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Medical Insurance

Understanding Work-Related Injuries
Resources: Appendix C; and Medical Insurance
Part A
Complete Appendix C by reading the five case studies and determine whether these injuries are covered under workers compensation. Provide supporting arguments and cite the appropriate workers’ compensation injury classification category as directed in the appendix.
Part B
Write a 700- to 1,050-word response describing the workers’ compensation claim process (NOT describing what workers’ compensation is). Include the following information in your answer:
• Overall description of the workers compensation claim process
• Responsibilities of the employee, employer, physician, and insurance carrier
• How HIPAA Privacy Rules apply to workers’ compensation
• The implications of unrestricted access to a patient’s medical records
Refer to Ch. 12 of Medical Insurance and at least one additional reference from the Internet or University Library, for a minimum of two references.
Format your response consistent with APA guidelines.
Associate Level Material
Appendix C

Understanding Work-Related Injuries

Case Studies:

1. Janet works as a branch manager for a large banking firm. Her job requires her to travel by personal vehicle to different branch offices several times each week. Janet has lower back problems from a result of a skiing accident many years ago, which is further aggravated by long periods of sitting while driving. Janet was returning from the branch office to the home office on Thursday afternoon when another driver struck her car from behind. A physician examined Janet and determined that the accident aggravated her pre-existing back injury. The physician ordered Janet to remain off work for at least two weeks.

a. Is this injury covered under workers’ compensation? Type your answer here.
b. Rationale for your decision: Type your answer here.
c. If covered, identify the appropriate injury category: Type your answer here.

2. Frank works as a clerk in a local convenience store with a non-smoking policy. On a personal work break, Frank stepped outside the building to smoke a cigarette. As Frank walked across the parking lot, he slipped on a patch of ice and fell, breaking his wrist and injuring his outstretched hand.

a. Is this injury covered under workers’ compensation? Type your answer here.
b. Rationale for your decision: Type your answer here.
c. If covered, identify the appropriate injury category: Type your answer here.

3. Tom is an electrician who works for Eagle Electrical Company as an independent contractor. Last Tuesday, the company dispatched Tom to a local business office to investigate a wiring problem. While checking the circuit box, Tom sustained severe burns to his hands and upper torso when a faulty switch caused an electrical arcing event. Tom’s medical bills totaled over $750,000.

a. Is this injury covered under workers’ compensation? Type your answer here.
b. Rationale for your decision: Type your answer here.
c. If covered, identify the appropriate injury category: Type your answer here.

4. Rich works for Home Solutions Experts as a carpet installer. The company actively promotes workplace safety and provides ergonomic equipment to all employees. Rich has had ongoing pain in his knees, and it is progressively worsening. After an examination, his physician determined he was suffering from bursitis, commonly known as “carpet layer’s knee.” This required an arthroscopic knee aspiration, a minimum of three weeks off work, and physical therapy.

a. Is this injury covered under workers’ compensation? Type your answer here.
b. Rationale for your decision: Type your answer here.
c. If covered, identify the appropriate injury category: Type your answer here.

5. Bonnie works as a transportation security officer for the Office of Homeland Security. During the course of a routine airport baggage screening, a passenger became agitated and shoved Bonnie, causing her to stumble backwards over a pile of luggage. As a direct result, Bonnie experienced severe back pain, which her physician diagnosed as a strained muscle. He ordered her to remain off work for at least one week and on light duty for three weeks after.

a. Is this injury covered under workers’ compensation? Type your answer here.
b. Rationale for your decision: Type your answer here.
c. If covered, identify the appropriate injury category: Type your answer here.
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