10 Questions on Workers Comp Benefits Info – Test Your Knowledge
The great response to the Workers Comp Benefits Info Quiz a few weeks ago made me think – let us do another one covering Workers Comp benefits info. Remember that certain states may have exceptions. Each question scores 10 points each – and possibly a bonus to help your score. Eighty points is a passing grade.
All these subjects have been covered in the 1800 articles on this website.
- Are Workers Comp benefits taxable? Why or why not? – The benefits are not taxable. The one-third reduction from the Average Weekly Wage (AWW *2/3) avoids incentivizing the injured employee by making their Workers Comp weekly benefits the same as what they would have received after taxes if they were currently working.
- An injured employee is balance-billed by a medical provider after receiving payment for medical services rendered. Does the employee or the employer have to pay the balance? The injured employee should not have to pay the balance. Balance billing is illegal in many states. Employees should rarely pay for their Workers Comp medical benefits – possibly for their own Independent Medical Exam.
- What is the term for medical benefits in a state without a medical fee schedule? Usual & Customary (U&C) is the average medical charge in the area where the medical services are provided.
- An employee receives authorized out-of-state treatment. Will the employer have to pay the bill in full or can the carrier/TPA apply a fee schedule? Most out-of-state treatment cannot be fee-scheduled as the medical provider in the other state does not have to acquiesce to the fee schedule in another state. The bill may be paid in full or at the U&C charges – see #3.
- Do volunteers receive weekly benefits if they are injured while working? Watch your answer on this one. Yes, many states have a minimum amount to be paid even to volunteer workers. I was fined many years ago for not paying a volunteer the state’s minimum Workers’ Comp benefits. Volunteer Workers Comp benefits were a hard lesson learned by me in the 1980s.
- An injured employee is rated with a 10% disability to their back/spine. The state maximum number of weeks for permanency is 300 weeks. The injured employee’s workers comp rate is $350 per week. How many weeks of PTD will the employee receive for the 10% rating? I must apologize for this trick question. The injured employee would receive PPD (Permanent Partial Disability) instead of Permanent Total Disability (PTD) benefits. The PTD benefits are usually lifetime or a certain state’s maximum benefit payments. If the question was PPD, then the injured employee would receive 30 weeks at $350 per week (non-taxable).
- An employee injures themselves while flying in a plane on a business trip. Is that injury going to be covered by Workers’ Comp? Yes, if the injured employee was traveling for a work assignment, benefits would be payable.
- Are Workers Comp benefits always primary for a compensable claim even if other types of insurance are involved such as automobile insurance or an employee’s short-term disability policy? Yes, Workers’ Comp benefits are almost always the primary payer of benefits for an on-the-job injury or occupational disease.
- A worker is injured while working at an overseas military base. What is the type of insurance that covers them for this injury? The coverage is called Defense Base Act insurance. The insurance is specifically designed for workers hurt on foreign military bases.
- Is an injured employee owed for mileage driven when attending Workers Comp medical appointments? Is the rate usually higher or lower than the IRS mileage allowed for medical travel? Yes, they are owed for roundtrip travel to the medical appointment. The rate is variable from state to state. The rate for Workers’ Comp mileage is usually higher than the IRS medical travel allowance. However, the mileage reimbursement is not taxable.
Bonus Question – Workers Comp Benefits Info Quiz
Can an employer not file a First Report of injury and pay an injured employee out-of-pocket and file their medical bills under health? If yes, in what instance? No, a Workers’ Comp claim should always be filed with the insurance carrier or TPA for self-insureds. Many of the mega claims I have handled started as unreported Workers’ Comp claims.
- Who is the main supplier of info for employers on their responsibilities when a Workers Comp claim occurs? There could be multiple sources – which ones? The state Industrial Commissions or Accident Boards always have a section online for information for employers once an accident has occurred. Carriers and TPAs provide a huge amount of info on what to do when an employee is injured on the job. Most states provide an employer section on their front page such as the Oklahoma example in the last link.
If you disagree with one of my answers, please include it in the comments. I did not cover every state exception for my answers due to space and readability.
Give yourself 10 points for every correct question. If you scored 120, then you are a Workers Comp benefits guru. A passing grade is 80 points. The bonus questions count for 10 points each.
Please remember that J&L is not providing legal or medical advice in this quiz. You can miss four of the questions on the workers comp benefits info quiz and still pass. Good luck.
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