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Survey of Medical Insurance pp ch13


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Survey of Medical Insurance pp ch13

  1. 1. 13 Workers’ Compensation and Disability
  2. 2. Learning Outcomes <ul><li>When you finish this chapter, you will be able to: </li></ul><ul><li>13.1 List the four federal workers’ compensation plans. </li></ul><ul><li>13.2 Describe the two types of workers’ compensation benefits that are offered by states. </li></ul><ul><li>13.3 List the five classifications of work-related injuries. </li></ul><ul><li>13.4 List three responsibilities of the physician of record in a workers’ compensation case. </li></ul><ul><li>13.5 Explain the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). </li></ul>13-2
  3. 3. Key Terms <ul><li>Admission of Liability </li></ul><ul><li>disability compensation programs </li></ul><ul><li>Federal Employees’ Compensation Act (FECA) </li></ul><ul><li>Federal Insurance Contribution Act (FICA) </li></ul><ul><li>final report </li></ul><ul><li>first report of injury </li></ul><ul><li>independent medical examination (IME) </li></ul>13-3 <ul><li>Notice of Contest </li></ul><ul><li>occupational diseases or illnesses </li></ul><ul><li>Occupational Safety and Health Administration (OSHA) </li></ul><ul><li>Office of Workers’ Compensation Programs (OWCP) </li></ul><ul><li>physician of record </li></ul><ul><li>progress report </li></ul>
  4. 4. Key Terms (Continued) <ul><li>Social Security Disability Insurance (SSDI) </li></ul><ul><li>Supplemental Security Income (SSI) </li></ul><ul><li>vocational rehabilitation </li></ul>13-4
  5. 5. Chapter 13 Introduction <ul><li>Occupational Safety and Health Administration (OSHA)— created by Congress in 1970 to protect workers from health and safety risks on the job </li></ul><ul><ul><li>Sets standards to guard against known dangers in the workplace </li></ul></ul><ul><ul><li>Businesses must meet these standards or they are subject to significant fines </li></ul></ul>13-5
  6. 6. 13.1 Federal Workers’ Compensation Plans <ul><li>Office of Workers’ Compensation Programs (OWCP)— administers programs to cover work-related illnesses or injuries suffered by civilian employees of federal agencies </li></ul><ul><li>Federal Employee Compensation Act (FECA)— provides workers’ compensation insurance for civilian employees of the federal government </li></ul>13-6
  7. 7. 13.1 Federal Workers’ Compensation Plans (Continued) <ul><li>The four workers’ compensation plans that provide coverage to federal government employees are: </li></ul><ul><ul><li>The Federal Employees’ Compensation Program </li></ul></ul><ul><ul><li>The Longshore and Harbor Workers’ Compensation Program </li></ul></ul><ul><ul><li>The Federal Black Lung Program </li></ul></ul><ul><ul><li>The Energy Employees Occupational Illness Compensation Program </li></ul></ul>13-7
  8. 8. 13.2 State Workers’ Compensation Plans <ul><li>States provide two types of workers’ compensation benefits: </li></ul><ul><ul><li>One pays the worker’s medical expenses that result from work-related illness or injury </li></ul></ul><ul><ul><li>The other pays for lost wages while the worker is unable to return to work </li></ul></ul><ul><li>Occupational diseases or illnesses— caused by the work environment over a period longer than one workday or shift </li></ul>13-8
  9. 9. 13.3 Workers’ Compensation Terminology <ul><li>Work-related injuries are grouped into five categories: </li></ul><ul><ul><li>Injury without disability </li></ul></ul><ul><ul><li>Injury with temporary disability </li></ul></ul><ul><ul><li>Injury with permanent disability </li></ul></ul><ul><ul><li>Injury requiring vocational rehabilitation </li></ul></ul><ul><ul><li>Injury resulting in death </li></ul></ul>13-9
  10. 10. 13.3 Workers’ Compensation Terminology (Continued) <ul><li>Final report— filed by the physician in a state workers’ compensation case when the patient is discharged </li></ul><ul><li>Independent medical examination (IME)— examination conducted by a physician to confirm that an individual is permanently disabled </li></ul><ul><li>Vocational rehabilitation— program to prepare a patient to return to the workforce </li></ul>13-10
  11. 11. 13.4 Claim Process <ul><li>Physician of record— provider who first treats a patient and assesses the level of disability </li></ul><ul><ul><li>The physician of record in workers’ compensation cases is responsible for: </li></ul></ul><ul><ul><li>Treating the injured worker </li></ul></ul><ul><ul><li>Determining the percentage of disability </li></ul></ul><ul><ul><li>Determining the return-to-work date and filing progress notes </li></ul></ul><ul><li>Progress report— filed by the physician in state workers’ compensation cases when a patient’s medical condition or disability changes </li></ul>13-11
  12. 12. 13.4 Claim Process (Continued) <ul><li>First report of injury— filed in state workers’ compensation cases, containing employer and accident information and patient’s description of the accident </li></ul><ul><li>Admission of Liability— determination that an employer is responsible for an employee’s claim under workers’ compensation </li></ul><ul><li>Notice of Contest— determination to deny liability for an employee’s workers’ compensation claim </li></ul>13-12
  13. 13. 13.5 Disability Compensation Programs <ul><li>Disability compensation programs— provide partial reimbursement for lost income when a disability prevents an individual from working </li></ul><ul><ul><li>Benefits are paid in the form of regular cash payments </li></ul></ul><ul><ul><li>The federal government provides disability benefits to individuals through several different programs </li></ul></ul>13-13
  14. 14. 13.5 Disability Compensation Programs (Continued) <ul><li>Social Security Disability Insurance (SSDI)— federal disability compensation program for some qualified people </li></ul><ul><ul><li>Provides compensation for lost wages to individuals who have contributed to Social Security through FICA payroll taxes </li></ul></ul><ul><li>Federal Insurance Contribution Act (FICA)– authorizes payroll deductions for the SSDI </li></ul><ul><li>Supplemental Security Income (SSI)— welfare program that helps pay living expenses for low-income older people and those who are blind or have disabilities </li></ul>13-14