General Claims Handling - California Workers Compensation, Self Insurance Test Questions And Answers
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Course
CALIFORNIA WORKERS COMPEnsation
Institution
CALIFORNIA WORKERS COMPEnsation
Social Security Number - ANS What does not have to be included in the Claim Log:
The Director of Industrial Relations - ANS To whom do you apply for a Certificate of Consent to Self-insurance:
The year in which it was reported. - ANS An injury occurs in late December but is not reported...
General Claims Handling - California
Workers Compensation, Self Insurance
Test Questions And Answers
Social Security Number - ANS What does not have to be included in the Claim Log:
The Director of Industrial Relations - ANS To whom do you apply for a Certificate of Consent to
Self-insurance:
The year in which it was reported. - ANS An injury occurs in late December but is not reported
until January of the next year. In which Claim Log is the injury recorded:
The self-insurer has a change in minority shareholders. - ANS You do not have to notify the
Manager of a change in status where:
3 days - ANS 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 Manger
within:
March 1 for private self-insurers and October 1 for public self-insurers. - ANS Every self-insurer
must file a Self-Insurer's Annual Report on or before:
Fails to initiate a self-insurance program within six months - ANS Reapplication to the Director
for a Certificate of Consent to Self-Insure is required if an employer:
yes, but only for the reporting year of the annual report - ANS Are medical only claims included
on the Annual Report?
Valid until revoked by the Director - ANS Once an employer has initiated a self-insurance
program, the employer's Certificate to Self-Insure is:
Utilize the self-insured's security deposit to administer and pay the employer's compensation
obligations. - ANS If the Director of Industrial Relations determines that a private self-insured
employer has failed to pay required workers compensation benefits he/she may:
When all benefits that are due and payable have been paid - ANS When can you close a
claims file?
, Five years from the date of injury or the date on which the last provision of compensation
benefits occurred, whichever is later. - ANS As a self-insured administrator how long do you
have to maintain the claim file?
Until claim liability has been exhausted pursuant to the law. - ANS When a self-insured
certificate has been revoked, the Director retains jurisdiction for what period of time:
Legal but the employer receives no credit against the security deposit. - ANS The employer
has an aggregate stop loss excess insurance policy. it is:
In California unless the Manager has given written approval to administer from a location
outside California. - ANS As an out-of-state self-insurer where must the claims files be kept
and maintained:
$5,000,000 net worth and average net income for the past 5 years of at least $500,000. - ANS
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:
$5,000 - ANS A self-insured employer has denied a claim but the file does not properly
document the reason for denial. What is the amount of the penalty:
Contact the prior administrator and inform the employer. - ANS You have assumed the
responsibility of another third party administrator. While auditing the files you discover that there
are missing indemnity files. you should:
For a Notice Denying Liability only - ANS When is a proof of service necessary?
$10,000 - ANS For an injury in 2013, resulting in death, reasonable expenses of the
employee's burial are allowed up to:
Where there is a dispute about the need for spinal surgery. - ANS When can the employer
request a second opinion under Labor Code 4062(b)?
Provides the employee with an implementation notice containing information about the MPN
and how to access care. - ANS An employee is considered a covered employee in the Medical
Provider Network when the employer?
72% - ANS An employee has an admitted injury resulting in permanent disability of 72%. The
employee is also guilty of serious and willful misconduct. What should the Board award?
Obtain an Order from the WCAB before reducing. - ANS The employee is guilty of serious &
willful misconduct. His permanent disability is 50%. You should:
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