Industrial Insurance

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  1. What type of relationship must exist?
    An employer-employee relationship.
  2. An employee must have sustained an IA within . . . ?
    The course of employment.
  3. What does acting in the course of employment mean?
    the worker at his employer's direction or in the furtherance of his or her employer's business which shall include time spent going to and from work on the jobsite insofar as such time is immediate to the actual time that the worker engaged in the work process in areas controlled by his employer except parking areas.
  4. What is it called when coverage extends to workers injured outside the state?
    Extraterritorial coverage.
  5. What is an industrial injury?
    A sudden and tangible happening of a traumatic nature producing an immediate or prompt result, and occurring from without, and such physical conditions as a result therefrom.
  6. What happens with an intentional injury?
    Where an employer intentionally causes an injury, the employee will receive worker's compensation benefits plus have a cause of action as if the Act had not been enacted.
  7. What is an occupational disease?
    Such disease or infection as arises naturally and proximately out of the distinctive conditions of employment. Claims based on mental conditions based on stress are noncompensable.
  8. What is the effect of the statute of limitations on a claim.
    The statute of limitations is jurisdictional and may be raised at any time.
  9. What is the statute of limitations for industrial injuries?
    Within one year after the day upon which the injury occurred or the rights of dependents or beneficiaries accrued.
  10. Who has the obligation to file the claim?
    The employee.
  11. What if the employee argues that the statute of limitations creates an unfair result?
    Too bad . . . no equity, no discretion.
  12. What is the statute of limitations for an occupational disease?
    Within two years of the date the worker is advised by a physician in writing of the existence of the disease and the right to file a claim of benefits.
  13. How is the amount of benefits determined?
    The schedule of awards.
  14. Which schedule of awards?
    The schedule of awards in effect at the date of injury?
  15. What are the possible award types?
    Time loss compensation, medical aid, and vocational rehabilitation.
  16. What are the two types of time loss compensation?
    Temporary partial disability and temporary partial disability.
  17. How is permanent partial disability established?
    Medical testimony.
  18. How must permanent partial disability be supported?
    By objective findings.
  19. What is the only way that total permanent disability differ from partial permanent disability?
    Duration of the benefits.
  20. What are total temporary disability benefits?
    Time loss.
  21. What are total permanent disability benefits?
  22. How is permanent total disability defined?
    The loss of both legs, or arms, or one leg and one arm, total loss of eyesight, parlysis or other condition permentally incapacitating the worker from performing any work at any gainful occupation.
  23. What is the court's definition of permanent total disability?
    A worker is permanently and totally disabled when as a result of an industrial injury or occupational disease he or she is unable to perform or obtain gainful occupation with a reasonable degree of sucess and continuity.
  24. What is the court's second definition of permanent total disability?
    It is the loss of all reasonable wage earning capacity.
  25. What needs to be studied in order to determine whether a worker is permanently and totally disabled?
    The whole person - weaknesses, strengths, age, education, training, experience, and any other relevant factors which contribute to the ultimate conclusion.
  26. What is the ultimate conclusion?
    Whether the person is disqualified from substantial gainful employment generally available in the labor market.
  27. What type of treatment is a worker entitled to?
    Proper and necessary medical and surgical services at the hands of a physician of his own choice.
  28. Treatment is limited in point of duration do that it does not continue (2)?
    • 1. beyond the time the worker returns to full employment (unless deemed by a suerpvisor of industrial insurance to be necessary to more complete recovery)
    • 2. beyond the date he is placed on the pension rolls (excep where such is deemed necessary protect life or alleviate continuing pain).
  29. When is a worker entitled to full time loss compensation?
    If he temporarily totally disabled as a result of an injury or occupational disease.
  30. Does the incapacity for temporary total disability purposes relate only to the former work?
    No, it relates to any fainful employment - not just the former work.
  31. What does the worker get in full time loss compensation (temporary total disability)?
    Full wages from all employment the Claimant would have received has the Claimant continued working.
  32. How is the benefit calculated for full time loss compensation (temporary total disability) if he is a part time or seasonal worker?
    Average the total wages earned from any representative twelve sucessive calendard months preceding the injury.
Card Set:
Industrial Insurance
2011-10-22 15:08:56
workers comp

workers comp
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