Vermont Workers' Compensation Law
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Form 1 - CORRECT ANSWER - First Report of Injury- must be filed with the carrier
within 72 hours of receiving notice or knowledge of a claimed work-related injury that either a)
causes an absence of one day or more from work or b) requires medical attention
- must be filed even if the employer disputes the factual basis of the injury
- must be filed for first aid injuries as well
21 days - CORRECT ANSWER - amount of time from date the employer receives notice
of the injury that the carrier has to accept or deny a claim, regardless of the date that the
employer contacts the insurer
Form 2 - CORRECT ANSWER - Denial of Benefits- must be filed if the employer/carrier
concludes that the injury is not compensable within the 21 day period
- Department will deny this form if it is not filed with adequate support
- if it is not filed within the 21 day period and no extension was granted, the Department may
order employer/carrier to pay benefits
Form 10 - CORRECT ANSWER - must be filed in order to obtain the claimant's average
weekly wage- requires claimant to list dependents
Form 25 - CORRECT ANSWER - must be filed in order to obtain the claimant's average
weekly wage- records gross wages for the 26 weeks prior to the injury
- gross wages include income from concurrently held jobs- separate form must be obtained from
each employer
Temporary Partial Disability (TPD) - CORRECT ANSWER - if the injury results in eight
or more days of partial disability, claimant is entitled to these benefits- compensation rate is two-
thirds of the difference between the claimant's pre-injury AWW and the claimant's current
weekly wage
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Form 1 - CORRECT ANSWER - First Report of Injury- must be filed with the carrier
within 72 hours of receiving notice or knowledge of a claimed work-related injury that either a)
causes an absence of one day or more from work or b) requires medical attention
- must be filed even if the employer disputes the factual basis of the injury
- must be filed for first aid injuries as well
21 days - CORRECT ANSWER - amount of time from date the employer receives notice
of the injury that the carrier has to accept or deny a claim, regardless of the date that the
employer contacts the insurer
Form 2 - CORRECT ANSWER - Denial of Benefits- must be filed if the employer/carrier
concludes that the injury is not compensable within the 21 day period
- Department will deny this form if it is not filed with adequate support
- if it is not filed within the 21 day period and no extension was granted, the Department may
order employer/carrier to pay benefits
Form 10 - CORRECT ANSWER - must be filed in order to obtain the claimant's average
weekly wage- requires claimant to list dependents
Form 25 - CORRECT ANSWER - must be filed in order to obtain the claimant's average
weekly wage- records gross wages for the 26 weeks prior to the injury
- gross wages include income from concurrently held jobs- separate form must be obtained from
each employer
Temporary Partial Disability (TPD) - CORRECT ANSWER - if the injury results in eight
or more days of partial disability, claimant is entitled to these benefits- compensation rate is two-
thirds of the difference between the claimant's pre-injury AWW and the claimant's current
weekly wage
