determinations are evidence only as to what?
• If an employer desires a change of employee-selected physician, which authority handles the petition?
• What is the penalty percentage of compensation for failing to obtain workers' compensation coverage?
• In the parking lot injury example, the injury is considered compensable for which of the following reasons?
• An injury to the trapezius muscle would affect which body part?
• A Pott's fracture involves which anatomical region?
• In a death case, which fact would negate the requirement to file a DIA Form 510?
• Who is the head of the California Division of Workers' Compensation (DWC)?
• The ER or insurance carrier shall submit a plan for the Medical Provider Network for approval by:
• Pott's fracture is best described as a fracture involving which bones just above the ankle?
• Who reviews an apportioned PD report for an unrepresented worker?
• In apportionment under the AMA Guides, apportionment is based on?
• If the Director of Industrial Relations determines that a private self-insured ER has failed to pay required benefits, he/she may:
• The zygoma is commonly known as the cheekbone and is located in which region?
• In a knee injury scenario where the employee wears a brace but there is no motion loss, what is the typical rating?
• The calcaneus is the bone commonly referred to as the heel bone. Which option correctly reflects this?
• Which statement about the Employer's First Report of Injury (5020) is true?
• An employee suffers a proximal joint finger amputation and his prescription glasses are broken. Which should be paid?
• An employee is injured in the company parking lot by a passerby before starting work. The injury is:
• Is a totally dependent minor grandchild entitled to the same special death benefit as a totally dependent minor child?
• An EE has an injury at 3pm on Friday afternoon. She is only paid for six hours. When does the waiting period begin?
• Voc Rehab may be settled where:
• The statute of limitations for subro claims is:
• Which bone is the bone of the upper arm?
• A cardiac condition results in preclusion from heavy lifting. What is the scheduled rating?
• How are death benefits paid?
• Under this division, compensation includes benefits or payments conferred upon whom, without regard to negligence?
• Which of the following does not produce ratable disability?
• The ER shall notify the administrative director of each employee death, except ...
• What is the required response time to return a QME form before a panel is selected?
• Who can impose a penalty for failing to notify the excess carrier of a claim?
• How should you reserve for the 2004 injury given prior 25% PD for right eye?
• Fibromyalgia is characterized by which of the following?
• While traveling on business at the employer’s request and stopping for lunch at a restaurant, the employee is injured. The claim would be:
• Volunteers are not covered unless the NPO adopts coverage.
• TD for an injury in 2012 was paid at the incorrect rate (too low). What is the proper course of action?
• Which dates define interim report deadlines for private and public cases?
• Which permanent disability is presumed to be total in character?
• Which bone is also known as the collarbone?
• A greenstick fracture is a?
• You investigate an EE's claim of injury and issue a denial. Just before the one year anniversary of the alleged injury the EE meets with an I&A officer who takes the case under submission. The statute of limitations:
• During a business trip, a traveling employee stops for lunch and is injured. Which rule most often governs compensability?
• What is the investigator's primary role in pursuing compensability?
• What is the amount a spouse can earn to claim dependency?
• Which of the following best describes the outcome if a good faith issue in vocational rehabilitation is resolved against the employee?
• Which statement best describes the scope of compensation under the division?
• A foreman and coworkers are drinking on the loading dock after work ends at 5 pm. A coworker is injured when he backs his truck into something while leaving because he was intoxicated. Is the injury compensable?
• Complete immobility of the great toe rating corresponds to which permanent disability percentage?
• Which statement about burial expenses is correct for DOI on or after 1/1/13?
• Carpal tunnel syndrome is associated with which nerve in the wrist?
• A bartender with earnings of $600 per week, averages tips of $250, and also receives one free meal per day from the ER. The ER's cost of the meal is $15. If the EE paid for the meal it would cost $125 per week. What are the EE's earnings?
• In the described scenario of potential underpayment of benefits, the employer's liability could reach how much?
• When the self insured ER has their certificate to self administer revoked who handles their claims?
• Who is responsible for approving a Medical Provider Network plan?
• Moderate vertigo rating is which percent?
• When is the annual report due for private self-insurers?
• The injured employee contracts Hepatitis C from a blood transfusion during surgery for a work related injury. You are responsible for:
• Which deadline applies to private self-insurers for the Self-Insurer's Annual Report?
• Which term describes coverage that provides protection after a cumulative loss limit is reached?
• After July 1, 1994, what net worth and net income are required to qualify for a master certificate?
• The scaphoid bone is located in the
• If you discover missing indemnity files after assuming responsibilities of another TPA, which party should you contact for assistance?
• Metacarpus refers to which region?
• Which statement best describes the liability for Hepatitis C contracted due to a transfusion during surgery for a work-related injury?
• Absolute percentage for loss of the radial head is which value?
• Which of the following is not considered an Activity of Daily Living?
• Which term describes a tear of the medial meniscus of the knee?
• A 27 year old chemist has a chemical burn to the eyes in 2010 producing a 14% whole person impairment. What is the rating?
• Which of the following is not an acceptable form of deposit to secure incurred liabilities for the payment of compensation and the performance of obligations of a self-insured ER?
• A 17-year-old is injured and is minimum for TD. What is the correct PD rate?
• An injured worker with dependents is incarcerated for an unrelated offense. TD otherwise due is:
• Which statement best describes how the rate for a TD payment is determined when the payment occurs in a year different from the injury year?
• Reapplication to the Director for a Certificate of Consent to Self-Insure is required if an employer fails to initiate a self-insurance program within how many months?
• Unless there is an Order of Credit, estimates of future liability may:
• Which bone lies on the opposite side of the forearm from the radius?
• The olecranon is part of which joint?
• Where is the navicular joint located?
• You have assumed the responsibilities of another TPA. While auditing the files you discover that there are missing indemnity files. You should:
• Which fracture refers to a fracture of the distal end of the radius with outward displacement?
• The calcis is the
• A DEU rater's apportioned PD report for an unrepresented worker must be sent to:
• What is the California Self-Insurer's Security Fund?
• If the Director of Industrial Relations determines that a private self-insured employer has failed to pay required workers' compensation benefits, he/she may:
• What are the three basic elements of rating for knee disability?
• PD stands for what in the context of permanent disability?
• How long does Self-Insurance Plans have to notify you that your application for self-insurance is deficient?
• Which description best defines a comminuted fracture?
• Which statement best describes the relationship between permanent disability (PD) rate and temporary disability (TD) rate?
• Volunteers are not covered unless ______.
• In 2005, what is the maximum permissible add-on for subjective factors?
• You do not have to notify the chief of a change in status where: