Workers Compensation Practice Test (Part 2 of 2)

Correct answer: D. $1,600

The waiting period means no wage-loss benefits for the first 7 days, but once disability passes the 14-day retroactive threshold, those days are paid too. Sam is owed all 20 days: 20 x $80 = $1,600. Without the retroactive rule he would receive only 13 days, or $1,040. Medical benefits are not subject to the waiting period. Actual waiting and retroactive periods vary by state.

Reference: Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Cash Benefits; 33 U.S.C. 906(a) as a federal example

Correct answer: C. Survivor benefits for dependents plus a burial allowance

When a work injury causes death, workers compensation pays survivor (death) benefits to dependents such as a spouse and dependent children, usually tied to the worker's wage, often ending on a spouse's remarriage or when children reach adulthood, with details varying by state. Systems also pay a separate burial allowance. Pain and suffering damages are not part of workers compensation, and disability benefits belong to a living worker.

Reference: Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Survivors Benefits

Correct answer: B. The Longshore and Harbor Workers' Compensation Act

The Longshore and Harbor Workers' Compensation Act covers maritime workers such as longshore workers, ship repairers, shipbuilders, and shipbreakers injured on navigable waters or adjoining areas like piers, wharves, dry docks, and terminals. It excludes masters and crew members of vessels, who fall under the Jones Act. Because the standard policy does not cover federal compensation laws, the employer needs the Longshore and Harbor Workers' Compensation Act Coverage Endorsement.

Reference: 33 U.S.C. 902(3) and 903(a); NCCI WC 00 01 06 A

Correct answer: B. Interstate railroad workers and seamen (vessel crew members)

Railroad workers are covered by the Federal Employers' Liability Act, which makes interstate railroads liable for injuries resulting in whole or in part from their negligence. Seamen use the Jones Act, which lets an injured seaman bring a civil action with a jury trial against the employer under the railroad-worker rules. The other groups receive no-fault compensation benefits, under state law or federal programs such as the Longshore Act and its extensions, FECA, or black lung benefits, rather than suing for negligence.

Reference: 45 U.S.C. 51; 46 U.S.C. 30104; Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Exclusive Remedy

Correct answer: D. The Federal Employees' Compensation Act

The Federal Employees' Compensation Act covers federal civilian employees, including Postal Service workers, and is administered by the Department of Labor's Office of Workers' Compensation Programs. FECA is the exclusive remedy against the United States for covered injuries. Do not confuse it with the Federal Employers' Liability Act, the negligence-based law for railroad workers. State laws do not govern federal employees' work injuries.

Reference: 5 U.S.C. 8116(c); Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Federal Employees' Compensation Act

Correct answer: C. The Defense Base Act

The Defense Base Act covers civilian employees working outside the United States on U.S. military bases or under contracts with the U.S. government for public works or national defense. It extends Longshore Act benefits to these workers, and contractors secure coverage through Department of Labor authorized carriers or approved self-insurance; a standard policy can be extended with the NCCI Defense Base Act Coverage Endorsement. FECA covers federal government employees, not contractor employees.

Reference: U.S. Department of Labor, OWCP, Defense Base Act; NCCI WC 00 01 01 A

Correct answer: A. Coal miners totally disabled by pneumoconiosis, and eligible survivors

The Black Lung Benefits Act compensates coal miners who are totally disabled by pneumoconiosis arising out of coal mine employment and survivors of miners whose deaths are attributable to the disease. It also provides medical coverage for related lung disease. Benefits are paid by responsible coal mine operators or the Black Lung Disability Trust Fund. Other occupational lung diseases fall under state or other federal compensation systems.

Reference: U.S. Department of Labor, OWCP, Division of Coal Mine Workers' Compensation

Correct answer: D. Maritime Coverage Endorsement (maritime employers liability)

The Maritime Coverage Endorsement (WC 00 02 01) removes the Part Two exclusion for masters and crew members of vessels and provides employers liability coverage for that exposure, with transportation, wages, maintenance, and cure covered only if a premium is shown. The Longshore Act endorsement does not apply to masters or crews of vessels. The FELA endorsement is for railroads, and the Defense Base Act endorsement is for overseas government contract work.

Reference: NCCI WC 00 02 01 B Maritime Coverage Endorsement and WC 00 01 06 A notes (as reprinted in the NYCIRB WC & EL Manual)

Correct answer: C. The injured worker, the employer, and the treating medical provider

Three-point contact means promptly reaching the injured worker, the employer, and the treating provider. The worker explains how the injury happened, the employer confirms the facts, witnesses, and wage information from its first report of injury, and the provider gives the diagnosis, causation opinion, and work restrictions. Together these contacts support a timely compensability decision, accurate benefit payments, and early return-to-work planning.

Reference: Standard workers compensation claim-handling practice (three-point contact)

Correct answer: B. Identify everyone present and get the worker's consent to be recorded

A recorded statement should open by identifying who is speaking, the date and time, and confirming on the recording that the worker knows the call is recorded and agrees. Some states require every party's consent to record a call, so consent on the record protects the statement's usefulness. The adjuster then asks open-ended questions about how the injury happened, witnesses, and prior injuries. Releases and policy exclusions have no place in the opening.

Reference: General claim-handling practice for recorded statements

Correct answer: D. Temporary benefits generally end, and the rating guides permanent benefits

MMI is the point where a worker's condition has plateaued and further material improvement is not expected. Temporary disability benefits generally stop at MMI, and the impairment rating, often based on the AMA Guides, is used to determine permanent disability benefits. Needed medical care for the injury may continue. An IME physician is not the treating doctor and does not take over care. Disputes over MMI can be challenged under state procedures.

Reference: Wikipedia, Maximum medical improvement; Wikipedia, Independent medical examination

Correct answer: C. Vocational rehabilitation, such as job placement or retraining

Vocational rehabilitation services, such as vocational evaluation, job placement, and retraining, help injured workers return to work when they cannot go back to their old jobs. Return-to-work and light-duty programs share the same goal. If Ben returns to work at lower wages, partial disability benefits may supplement his pay. Temporary total disability does not continue indefinitely, and the other options do not address employment.

Reference: Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Vocational Rehabilitation and Return to Work

Correct answer: B. Ana may sue the motorist, and the insurer may recover what it paid

Exclusive remedy only bars suits against the employer. Ana may still sue the negligent third-party motorist. Part One of the standard policy gives the insurer the employer's and the worker's rights to recover its payments from anyone liable for the injury, and the employer must help protect those rights. The insurer typically asserts a lien on Ana's recovery. A waiver of subrogation endorsement can give up this right against a named party.

Reference: NCCI WC 00 00 00 C (2013 ed., as reprinted in the NYCIRB WC & EL Manual), Part One, G. Recovery From Others; Congressional Research Service, Workers' Compensation: Overview and Issues (R44580), Exclusive Remedy

Correct answer: A. Treat the facts as red flags calling for a thorough investigation

A Monday morning report of an unwitnessed injury said to have happened late Friday, delayed reporting, and a pending layoff are classic fraud indicators. Indicators are not proof. The adjuster should investigate in good faith: take statements, interview coworkers, review medical records and prior claims, and refer the file to a special investigations unit if facts warrant. Denying without investigation or accepting without investigation are both improper.

Reference: The Hartford, Workers' Compensation Fraud (red flags such as delayed reporting and inconsistent details)

Correct answer: B. $40,800

The experience modification compares an employer's actual losses with the losses expected for its classifications and payroll. A factor of 1.00 is average, below 1.00 is a credit, and above 1.00 is a debit. Multiply manual premium by the factor: $48,000 x 0.85 = $40,800. $55,200 would result from a 1.15 debit mod, and $7,200 is only the amount of the credit.

Reference: Wikipedia, Experience modifier; NCCI WC 00 04 03 Experience Rating Modification Factor Endorsement