Module1_WorkersComp_Brainscape Flashcards

(105 cards)

1
Q

What do California Labor Code §§3200–6209 cover?

A

They establish the fundamental structure of the California workers’ compensation system, including rights and obligations of employees and employers.

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2
Q

What do California Labor Code §§4600–4607 cover?

A

They govern medical treatment and care for workers’ compensation claims, including surgeries, meds, therapy, and rehab.

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3
Q

What does California Labor Code §132a prohibit?

A

It prohibits discrimination or retaliation against workers who file or intend to file workers’ compensation claims.

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4
Q

Who must provide workers’ compensation insurance in California?

A

Employers must either buy workers’ compensation insurance or be self‑insured by law.

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5
Q

Are part‑time and seasonal workers covered by California workers’ comp?

A

Yes, most employees, including part‑time, temporary, and seasonal workers are covered unless they fall into limited exceptions like certain independent contractors.

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6
Q

What is the primary purpose of California workers’ compensation laws?

A

To provide medical care, wage replacement, and benefits for employees injured or made ill by work activities.

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7
Q

What agency oversees California’s workers’ compensation system?

A

The Department of Industrial Relations (DIR), including its Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB).

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8
Q

What body resolves disputes in California workers’ compensation cases?

A

The Workers’ Compensation Appeals Board (WCAB).

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9
Q

What are the key regulations governing California workers’ comp?

A

Title 8 of the California Code of Regulations provides rules for medical treatment, impairment rating, and QME conduct.

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10
Q

What is a Qualified Medical Examiner (QME)?

A

A physician certified by the DWC to perform impartial medical evaluations in workers’ compensation disputes.

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11
Q

What do Medical Benefits under CA workers’ comp cover?

A

Necessary medical treatment, surgeries, medications, therapy, and rehabilitation for work injuries.

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12
Q

How are Temporary Disability (TD) benefits calculated in CA?

A

Typically two‑thirds of the worker’s average weekly wage up to a statutory maximum while the employee cannot work.

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13
Q

When are Permanent Disability (PD) benefits provided?

A

If an injury results in permanent impairment affecting the worker’s daily function and earning capacity.

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14
Q

What is Vocational Rehabilitation in CA workers’ comp?

A

Training or education for a new job if a permanent injury prevents returning to the old job.

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15
Q

Who can receive Death Benefits under CA workers’ comp?

A

Dependents such as spouse, children, or other qualifying family members of a worker who died from a work‑related injury.

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16
Q

What form must an injured CA worker file to start a claim?

A

The DWC‑1 Claim Form, usually within 30 days of injury notice.

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17
Q

What is the employer’s responsibility after a worker reports an injury?

A

Provide benefits promptly, including medical care and temporary disability payments.

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18
Q

Who processes and pays CA workers’ comp claims?

A

The employer’s insurance company or the self‑insured employer handles payments and treatment authorization.

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19
Q

What is a medical‑legal evaluation?

A

An independent exam, usually by a QME, to resolve disputes about the extent of injury, disability, or treatment.

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20
Q

What happens if an injured worker is medically cleared to return to work?

A

They must return to work, or the employer may offer modified/alternative work if available.

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21
Q

What agency hears appeals when benefits are disputed?

A

The Workers’ Compensation Appeals Board (WCAB).

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22
Q

What does PTD stand for in CA workers’ comp?

A

Permanent Total Disability — worker is completely unable to work.

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23
Q

What does TPD stand for?

A

Temporary Partial Disability — worker can do some but not all job duties temporarily.

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24
Q

What is Average Weekly Wage (AWW)?

A

The average wage used to calculate benefits like Temporary Disability payments.

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25
What is a compensable injury?
A work‑related injury that qualifies for workers’ comp benefits.
26
What is aggravation of pre‑existing conditions?
When work worsens a prior condition, making it compensable under workers’ comp.
27
What reforms have impacted CA workers’ comp medical treatment?
Updated evidence‑based medical treatment guidelines to ensure appropriate care.
28
How have CA workers’ comp reforms addressed costs?
They implemented cost‑containment measures to reduce premiums and medical expenses.
29
What is a return‑to‑work program in CA workers’ comp?
Employer efforts to bring injured workers back to suitable jobs as soon as medically possible.
30
What is a disability rating schedule?
A standardized system to evaluate impairment and calculate permanent disability benefits.
31
What is the DIR in CA workers’ comp?
The Department of Industrial Relations — oversees the entire workers’ compensation system.
32
What is the WCAB?
Workers’ Compensation Appeals Board — resolves benefit and injury disputes.
33
What is the DWC?
Division of Workers’ Compensation — provides forms, rules, and QME certification.
34
What law governs QME certification requirements?
CA Labor Code §§4060–4064 set standards for QME certification and report writing.
35
Why are QME medical‑legal reports important?
They influence benefit decisions, disability ratings, and dispute resolution.
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