California Self-Insurance Plans (SIP) Practice Exam

These questions are part of the practice quiz. Start practicing

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