HCMII Chapter 17 Terminology/ Summary/ Question Bank

HCMII Chapter 17 terminology/ summary/ question bank

Office of Workers’ Compensation Programs (OWCP)- The U.S. Department of Labor’s (DOL) Office of Workers’ Compensation Programs (OWCP) administers programs that provide wage-replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers (or eligible dependents) who are injured at work or acquire an occupational disease.

Energy Employees Occupational Illness Compensation Program- Effective July 31, 2001, the Energy Employees Occupational Illness Compensation Program started providing benefits to eligible employees and former employees of the Department of Energy, its contractors and subcontractors or to certain survivors of such individuals, and to certain beneficiaries of the Radiation Exposure Compensation Act.

Federal Black Lung Program- The Federal Black Lung Program, enacted in 1969 as part of the Black Lung Benefits Act, provides medical treatment and other benefits for respiratory conditions related to former employment in the nation’s coal mines.

Longshore and Harbor Workers’ Compensation Program- The Longshore and Harbor Workers’ Compensation Program, administered by the U.S. Department of Labor, provides medical benefits, compensation for lost wages, and rehabilitation services to longshoremen, harbor workers, and other maritime workers who are injured during the course of employment or suffer from diseases caused or worsened by conditions of employment. The program also covers private-industry workers who are engaged in the extraction of natural resources from the outer continental shelf, employees on American defense bases, and those working under contract with the U.S. government for defense or public-works projects outside the continental United States.

Mine Safety and Health Administration (MSHA)- The U.S. Labor Department’s Mine Safety and Health Administration (MSHA) helps to reduce deaths, injuries, and illnesses in U.S. mines through a variety of activities and programs.

Occupational Safety and Health Administration (OSHA)- The Occupational Safety and Health Act of 1970 created the occupational Safety and Health Administration (OSHA) to protect employees against injuries from occupational hazards in the workplace. OSHA and its state partners (of approximately 2,100 inspectors) establish protective standards, enforce those standards, and reach out to employers and employees by providing technical assistance and consultation programs.

Material Safety Data Sheet (MSDS)- OSHA has special significance for those employed in health care because employers are required to obtain and retain manufacturers’ Material Safety Data Sheets (MSDS), which contain information about chemical and hazardous substances used on site. Training employees in the safe handling of these substances is also required.

Federal Employment Liability Act (FELA)- The Federal Employment Liability Act (FELA) is not a workers’ compensation statute, but it provides railroad employees with protection from employer negligence, and makes railroads engaged in interstate commerce liable for injuries to employees if the railroad was negligent.

Merchant Marine Act (Jones Act)- The Merchant Marine Act (or Jones Act) is also not a workers’ compensation statute, but it provides seamen with the same protection from employer negligence as FELA provides railroad workers.

Workers’ Compensation Board (or Workers’ Compensation Commission)- Each state establishes a Workers’ Compensation Board or Commission, a state agency responsible for administering workers’ compensation laws and handling appeals for denied claims or cases in which a worker feels compensation was too low.

State Insurance Fund (or State Compensation Fund)- State Insurance (or Compensation) Fund: a quasi-public agency that provides workers’ compensation insurance coverage to private and public employers and acts as an agent in state workers’ compensation cases involving state employees. on-the-job injury- The worker does not have to be physically on company property to qualify for workers’ compensation. An on-the- job injury would include, for example, a medical assistant who is injured while picking up reports for the office at the local hospital or a worker who is making a trip to the bank to deposit checks. These both qualify as job-related assignments. An employee sent to a workshop in another state who falls during the workshop would also be eligible for compensation, but not if she was injured while sightseeing. temporary disability- Temporary disability claims cover healthcare treatment for illness and injuries, as well as payment for lost wages. Temporary disability is subclassified as:

● Temporary total disability, in which the employee’s wage-earning capacity is totally lost, but only on a temporary basis. ● Temporary partial disability, in which the employee’s wage-earning capacity is partially lost, but only on a temporary basis. permanent disability- Permanent disability refers to an ill or injured employee’s diminished capacity to return to work. In this case, a provider has determined that although the employee’s illness or injury has stabilized, he or she has been permanently impaired. The employee is therefore unable to return to the position held prior to the illness or injury. Sub-classifications include:

● Permanent total disability, in which the employee’s wage-earning capacity is permanently and totally lost. (There is no limit on the number of weeks payable, and an employee may continue to engage in business or employment if his or her wages, combined with the weekly benefit, do not exceed the maximums established by law.) ● Permanent partial disability, in which part of the employee’s wage-earning capacity has been permanently lost. Benefits are payable as long as the partial disability exists, except in the following circumstances: ● Schedule loss of use, in which the employee has a loss of eyesight, hearing, or a part of the body or its use. Compensation is limited to a certain number of weeks, according to a schedule set by law. ● Disfigurement, in which serious and permanent disfigurement to the face, head, or neck may entitle the employee to compensation (up to a maximum benefit, depending on the date of the accident). vocational rehabilitation- Vocational rehabilitation claims cover expenses for vocational retraining for both temporary and permanent disability cases. Vocational rehabilitation retrains an ill or injured employee so he or she can return to the workforce, although the employee may be incapable of resuming the position held prior to the illness or injury. survivor benefits- Survivor benefits claims provide death benefits to eligible dependents. These benefit amounts are calculated according to the employee’s earning capacity at the time of illness or injury.

First Report of Injury- First Report of Injury forms are completed by the provider (e.g., physician) when the patient first seeks treatment for a work-related illness or injury (Figure 17-1). This report must be completed in quad ruplicate with one copy distributed to each of the following parties:

● State Workers’ Compensation Board/Commission ● Employer-designated compensation payer ● Ill or injured party’s employer ● Patient’s work-related injury chart

Adjudication- When a workers’ compensation claim is denied, the employee (or eligible dependents) can appeal the denial to the state Workers’ Compensation Board (or Commission) and undergo a process called adjudication, a judicial dispute resolution process in which an appeals board makes a final determination.

Arbitration- Adjudication is different from arbitration, a dispute resolution process in which a final determination is made by an impartial person who may not have judicial powers.

Summary:

The U.S. DOL Office of Workers’ Compensation Programs administers programs that provide wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers (or eligible dependents) who are injured at work or who acquire an occupational disease. Federal programs include Energy Employees Occupational Illness Compensation Program, Federal Black Lung Program, Federal Employees’ Compensation Program, Longshore and Harbor Workers’ Compensation Program, Mine Safety and Health Administration, and Occupational Safety and Health Administration. State programs include the following types of coverage: State Insurance (or Compensation) Fund; employer self-insured programs; private, commercial workers’ compensation programs; and combination programs. To qualify for workers’ compensation, employees must either be injured while working within the scope of their job description, injured while performing a service required by the employer, or contracts an illness that can be directly linked to employment. Workers’ compensation cases are classified as (1) medical claims with no disability, (2) temporary disability, (3) permanent disability, (4) vocational rehabilitation, and (5) death of the worker.

Providers are required to accept workers’ compensation reimbursement as payment in full. Balance billing of patients is prohibited. Many workers’ compensation programs incorporate managed care to improve quality of medical benefits and services provided, as well as to control costs.

The First Report of Injury form is completed when the patient first seeks treatment for a work-related illness or injury. The report is filed in quadruplicate with a copy distributed to the State Workers’ Compensation Board/Commission, employer-designated compensation payer, ill or injured party’s employer, and patient’s work-related injury chart. When employers initially deny workers’ compensation claims, the employee has the right to appeal the denial. Detailed narrative progress/supplemental reports document significant changes in the employee’s medical or disability status.

Questions:

1. The Office of Workers’ Compensation Programs (OWCP) administers programs that provide a. medical treatment. b. vocational rehabilitation. c. wage replacement benefits. d. all of the above.

2. The Energy Employees Occupational Illness Compensation Program began providing benefits to eligible employees and former employees of the Department of Energy in a. 1999. b. 2000. c. 2001. d. 2002.

3. The Federal Black Lung Program was enacted in 1969 to provide _____ and other benefits for respiratory conditions related to persons formerly employed in the nation’s coal mines. a. medical treatment b. vocational rehabilitation c. wage replacement benefits d. all of the above

4. The Federal Employees’ Compensation Act (FECA) program provides workers’ compensation to all federal and postal workers throughout the world for employment-related injuries and occupational diseases, and includes a. medical and vocational rehabilitation. b. payment for medical care. c. wage replacement. d. all of the above.

5. The Longshore and Harbor Workers’ Compensation Program covers private-industry workers who are a. employees that work for American companies in foreign countries. b. engaged in extracting natural resources from the outer continental shelf. c. those associated with industry, labor, and other federal and state agencies. d. working under contract for foreign countries outside the continental United States.

6. Material Safety Data Sheets contain information about a. activities and programs associated with mining. b. chemical and hazardous substances used on site. c. interstate commerce injuries from railroads. d. occupational hazards in the workplace. 7. Which is responsible for administering workers’ compensation laws? a. Office of Workers’ Compensation Programs b. State Compensation Commission c. State Insurance Fund d. Workers’ Compensation Board

8. Which situation qualifies a worker for workers’ compensation coverage? a. Cindy Frasier administered an injection to a patient and stuck her finger with the needle; this required immediate treatment at the hospital and follow-up treatment by her primary care provider. b. Jenny Baker traveled to the local hospital from her place of employment to have lunch with friends; after eating lunch, she suffered food poisoning and underwent emergency care. c. Peter Mills attended an out-of-state conference for which his employer had preapproved reimbursement of his expenses; while attending a concert one evening during the trip, he fell and broke his arm. d. Sally Jones left the doctor’s office where she is employed and stopped at the bank to deposit the day’s accounts receivable; thereafter, while on the way to her residence, she was injured in a car accident.

9. The judicial dispute resolution process in which an appeals board makes a final determination is called a. adjudication. b. intercession. c. mediation. d. negotiation.

10. Which is completed when the patient initially seeks treatment for a work-related illness or injury? a. billing information notes b. First Report of Injury c. Material Safety Data Sheet d. progress report

Answers: 1. D 2. C 3. A 4. D 5. B 6. B 7. D 8. A 9. A 10. B