Module 1 – Workers’ Compensation System (Flashcards 36 – 70)

(39 cards)

1
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2
Q
A

What triggers an employer’s duty to give the DWC-1 claim form?

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3
Q
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Penalty if employer fails to provide DWC-1?

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4
Q
A

Who files the Employer’s First Report of Injury (5020)?

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5
Q
A

Mnemonic

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6
Q
A

Define Medical Provider Network (MPN).

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7
Q
A

Employee’s right to change doctor in MPN?

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8
Q
A

What is Predesignation?

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9
Q
A

Time frame to predesignate

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10
Q
A

Define Primary Treating Physician (PTP).

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11
Q
A

What is a PR-2 form?

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12
Q
A

Define MMI (Maximum Medical Improvement).

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13
Q
A

Mnemonic

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14
Q
A

PD rating based on what guides?

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15
Q
A

Who issues the Permanent Disability Rating (PDR)?

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16
Q
17
Q
A

What is apportionment?

18
Q
A

Penalty for delayed TD payments?

19
Q
A

What is a voucher (SJDB)?

20
Q
A

What is UR time frame for prospective care?

21
Q
A

Mnemonic UR timing

22
Q
A

If UR denies, worker can file?

23
Q
A

What is an AME (Agreed Medical Evaluator)?

24
Q
A

QME panel: how many doctors?

25
Time to request QME panel
26
Mnemonic QME timing
27
If parties can’t agree on AME, next step?
28
When can WCAB order another QME?
29
What is **ex parte communication**?
30
Penalty for ex parte?
31
Define **utilization schedule** (MTUS).
32
Mnemonic MTUS
33
Who enforces MTUS compliance?
34
What is the **QME’s duty** when records are incomplete?
35
WC fraud consequences
36
Who can file **serious & willful misconduct** claim?
37
Employer defenses to S&W
38
132a discrimination claim means?
39
Mnemonic for 132a