CA SIP LATEST EXAMS SCRIPT ALL QUESTIONS
AND ANSWERS SURE A+
✔✔Who does CIGA (CA Insurance Guarantee Association) insure? - ✔✔Insolvent
insurance companies.
✔✔The statute of limitations for subro claims is: - ✔✔2 years.
✔✔In a 3rd party case there is a $100k recovery from a negligent third party. Attorney
fees = $36k. Costs = $4k. WC lien is $40k. What is the net recovery to the IW/Petition
for Credit for the 3rd party recovery? - ✔✔$20k
✔✔An ER and EE file 3rd party actions and obtain a recovery. Who has first right of
recovery? A. The EE. B. The ER. C. The ER, if the lien does not exceed the amount of
the recovery. D. 1/3 to the EE, 1/3 to ER, 1/3 to ER attorney. - ✔✔c
✔✔Can an EE bring his personal physician to a medical exam requested by his ER? A.
Yes, but he is responsible for the fees. B. yes, and the ER must pay the fees. - ✔✔A.
Yes, but he is responsible for the fees.
✔✔When would an IW be justified for missing or refusing to attend a medical exam
arranged by his ER? - ✔✔When mileage isn't paid in advance.
,✔✔An IW unreasonably fails or refuses to get medical treatment for his injuries. You
should: - ✔✔File a Petition to Suspend Benefits
✔✔What is the 2010 Max TTD rate? - ✔✔$986.69
✔✔A nursing student works PT 20 hrs/wk, $10/hr. After graduating she works 40 hrs/wk
and is promised a raise to $1000/wk after receiving her certificate. She has an injury in
2005 while working PT but graduates and gets her certificate. Her TD rate is: A.
$133.33 while PT; $266.67 after she graduates; and $666.67 after receiving her
certificate. B. $200 while PT; $266.67 after she graduates, and $666.67 after receiving
her certificate. C. Who cares. D. $200 while PT, $266.67 after graduating. - ✔✔a
✔✔A bartender with earnings of $600/wk averages tips of $250, and also receives one
free meal/day from the ER. The ER's cost of the meal is $15. If the EE paid for the meal
it would cost $125/wk. What are the EE's earnings? - ✔✔$975.00
✔✔What is his TD rate for an injury in 2005? - ✔✔$650
✔✔A 17 yo is injured and is minimum for TD. What is the correct PD rate? A. Minimum.
B. Maximum. C. Average weekly earnings of $189. D. Probably earnings at age 18. -
✔✔d
✔✔EE is seriously injured as a result of his own serious and willful mixdonduct. The
EE's compensation is reduced by 50% unless: A. He is a minor. B. The injury results in
death. C. The injury produces PD of 70% or greater. D. Both b and c. - ✔✔d
✔✔A finding that the injuries results from the injured EE's serious and willful misconduct
means: A. A 50% reduction in the applicant's indemnity benefits. B. The compensation
otherwise payable shall be reduced by one-half. C. 10% reduction if the injury causes
PD greater than 70%. D. No reduction if the EE is under 18 years of age at the time of
injury. - ✔✔b
✔✔If an ER is guilty of serious and willful misconduct the EE's compensation is: A.
Increased by 10%. B. Increased by $250. C. Increased by one-half. D. Increased by
one-half up to $10k. - ✔✔c
✔✔The penalty for failing to obtain worker's compensation coverage is what percentage
of the compensation paid? 10%, 15%, 20%, or 25%? - ✔✔10%
✔✔Where the injry is to an EE under ___ years of age and illegally employed at the
time of injury, the entire compensation otherwise recoverable shall be increased by
____ percent. - ✔✔16, 50
, ✔✔How many days does an ER or insurance carrier, from the date of request, have to
provide an EE with a change of physician form? 5 calendar days; 5 working days; 10
calendar days; 10 working days. - ✔✔5 working days.
✔✔If the ER desires a change of physicians or chiropractor, who may he petition? -
✔✔The administrative director
✔✔Do UR Policies and Procedures and a description of the process have to be filed
with the administrative director? Yes; No; Only if requested; Only in the event of a
dispute. - ✔✔Yes
✔✔UR Review Policies and Procedures shall be filed with the: Administrative Director;
Medical Director; WCAB; Director of Industrial Relations. - ✔✔Administrative director
✔✔An ER has established a UR department under LC 4610 and hired a nurse to
approve or deny requests. This is: Always permissible; Never permissible; Only a
licensed physician may modify, delay, or deny requests for medical treatment; Ok if the
nurse has met CE requirements. - ✔✔Only a licensed physician may modify, delay, or
deny requests for medical treatment
✔✔The ER or insurance carrier shall submit a plan for the Medical Provider Network for
approval by: Medical Director; Mgr of SIP; CA Insurance Commissioner; Administrative
Director - ✔✔Administrative Director
✔✔Who can modify, delay and deny requests for treatment? Certified physician;
Licensed physician's assistant or nurse; Licensed medical provider in that speciality;
Claims adjuster - ✔✔Licensed medical provider in that speciality
✔✔You find a doctor's medical-legal bill in a claims file 62 days after the bill was date
stamped received. You should: Voluntarily add 10% plus 7% interest; Send an objection
to the bill immediately; Deny the bill; Wait until you are forced to pay the penalty. -
✔✔Voluntarily add 10% plus 7% interest
✔✔If a physician didn't perform a particular exam or prepare the report, you should:
Object to the report as inadmissable; Contact the physician's office and negotiate;
Report the physician to the WCAB. - ✔✔Report the physician to the Fraud Bureau.
Object to the report as inadmissable
✔✔Voc Rehab may be settled where: All the parties are in agreement; The EE could
lose the case; There is a good faith issue which if resolved against the IW would defeat
the EE's right to all benefits; Never - ✔✔There is a good faith issue which if resolved
against the IW would defeat the EE's right to all benefits
AND ANSWERS SURE A+
✔✔Who does CIGA (CA Insurance Guarantee Association) insure? - ✔✔Insolvent
insurance companies.
✔✔The statute of limitations for subro claims is: - ✔✔2 years.
✔✔In a 3rd party case there is a $100k recovery from a negligent third party. Attorney
fees = $36k. Costs = $4k. WC lien is $40k. What is the net recovery to the IW/Petition
for Credit for the 3rd party recovery? - ✔✔$20k
✔✔An ER and EE file 3rd party actions and obtain a recovery. Who has first right of
recovery? A. The EE. B. The ER. C. The ER, if the lien does not exceed the amount of
the recovery. D. 1/3 to the EE, 1/3 to ER, 1/3 to ER attorney. - ✔✔c
✔✔Can an EE bring his personal physician to a medical exam requested by his ER? A.
Yes, but he is responsible for the fees. B. yes, and the ER must pay the fees. - ✔✔A.
Yes, but he is responsible for the fees.
✔✔When would an IW be justified for missing or refusing to attend a medical exam
arranged by his ER? - ✔✔When mileage isn't paid in advance.
,✔✔An IW unreasonably fails or refuses to get medical treatment for his injuries. You
should: - ✔✔File a Petition to Suspend Benefits
✔✔What is the 2010 Max TTD rate? - ✔✔$986.69
✔✔A nursing student works PT 20 hrs/wk, $10/hr. After graduating she works 40 hrs/wk
and is promised a raise to $1000/wk after receiving her certificate. She has an injury in
2005 while working PT but graduates and gets her certificate. Her TD rate is: A.
$133.33 while PT; $266.67 after she graduates; and $666.67 after receiving her
certificate. B. $200 while PT; $266.67 after she graduates, and $666.67 after receiving
her certificate. C. Who cares. D. $200 while PT, $266.67 after graduating. - ✔✔a
✔✔A bartender with earnings of $600/wk averages tips of $250, and also receives one
free meal/day from the ER. The ER's cost of the meal is $15. If the EE paid for the meal
it would cost $125/wk. What are the EE's earnings? - ✔✔$975.00
✔✔What is his TD rate for an injury in 2005? - ✔✔$650
✔✔A 17 yo is injured and is minimum for TD. What is the correct PD rate? A. Minimum.
B. Maximum. C. Average weekly earnings of $189. D. Probably earnings at age 18. -
✔✔d
✔✔EE is seriously injured as a result of his own serious and willful mixdonduct. The
EE's compensation is reduced by 50% unless: A. He is a minor. B. The injury results in
death. C. The injury produces PD of 70% or greater. D. Both b and c. - ✔✔d
✔✔A finding that the injuries results from the injured EE's serious and willful misconduct
means: A. A 50% reduction in the applicant's indemnity benefits. B. The compensation
otherwise payable shall be reduced by one-half. C. 10% reduction if the injury causes
PD greater than 70%. D. No reduction if the EE is under 18 years of age at the time of
injury. - ✔✔b
✔✔If an ER is guilty of serious and willful misconduct the EE's compensation is: A.
Increased by 10%. B. Increased by $250. C. Increased by one-half. D. Increased by
one-half up to $10k. - ✔✔c
✔✔The penalty for failing to obtain worker's compensation coverage is what percentage
of the compensation paid? 10%, 15%, 20%, or 25%? - ✔✔10%
✔✔Where the injry is to an EE under ___ years of age and illegally employed at the
time of injury, the entire compensation otherwise recoverable shall be increased by
____ percent. - ✔✔16, 50
, ✔✔How many days does an ER or insurance carrier, from the date of request, have to
provide an EE with a change of physician form? 5 calendar days; 5 working days; 10
calendar days; 10 working days. - ✔✔5 working days.
✔✔If the ER desires a change of physicians or chiropractor, who may he petition? -
✔✔The administrative director
✔✔Do UR Policies and Procedures and a description of the process have to be filed
with the administrative director? Yes; No; Only if requested; Only in the event of a
dispute. - ✔✔Yes
✔✔UR Review Policies and Procedures shall be filed with the: Administrative Director;
Medical Director; WCAB; Director of Industrial Relations. - ✔✔Administrative director
✔✔An ER has established a UR department under LC 4610 and hired a nurse to
approve or deny requests. This is: Always permissible; Never permissible; Only a
licensed physician may modify, delay, or deny requests for medical treatment; Ok if the
nurse has met CE requirements. - ✔✔Only a licensed physician may modify, delay, or
deny requests for medical treatment
✔✔The ER or insurance carrier shall submit a plan for the Medical Provider Network for
approval by: Medical Director; Mgr of SIP; CA Insurance Commissioner; Administrative
Director - ✔✔Administrative Director
✔✔Who can modify, delay and deny requests for treatment? Certified physician;
Licensed physician's assistant or nurse; Licensed medical provider in that speciality;
Claims adjuster - ✔✔Licensed medical provider in that speciality
✔✔You find a doctor's medical-legal bill in a claims file 62 days after the bill was date
stamped received. You should: Voluntarily add 10% plus 7% interest; Send an objection
to the bill immediately; Deny the bill; Wait until you are forced to pay the penalty. -
✔✔Voluntarily add 10% plus 7% interest
✔✔If a physician didn't perform a particular exam or prepare the report, you should:
Object to the report as inadmissable; Contact the physician's office and negotiate;
Report the physician to the WCAB. - ✔✔Report the physician to the Fraud Bureau.
Object to the report as inadmissable
✔✔Voc Rehab may be settled where: All the parties are in agreement; The EE could
lose the case; There is a good faith issue which if resolved against the IW would defeat
the EE's right to all benefits; Never - ✔✔There is a good faith issue which if resolved
against the IW would defeat the EE's right to all benefits
