Issues and Trends in HBI Ch 12

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  • Teaching Notes:
     
    Suggest to students that they review the key terms in this chapter prior to reading the chapter or hearing the lecture. This will enhance their understanding of the material.
     
  • Teaching Notes:
     
    Identify and discuss with students some of the workplace hazards that OSHA guards against (toxic fumes, faulty machinery, excess noise, etc.).
    Ask students to provide an example of the kind of injuries or illnesses from which OSHA can protect workers.
    Optional Assignment:
    Ask students to visit the OSHA website at www.osha.gov/ and write a short paragraph describing what they have learned about occupational hazards and safety.
  • Learning Outcome: 12.1 Explain the four federal workers’ compensation plans.
    Teaching Notes:
     
    Identify and discuss with students how workers’ compensation programs protect employees who are injured on the job or develop occupational illnesses.
    Examine and discuss with students the differences between OWCP and FECA.
    Optional Assignment:
    Ask students to visit the workers’ compensation website at www.workerscompensation.com and write a short paragraph describing what they have learned about workers’ compensation benefits.
  • Learning Outcome: 12.1 Explain the four federal workers’ compensation plans.
    Teaching Notes:
     
    Identify and discuss with students how each of the four workers’ compensation programs protect employees who are injured on the job or develop occupational illnesses.
    Ask students to provide an example of coverage for each program.
    Optional Assignment:
    Ask students to visit the workers’ compensation website at www.workerscompensation.com and write a short paragraph that provides an example of how one of the four workers’ compensation benefits programs works.
  • Learning Outcome: 12.2 Describe the two types of state workers’ compensation benefits.
    Teaching Notes:
    Examine and discuss with students the two types of workers’ compensation benefits.
    Ask students to provide three examples of the type of diseases or illnesses that can affect employees.
    Optional Assignment:
    Ask students to visit the workers’ compensation website at www.workerscompensation.com and write a short paragraph that describes three of the most common reported illnesses or conditions.
  • Learning Outcome: 12.3 Classify work-related injuries.
    Teaching Notes:
     
    Examine and discuss with students the five categories of work-related injuries (provide one example of each category).
  • Learning Outcome: 12.3 Classify work-related injuries.
    Teaching Notes:
    Examine and discuss with students how vocational rehabilitation improves the patient’s outlook for recovery.
    Ask students to describe the final report and provide a few examples of the advantages of an IME.
    Optional Assignment:
    Ask students to visit the workers’ compensation website at www.workerscompensation.com and write a short paragraph that discusses the requirements of vocational rehabilitation.
  • Learning Outcome: 12.4 List three responsibilities of the physician of record in a workers’ compensation case.
    Teaching Notes:
    Examine and discuss with students how workers’ compensation utilizes a physician of record.
    Ask students to provide an example of how the progress report is used.
  • Learning Outcome: 12.4 List three responsibilities of the physician of record in a workers’ compensation case.
    Teaching Notes:
     
    Examine Figure 12.1 with students; then identify and discuss the components of the sample workers’ compensation first report of injury or illness form.
    Ask students to define and describe how the Notice of Contest and Admission of Liability forms are used to process a claim.
    Optional Assignment:
    Ask students to visit the workers’ compensation website at www.workerscompensation.com and write a short paragraph that describes what they have learned about eligibility.
  • Learning Outcome: 12.5 Differentiate between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
    Teaching Notes:
     
    Identify and discuss with students the differences between automobile insurance policies and disability compensation programs.
  • Learning Outcome: 12.5 Differentiate between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
    Teaching Notes:
     
    Identify and discuss with students the differences between SSDI and SSI as they relate to the patient and reimbursement.
    Ask students to write a short paragraph that describes how SSI can help patients with long-term illnesses.
  • Learning Outcome: 12.5 Differentiate between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
    Teaching Notes:
     
    Ask students to define and provide examples of subrogation and liens.
  • Issues and Trends in HBI Ch 12

    1. 1. CHAPTER 12 Workers’ Compensation and Disability/Automotive Insurance © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
    2. 2. Learning Outcomes 12-2 When you finish this chapter, you will be able to: 12.1 Explain the four federal workers’ compensation plans. 12.2 Describe the two types of state workers’ compensation benefits. 12.3 Classify work-related injuries. 12.4 List three responsibilities of the physician of record in a workers’ compensation case. 12.5 Differentiate between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
    3. 3. Key Terms • Admission of Liability • automobile insurance policy • disability compensation programs • Federal Employees’ Compensation Act (FECA) • Federal Insurance Contribution Act (FICA) • final report • first report of injury 12-3 • independent medical examination (IME) • liens • Notice of Contest • occupational diseases or illnesses • Occupational Safety and Health Administration (OSHA) • Office of Workers’ Compensation Programs (OWCP)
    4. 4. Key Terms (continued) • personal injury protection (PIP) • physician of record • progress report • Social Security Disability Insurance (SSDI) • subrogation • Supplemental Security Income (SSI) • vocational rehabilitation 12-4
    5. 5. Chapter 12 Introduction 12-5 • Occupational Safety and Health Administration (OSHA)—created by Congress in 1970 to protect workers from health and safety risks on the job – Sets standards to guard against known dangers in the workplace – Businesses must meet these standards or be subject to significant fines
    6. 6. 12.1 Federal Workers’ Compensation Plans 12-6 • Office of Workers’ Compensation Programs (OWCP)—administers programs to cover workrelated illnesses or injuries suffered by civilian employees of federal agencies • Federal Employee Compensation Act (FECA) —provides workers’ compensation insurance for civilian employees of the federal government
    7. 7. 12.1 Federal Workers’ Compensation Plans (continued) 12-7 • The four workers’ compensation plans that provide coverage to federal government employees are: 1. The Federal Employees’ Compensation Program 2. The Longshore and Harbor Workers’ Compensation Program 3. The Federal Black Lung Program 4. The Energy Employees Occupational Illness Compensation Program
    8. 8. 12.2 State Workers’ Compensation Plans 12-8 • States provide two types of workers’ compensation benefits: 1. One pays the worker’s medical expenses that result from work-related illness or injury 2. The other pays for lost wages while the worker is unable to return to work • Occupational diseases or illnesses—caused by the work environment over a period longer than one workday or shift
    9. 9. 12.3 Workers’ Compensation Terminology • Work-related injuries are grouped into five categories: 1. 2. 3. 4. 5. Injury without disability Injury with temporary disability Injury with permanent disability Injury requiring vocational rehabilitation Injury resulting in death 12-9
    10. 10. 12.3 Workers’ Compensation Terminology (continued) 12-10 • Final report—filed by the physician in a state workers’ compensation case when the patient is discharged • Independent medical examination (IME)— examination conducted by a physician to confirm that an individual is permanently disabled • Vocational rehabilitation—program to prepare a patient to return to the workforce
    11. 11. 12.4 Claim Process 12-11 • Physician of record—provider who first treats a patient and assesses the level of disability – The physician of record in workers’ compensation cases is responsible for: 1. Treating the injured worker 2. Determining the percentage of disability 3. Determining the return-to-work date and filing progress notes • Progress report—filed by the physician in state workers’ compensation cases when a patient’s medical condition or disability changes
    12. 12. 12.4 Claim Process (continued) 12-12 • First report of injury—filed in state workers’ compensation cases, containing employer and accident information and patient’s description of the accident • Admission of Liability—determination that an employer is responsible for an employee’s claim under workers’ compensation • Notice of Contest—determination to deny liability for an employee’s workers’ compensation claim
    13. 13. 12.5 Disability Compensation and Automotive Insurance Programs 12-13 • Disability compensation programs—provide partial reimbursement for lost income when a disability prevents an individual from working – Benefits are paid in the form of regular cash payments – The federal government provides disability benefits to individuals through several different programs • Automobile insurance policy – contract between an insurance company and an individual for which the individual pays a premium in exchange for coverage of specified car-related financial losses
    14. 14. 12.5 Disability Compensation and Automotive Insurance Programs 12-14 • Social Security Disability Insurance (SSDI)— federal disability compensation program for some qualified people – Provides compensation for lost wages to individuals who have contributed to Social Security through FICA payroll taxes • Federal Insurance Contribution Act (FICA)– authorizes payroll deductions for the SSDI • Supplemental Security Income (SSI)—welfare program that helps pay living expenses for lowincome older people and those who are blind or have disabilities
    15. 15. 12.5 Disability Compensation and Automotive Insurance Programs 12-15 • Subrogation – action by payer to recoup expenses for a claim paid when another party should have been responsible for paying at least a portion of the claim • Personal injury protection – insurance coverage for medical expenses and other expenses related to a motor vehicle accident • Liens – written, legal claims on property to secure debt payment
    16. 16. Summary
    17. 17. Summary

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